Almost two thirds of acute stroke patients will be dead within 10 years and a quarter will have another stroke, according to new research from the University of Queensland published last week in the AHA Journal, Stroke.
Based on data from more than 300,000 Australian and New Zealand patients between 2008 and 2017, study lead and UQ epidemiologist, Dr Yang Peng, said only 36.4% of patients survived beyond 10 years and 26.8% had another stroke.
“On average, a stroke reduced life expectancy by a third (or 5.5 years in absolute terms), but this does vary by age group,” Dr Peng said.
“For those aged 18-54 years, we found a stroke reduced the remaining life expectancy by 20.5% which equated to 8 years in absolute terms. For those aged 85 years or over, a stroke reduced the remaining life expectancy by 54.2% – which is three years in absolute terms.
“Cumulative incidence of stroke recurrence was 19.8% at five years and 26.8% at ten years.”
Given the number of patients who have a recurrent stroke, Dr Peng said there should be a focus on lifestyle and risk factor modifications for secondary prevention.
““Very few population studies have explored the long-term outcomes of stroke – this information is crucial for patients to understand their prognosis, and for health professionals seeking to improve stroke care and preventative measures.”
Even survivors who are not physically disabled, or who have a ‘mild’ stroke, experience ongoing ‘invisible’ changes such as fatigue, memory problems, anxiety, mood disturbance, and depression.
“Unfortunately, we could not measure the effects of lifestyle factors such as smoking but these can vary among patients and may further impact their survival,” Dr Peng said.
“Generally adopting a good lifestyle such as regular exercise, quitting smoking, and maintaining a healthy diet, in addition to secondary preventative therapy, can reduce the risk of a subsequent stroke.”
Though this seems straightforward, audits by the Australian Stroke Foundation have found that 40% of patients do not receive information on stroke, lifestyle management, second prevention, and recovery at the time of rehabilitation discharge.
Dr Peng highlighted the need for more specialised stroke units, where care is provided by nurses, doctors, and allied health professionals such as physiotherapists, occupational therapists and speech therapists.
“They work as a coordinated team to provide the most appropriate care tailored to the needs of patients with a stroke,” Dr Peng said.
“There is a lot of evidence that shows dedicated stroke units reduce the risk of death and disability after a stroke compared with care in non-specialised units.”
His call for a multidisciplinary approach to treatment coincides with the publication of another study on stroke survival, released on April 19th by the University of Newcastle, which demonstrates the positive impact of just 12 weeks’ access to an online, interactive, healthy lifestyle program in improving adult stroke survivors’ quality of life.
Lead researcher Ashleigh Guillaumier and his team designed ‘Prevent 2nd Stroke’ (P2S) based on the consistently demonstrated effectiveness of online interventions in helping to change health behaviour and reduce pain, disability, depression, and anxiety.
At the six-month follow up, higher proportions of people in the group who received access to P2S reported health benefits – such as being able to participate in their usual daily activities – compared to the control group, who were simply given access to a list of generic health information websites.
Their research concludes that an online program can work as a supplementary tool to use at home while still receiving other rehabilitation services.
“Online platforms are a viable and impactful model to address the health information needs and behaviour change challenges of stroke survivors,” Mr Guillaumier said.
“It would be ideal to see a program like P2S offered as part of a toolkit of support options for stroke survivors, and such a program may extend outreach to those who are less well recovered.”