Conditions

Stroke Survivors Need Close Monitoring Well Past 90-Day Danger Period

Stroke
Danger period following a stroke should be extended to five years, not 90 days. Photo courtesy of Shutterstock

Even after surviving a stroke or mini-stroke, also known as a transient ischemic attack (TIA), patients still face a lifetime of rehabilitation. A recent study presented at the Canadian Stroke Congress has revealed that stroke victims are still at high risk for a second event or serious medical complication up to five years after the initial event. Researchers at the Institute for Clinical Evaluative Sciences (ICES) have outlined follow-up steps for doctors and their patients to help avoid future problems.

"This high long-term risk was surprising and shows that we need to develop better strategies and interventions for these patients to prevent as many of these serious problems as we can," Dr. Richard Swartz, lead researcher and director of the University of Toronto stroke program, said in a statement. "We now need to identify ways to determine which people, among those who have made it through the riskiest period, remain most at risk for serious events so we can develop appropriate preventive interventions."

Swartz and his colleagues gathered data on 34,000 stroke or mini-stroke patients enrolled in the Ontario Stroke Registry. Patients had been discharged following a stroke or mini-stroke between 2003 and 2011. Over 10,000 patients who died, suffered another stroke, mini-stroke or heart attack, were hospitalized for any medical reason, or were admitted for long-term care within 90 days after their discharge were excluded from the study. The research team examined the medical records of the remaining 24,000 patients in the years following their stroke or mini-stroke.

Results showed that 9.3 percent of patients who did not die, suffer another stroke, mini-stroke or heart attack, were hospitalized, or admitted for long-term care within 90 days of their initial stroke did so a year after the high-risk period ended. Death was the most common event to occur at 5.1 percent of patients in the first year of recovery. It remained at five percent each of the years after the initial year of survival. Overall, patients have around a 10 percent risk of dying, suffering a second stroke, having a heart attack, or being admitted to for long-term care in the first year of recovery.

"If we determine that cognitive decline is a predictor of greater risk for a subsequent stroke or TIA, a simple tool such as this could allow doctors to easily identify patients at higher risk and take more aggressive measures to help prevent subsequent events," Swartz added.

The ICES research team has already developed a quick test for doctors to use that can evaluate cognitive decline in stroke and mini-stroke victims. The Taking Charge of Your Stroke Recovery patients guide developed by The Heart and Stroke Foundation also offers the best practices for stroke care transition and provides a communication guide for doctors, patients, and their families.

“If it's not feasible, due to lack of resources, to follow patients longer in stroke clinics, we must do more to educate patients, their families and their family physicians and nurse practitioners to be more alert to the ongoing risks," said Ian Joiner, director of stroke for the Heart and Stroke Foundation. "Even those who seem to recover very well after a stroke or TIA must be followed closely."

Source: Swartz R, et al. Canadian Stroke Congress. 2014.

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