Stroke: death was common after a first stroke

Clinical bottom line (level 1b)

  1. 60% of patients with a first stroke were dead within 5 years.
  2. 35% of patients who survived 30 days were dead within 5 years.
  3. The risk of dying after 30 days was increased with
    • a previous TIA
    • intermittent claudication
    • urinary incontinence
    • prestroke functional disability
Hankey et al: Stroke 2000; 31 : 2080-2086
Expires November 2003

The study

Inception cohort study with objective outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: community, Perth, Australia

370 patients (aged mean 73, 54% male) with a first stroke

Factors studied:
  • age, sex, stroke risk factors, stroke disability, previous stroke or TIA, functional status
  • intermittent claudication
  • urinary incontinence
  • previous TIA
  • prestroke Barthel's Index < 20/20



    Cox proportional regression analysis was used to adjust for confounding factors.

    98% followed for
    Outcomes studied:
  • death
  • death after first 30 days

    The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)    		 NNF
    (95% CI)
    death 5 years 210/362 58.0%
    (52.9% to 63.1%)    		 1.7
    (1.6 to 1.9)
    death after first 30 days 5 years 125/362 35%
    (30% to 39%)    		 2.9
    (2.5 to 3.4)

    prognostic factor for
    death after first 30 days     		time to outcome adjusted RR
    (95% CI)    		 NNF+
    (95% CI)
    intermittent claudication ? 1.9
    (1.2 to 2.9)     		3
    (2 to 14)
    urinary incontinence ? 2.0
    (1.3 to 3.0)     		3
    (1 to 10)
    previous TIA ? 2.4
    (1.4 to 4.1)     		2
    (1 to 7)
    prestroke Barthel's Index < 20/20 ? 2.0
    (1.2 to 3.2)     		3
    (1 to 14)

    Citation

    1. Hankey GJ, Jamrozik K, Broadhurst RJ, et al: five-year survival after first-ever stroke and related prognostic factors in the Perth Community Stroke Study. Stroke 2000; 31 : 2080-2086
    Search Terms: from ACP Journal Club other articles noted
    Contributor: Chris Ball, November 2001
    Reviewer:

    Clinical Question.
    Patient first-ever stroke
    Intervention or Exposure clinical features, stroke risk factors
    Outcome death
    		•