Even Stable Survivors Face 5-Year Risk of Second Stroke

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New approaches to prevention, potentially embedded in community or primary care, are required for long-term management of stable, but high-risk patients.
New approaches to prevention, potentially embedded in community or primary care, are required for long-term management of stable, but high-risk patients.

HealthDay News — Risk of a second stroke or transient ischemic attack (TIA) remains considerable for at least 5 years after the first event, according to a study published in CMAJ, the Journal of the Canadian Medical Association.1

Jodi Edwards, PhD, of the Sunnybrook Health Sciences Center in Toronto, and colleagues collected data on 26,366 stroke and TIA survivors without recurrent stroke, myocardial infarction, all-cause admission to hospital, admission to an institution, or death in the first 90 days after discharge.

The researchers compared them with 263,660 healthy individuals matched by age, gender, and region. The team assessed the primary composite outcome of death, stroke, myocardial infarction, or admission to long-term or continuing care.

The investigators found that risk the primary outcome was increased at 1, 3, and 5 years (hazard ratios [HRs], 2.4, 2.2, and 2.1, respectively). The risks were highest for recurrent stroke at 1 year (HR, 6.8), continuing to 5 years (HR, 5.1), and for admission to an institution (HR, 2.1).

"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," the authors wrote. "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."

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. CMAJ. 2017;189(29):e954-e961.

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