LONG-TERM SURVIVAL AFTER 1ST-EVER STROKE - THE OXFORDSHIRE COMMUNITY STROKE PROJECT

Background and Purpose: There have been relatively few community-based studies of long-term prognosis after acute stroke. This study aimed t o provide precise estimates of the absolute and relative risks of dyin g in an unselected cohort of patients with a first-ever stroke. Method s: Six hundred seventy-five patients were registered by a community-ba sed stroke register (the Oxfordshire Community Stroke Project) and pro spectively followed up for up to 6.5 years. Their relative risk of dea th was calculated using age- and sex-specific mortality rates for Oxfo rdshire. Results: During the first 30 days, 129 (19%) patients died. P atients who survived at least 30 days after a first-ever stroke therea fter had an average annual risk of death of 9.1%, 2.3-fold the risk in people from the general population. Although the absolute (about 15%) and relative (about threefold) risks of death were highest in these 3 0-day survivors over the first year after the stroke, they were at inc reased risk of dying over the next few years (range of relative risk f or individual years, 1.1-2.9). Predictably, older patients had a worse absolute survival but, relative to the general population, stroke als o increased the relative risk of dying in younger patients. During the first 30 days stroke accounts for most deaths; after this time nonstr oke cardiovascular disease becomes increasingly important and is the m ost common cause of death after the first year. Conclusions: These dat a highlight the importance of long-term secondary prevention of vascul ar events in stroke patients, targeted as much at the cardiovascular a s at the cerebrovascular circulation.