Background and Aims: To estimate changes in mortality and functional dependence after ischaemic strokes (ISs) over a 16-year period, and to ascertain demographic disparities.
Methods: We identified all first-ever IS cases from the population-based South London Stroke Register (SLSR) between 2000 and 2015. IS was classified into large-artery atherosclerosis (LAA), cardio-embolism (CE), small-vessel occlusion (SVO), other determined aetiologies (OTH), and undetermined aetiologies (UND). Using proportional-hazards survival modelling, adjusted for demographic factors and case mix variables, we examined temporal trends in one-year mortality rates. Additional regression analyses explored whether trends occurred at the expense of greater functional dependence (Barthel index <15) among survivors.
Results: A total of 3,128 patients with first ISs were registered. Risk-adjustedrates of one-year mortality decreased from 301% in 2000–2003 to 228% in 2012–2015 (adjusted hazard ratio per year, 097; 95% confidence interval [CI], 096 to 099; P¼00002 for trend). Improvements were noted in all IS subtypes and ethnic groups, however, were only significant in CE and UND and in those of white ethnic origins. Functional dependence has decreased between 2000–2003 and 2012–2015 at seven days post-stroke (adjusted odds ratio [OR], 061; 95% CI, 044 to 084) but not at one-year post-stroke (OR, 115; 95% CI, 08 to 164).
Conclusions: Both mortality and functional dependence after ISs have decreased during the past 16 years in association with improvements in the acute processes of care. Reductions in mortality are particularly evident in CE and UND subtypes and in the white population.