Abstract MP080: Trends in Nine-year Survival of Stroke Patients between 1980 and 2000 The Minnesota Stroke Survey
Authors: Candace Schissel, Alan K Berger, Russell V Luepker, Lyn M Steffen, Arthur Sillah, David R Jacobs, David C Anderson, Kamakshi Lakshminarayan
Journal: Circulation (2012)

Background: There have been numerous advances in stroke care over the past 30 years. We examined early and long-term stroke survival over this period to learn if these advances were associated with improved outcomes. Methods: Data for years 1980, 1985, 1990, 1995, and 2000 were obtained from the Minnesota Stroke Survey, a population-based surveillance of hospitalized acute stroke patients aged 30-74 years in the Minneapolis-St. Paul metropolitan area. Cases with an acute stroke hospital discharge code (ICD-9-CM 431, 432, 434, 436, 437) and a new neurological deficit of vascular origin lasting at least 24 hours or until death were selected (n= 3,737). Non-stroke etiologies were excluded. Cases were sub-typed as ischemic (IS) (n=1,638) or hemorrhagic strokes (HS) (n=485) for years 1990, 1995, and 2000 by neuroimaging. Mortality was obtained by linkage to the Department of Health vital statistics. We report 30 day, 1 year, and 9 year age-adjusted post-stroke survival. Results: All stroke: Survival improved from 1980 to 2000 (Table). Early (30 day) survival improved (men 78% to 86%, p=0.003; women 79% to 88%, p=0.001) as did long-term (9 year) survival (men 33% to 49%, p=&lt;0.001; women 35% to 53%, p&lt;0.001). Long-term survival gains were not simply due to early survival improvements as shown by increased post 30-day and post-1-year survival (Table). Stroke Subtypes: Early (30 day) IS survival did not improve significantly from 1990 to 2000 (men 88% to 90%, p=0.56; women 87% to 92%, p=0.08) and neither did 30 day HS survival (men 61% to 69%, p=0.39; women 63% to 69%, p=0.38). For IS, 9-year survival improved (men 39% to 53%, p&lt;0.001; women 43% to 59%, p&lt;0.001). For HS, 9 year survival improved in men (men 29% to 48%, p=0.03; women 44% to 51%, p=0.34). Conclusion: Early and long-term stroke survival improved between 1980 and 2000. Improved long-term survival was not merely due to improved early survival. Long-term survival improved for IS in both sexes. Small samples sizes may explain the lack of significant improvements in HS survival in women. Table. Age Adjusted Stroke Survival Between 1980 and 2000 Among Men and Women Aged 30-74 Years in the Minneapolis-St. Paul, Minnesota Metropolitan Area. Data shown is for all stroke. Age Adjusted Survival, % 1980 1985 1990 1995 2000 P-trend Men, n 318 325 368 361 637 30-day 77.9 82.9 87.9 84.6 85.7 0.003 1-year 67.5 70.8 77.7 77 78.7 &lt;0.001 5-years 51.4 47.7 55.5 60.4 62.3 &lt;0.001 9-years 32.9 33.8 39.5 43.9 49 &lt;0.001 1-year survival among 30-day survivors 86.5 85.3 88.5 91 91.9 0.002 9-year survival among 1 year survivors 48.2 47.3 51.1 57.5 62.3 &lt;0.001 Women, n 249 277 327 299 576 30-day 79.1 85.1 84.4 86.8 88.1 0.001 1-year 64.3 74.6 72.2 75.5 79.6 &lt;0.001 5-years 47.8 58.8 53.2 57.8 64.6 &lt;0.001 9-years 35.4 47.2 41.5 43.6 53.3 &lt;0.001 1-year survival among 30-day survivors 81.2 87.6 85.5 87 90.4 0.005 9-years survival among 1 year survivors 54.5 63.1 57.7 57.4 67.3 0.040