Five-year mortality and related prognostic factors after inpatient stroke rehabilitation: A European multi-centre study

Abstract

Objective: To determine 5-year mortality and its association with baseline characteristics and functional status 6 months post-stroke for patients who received inpatient rehabilitation. Design: A prospective rehabilitation-based cohort study. Subjects: A total of 532 consecutive stroke patients from 4 European rehabilitation centres. Methods: Predictors were recorded on admission. Barthel Index was assessed at 6 months (BI6mths) and patients were followed for 5 years post-stroke. Survival probability was computed using Kaplan?Meier analysis and compared across 3 BI6mths-classes (0?60, 65?90, 95?100) (log-rank test). Significant independent predictors were determined using multivariate Cox regression analysis (hazard ratio (HR)). Results: Five-year cumulative risk of death was 29. 12% (95% confidence interval (CI): 22. 86?35. 38). Age (HR = 1. 06, 95% CI: 1. 04?1. 09), cognitive impairment (HR = 1. 77, 95% CI: 1. 21?2. 57), diabetes mellitus (HR = 1. 68, 95% CI: 1. 16?2. 41) and atrial fibrillation (HR = 1. 52, 95% CI: 1. 08?2. 14) were independent predictors of increased mortality. Hyperlipidaemia (HR = 0. 66, 95% CI: 0. 46?0. 94), and higher BI6mths (HR = 0. 98, 95% CI: 0. 97?0. 99) were independent predictors of decreased mortality. Five-year survival probability was 0. 85 (95% CI: 0. 80?0. 89) for patients in BI6mths-class: 95?100, 0. 72 (95% CI: 0. 63?0. 79) in BI6mths-class: 65?90 and 0. 50 (95% CI: 0. 40?0. 60) in BI6mths-class: 0?60 (p < 0. 0001). Conclusion: Nearly one-third of rehabilitation patients died during the first 5 years following stroke. Functional status at 6 months was a powerful predictor of long-term mortality. Maximum functional independence at 6 months post-stroke should be promoted through medical interventions and rehabilitation. Future studies are recommended to evaluate the direct effect of rehabilitation on long-term survival.