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Abstract Details

Association of Late Functional Improvement With 5-Year Post-stroke Outcomes: A Population-based Cohort Study
Cerebrovascular Disease and Interventional Neurology
S47 - Stroke Outcomes and Recurrence (1:22 PM-1:33 PM)
003

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

In 1-year ischaemic stroke survivors of the Oxford Vascular Study (OXVASC; 2002-2014), we examined changes in functional status (modified Rankin Scale[mRS], Rivermead Mobility Index[RMI], Barthel Index[BI]) from 3-12 months post-stroke. We used Cox regressions adjusted for age, sex, 3-month disability, and stroke subtype (lacunar vs non-lacunar) to examine the association of late functional improvement (by ≥1 mRS grades, ≥1 RMI points, and/or ≥2 BI points between 3-12 months) with 5-year mortality and institutionalization (admission to nursing/residential care-home). We used similarly adjusted generalized linear models to examine the association with 5-year health/social-care costs. Analyses were restricted to patients capable of showing improvement per the relevant scale (mRS>0, RMI<15, BI<20). 

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).

Late functional improvement post-stroke is associated with lower 5-year mortality, institutionalization rates, and health/social-care costs. These findings should motivate patients and clinicians to maximize late recovery in routine practice, and consider access to rehabilitative services for at least 1-year post-stroke.
Authors/Disclosures
Aravind Ganesh, MD (Department of Clinical Neurosciences, University of Calgary)
PRESENTER
Dr. Ganesh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for MD Analytics. Dr. Ganesh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for MyMedicalPanel. Dr. Ganesh has received personal compensation in the range of $0-$499 for serving as a Consultant for Figure 1. Dr. Ganesh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Atheneum. Dr. Ganesh has received personal compensation in the range of $0-$499 for serving as a Consultant for Creative Research Designs. Dr. Ganesh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Servier Canada. Dr. Ganesh has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eisai. Dr. Ganesh has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for Let's Get Proof (Collavidence Inc). Dr. Ganesh has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for 好色先生 (journals Neurology and Neurology: Clinical Practice). Dr. Ganesh has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association (journal: Stroke). Dr. Ganesh has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Frontiers (for Frontiers in Neurology). Dr. Ganesh has stock in SnapDx. Dr. Ganesh has stock in Collavidence Inc. Dr. Ganesh has stock in DataSimpl. The institution of Dr. Ganesh has received research support from Canadian Institutes of Health Research . The institution of Dr. Ganesh has received research support from Alberta Innovates. The institution of Dr. Ganesh has received research support from University of Calgary Centre for Clinical Research. The institution of Dr. Ganesh has received research support from Innovation 4 Health. The institution of Dr. Ganesh has received research support from Government of Canada INOVAIT. The institution of Dr. Ganesh has received research support from Campus Alberta Neuroscience. The institution of Dr. Ganesh has received research support from Alzheimer Society of Canada. The institution of Dr. Ganesh has received research support from Heart and Stroke Foundation of Canada. The institution of Dr. Ganesh has received research support from New Frontiers in Research Fund. The institution of Dr. Ganesh has received research support from Panmure House. The institution of Dr. Ganesh has received research support from Brain Canada. The institution of Dr. Ganesh has received research support from MSI Foundation. The institution of Dr. Ganesh has received research support from France Canada Research Fund. Dr. Ganesh has received intellectual property interests from a discovery or technology relating to health care.
No disclosure on file
No disclosure on file