In this issue of Stroke, Persson and colleagues seek to establish the long-term impact of stroke on a stroke survivor’s spouse. They ask whether a patient’s stroke impacts his or her spouse beyond the short-term or if perhaps improvements in a patient’s stroke deficits or the general adaptability of the human spirit attenuate the consequences for the spouse over the long-term.

They derived their cohort from a Swedish ischemic stroke study that enrolled 600 consecutive patients under the age of 70 with ischemic stroke. After seven years, spouses of stroke survivors and age- and sex-matched controls were identified for comparison. The unit of analysis was survivor and spouse dyad and control and spouse dyad. 248 stroke survivor and 245 control dyads were included after excluding stroke survivors who had deceased or become single. Importantly, those who were excluded had greater disability at 3 months than those who were included. The outcome was self-reported health-related quality of life measured by the multidimensional Short Form 36 tool after controlling for multiple demographic and stroke outcome variables.

Notably, the median NIHSS for stroke survivors had been zero and the median mRS had been only 2. Regardless, even after 7 years, spouses of stroke survivors suffered significantly lower health in multiple domains as compared to spouses of controls. Attributes of the stroke survivor that predicted poor spousal health included the survivor’s levels of disability, depression and cognitive impairment. Perceived lack of social support also predicted poorer spousal mental and emotional health.

It is surprising that minor strokes in young persons with relatively good functional outcomes lead to persistent spousal health consequences. Patients who have strokes before 70 likely have predisposing vascular risk factors (some of which, such as diabetes, can require continued, laborious management) that may be responsible for this study’s findings; there is possible significant residual confounding as the dyads are only matched for age and sex.

If we are to believe the findings, it is worth noting that Sweden has a nationalized healthcare system with near universal coverage, excellent literacy and a high GDP per capita. Extrapolating their findings to developing nations where healthcare and social resources are scant underscores the importance of stroke prevention.