Prognosis

National Audit Programme show that 13.6% of people admitted to hospital with stroke in England and Wales died (either in hospital or after being discharged from inpatient care) within 30 days (1)

Prognosis (2)

85% of stroke patients in England, Wales and Northern Ireland survive to hospital discharge.

2 in 3 stroke survivors either have supported community discharge or return home on hospital discharge.

Almost 2 in 3 stroke survivors leave hospital with a disability.

4 in 10 stroke survivors require help with activities of daily living on discharge.

Approximately 1 in 4 stroke survivors will have another stroke within five years.

The proportion of the UK population who are stroke survivors ranges from 1.7% in England to 2.2% in Scotland.

Approximately half of stroke survivors have residual swallowing problems, bladder or bowel dysfunction and fatigue.

1 in 3 stroke survivors experience depression and 1 in 5 experience anxiety symptoms.

• there are approximately 1.2 million stroke survivors in the UK. The risk of recurrent stroke is 26% within 5 years of a first stroke and 39% by 10 years

There is an approximate 40% complete recovery rate.

The majority of recovery of function - for example from hemiparesis - occurs in the first week. Any deficit remaining at 1 month is likely to be permanent. However, this is not to say that the disabilities caused by these impairments are unsurmountable at this stage - rehabilitation can continue for a long while.

The type of event happening determines the prognosis. After infarcts there is a 23% fatality at 12 months, and of the survivors, 65% have an independent existence. With primary intracranial haemorrhage the figures are 62% and 68% respectively; for subarachnoid haemorrhage it is 48% and 76%.

Mortality and morbidity vary with type of ischaemic stroke (3):

• atherosclerotic - mortality at 5 years 32.2%; good function at 1 year 53.4%; recurrent stroke at 5 years 40.2%
• cardioembolic - mortality at 5 years 80.2%; good function at 1 year 26.7%; recurrent stroke at 5 years 31.7%
• lacunar - mortality at 5 years 35.1%; good function at 1 year 81.9%; recurrent stroke at 5 years 24.8%

Another study also examined the risk of recurrent stroke (4) versus the risk of a first-ever stroke:

• over 10 years of follow-up, the risk of first recurrent stroke is 6 times greater than the risk of first-ever stroke in the general population of the same age and sex, almost one half of survivors remain disabled, and one seventh require institutional care

In severe strokes the patient may need to be accommodated in a rehabilitation centre for intensive rehabilitative therapy. There is evidence that care given by a specialist multidisciplinary team (stroke unit) reduces mortality and institutionalisation compared with routine care in general medical wards.

Notes (5):

• a systematic review revealed risks for myocardial infarction or non-stroke vascular death after ischaemic stroke were each 2% per year

References:

1. National Institute for Health and Care Excellence. Stroke and transient ischaemic attack in over 16s: diagnosis and initial management. April 2022 [internet publication].
2. State of the Nation - Stroke statistics. Stroke Association 2017
3. Petty GW et al. Ischaemic stroke subtypes. A population-based study of functional outcome, survival and recurrence. Stroke 2000; 31: 1062-8.
4. Hardie K et al. Ten-year risk of first recurrent stroke and disability after first-ever stroke in the Perth Community Stroke Study. Stroke 2004;35:731-5
5. Touze E et al. Risk of myocardial infarction and vascular death after transient ischemic attack and ischemic stroke: a systematic review and meta-analysis. Stroke 2005;36:2748-55.