We recently demonstrated that late functional improvement occurs in about one in four patients with ischaemic stroke, more commonly in lacunar strokes. It is unknown whether this late improvement is associated with better long-term clinical or health-economic outcomes.

To examine how late functional improvement between 3-12 months post-stroke translates into 5-year outcomes

Among 1,288 1-year survivors, 1,135 had 3-month mRS>0, of whom 319(28.1%) demonstrated late functional improvement between 3-12 months post-stroke. 1-year survivors who demonstrated late functional improvement per the mRS had lower 5-year mortality (aHR 0.68, 95%CI 0.51-0.91, p=0.009), were less likely to be institutionalized at 5-years (aHR 0.48, 0.33-0.72, p<0.001), and incurred lower 5-year health/social-care costs (margin -$17,524, -24,763 to -10,284, p<0.001). These associations remained on excluding patients with recurrent strokes during follow-up (e.g. 5-year mortality: aHR 0.69, 0.49-0.96, p=0.026) and on examining late improvement per RMI and/or BI (e.g. 5-year mortality with RMI: aHR 0.64, 0.46-0.87, p=0.004).