Recurrent Stroke Risk Higher in Patients Without Post-Stroke Complications

A lack of early complications following a stroke or transient ischemic attack (TIA) is associated with increased long-term risk of adverse outcomes, especially with recurrent stroke and institution admission risk, according to the results of a recent study.

While secondary prevention following stroke and TIA focus predominantly on the high risk of early recurrence, patients who survive stroke or TIA without early complication are typically discharged from secondary stroke prevention services.
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In order to quantify the long-term morbidity and mortality in patients with no early complications following stroke or TIA, researchers conducted a longitudinal case-control study of 26,366 patients who survived for 90 days without recurrent stroke, myocardial infarction, all-cause hospital admission, admission to an institution, or death.

Overall, the hazard of the primary outcome (death, stroke, myocardial infarction, or admission to long-term or continuing care) was more than double at 1 year (hazard ratio [HR] 2.4), 3 years (HR 2.2), and 5 years (HR 2.1). Hazard was highest for recurrent stroke at 1 year (HR 6.8).

“Patients who survive stroke or TIA without early complications are typically discharged from secondary stroke prevention services. However, these patients remain at substantial long-term risk, particularly for recurrent stroke and admission to an institution. Novel approaches to prevention, potentially embedded in community or primary care, are required for long-term management of these initially stable but high-risk patients.”

—Michael Potts

Reference:

Edwards JD, Kapral MK, Fang J, Swartz RH. Long-term morbidity and mortality in patients without early complications after stroke or transient ischemic attack [published online July 24, 2017]. CMAJ. doi: 10.1503/cmaj.161142.