Peter Hannon, MD

Luengo-Fernandez R, Paul NLM, Gray AM, Pendlebury ST, Bull LM, Welch SJV, et al.Population-Based Study of Disability and Institutionalization AfterTransient Ischemic Attack and Stroke10-YeaResults of the OxfordVascular Study. Stroke. 2013

Luengo-Fernandez and colleagues utilize a large UK population-based study, the Oxford Vascular Study, to investigate the impact of TIA and stroke on disability and rate of institutionalization over 5 years. Seven hundred and forty eight index strokes and 440 TIA cases were identified from 2002-2007, with patients followed up at 1, 6, 12 and 60 months. The mean age of study participants was 74 years old.  

Disability among stroke patients jumped from 21% to 43% after their stroke, and among TIA patients climbed from a pre-morbid rate of 14% to 23% at 5 years. 47% of the stroke patients and 27% of the TIA patients died during the study. Eleven percent of stroke patients and 9% of TIA patients required long-term nursing or residential care. Significant predictors for disability included age, event severity, pre-morbid disability, subsequent vascular events, being widowed or single, diabetes and atrial fibrillation.  

Interestingly, the authors note that this study mirrored results from a study of a similar population in the early 1980’s regarding disability at 1 and 12 months after stroke, suggesting that even with advances in stroke care, there is still significant work to be done.  As you would expect, early disability after a stroke translated to a worse outcome, making it clear once again that prevention and early intervention are paramount in stroke care. The gradual increase in disability and need for long-term nursing care after TIA were notable, and it would have been very interesting to see how this compared to an age-matched healthy population control.  Overall, this study reaffirms the high cost to patient and community surrounding TIA and stroke, and specifically makes a case for stroke prevention, early intervention and special attention to follow-up care after any cerebrovascular event.