FIve - yeAR MORTALITy AND ReLATeD pROgNOSTIC FACTORS AFTeR INpATIeNT STROke RehABILITATION : A eUROpeAN MULTI - CeNTRe STUDy

J Rehabil Med 44 © 2012 The Authors. doi: 10.2340/16501977-0991 Journal Compilation © 2012 Foundation of Rehabilitation Information. ISSN 1650-1977 Objective: To determine 5-year mortality and its association with baseline characteristics and functional status 6 months post-stroke for patients who received inpatient rehabilitation. Design: A prospective rehabilitation-based cohort study. Subjects: A total of 532 consecutive stroke patients from 4 European rehabilitation centres. Methods: Predictors were recorded on admission. Barthel Index was assessed at 6 months (BI6mths) and patients were followed for 5 years post-stroke. Survival probability was computed using Kaplan–Meier analysis and compared across 3 BI6mths-classes (0–60, 65–90, 95–100) (log-rank test). Significant independent predictors were determined using multivariate Cox regression analysis (hazard ratio (HR)). Results: Five-year cumulative risk of death was 29.12% (95% confidence interval (CI): 22.86–35.38). Age (HR = 1.06, 95% CI: 1.04–1.09), cognitive impairment (HR = 1.77, 95% CI: 1.21–2.57), diabetes mellitus (HR = 1.68, 95% CI: 1.16– 2.41) and atrial fibrillation (HR = 1.52, 95% CI: 1.08–2.14) were independent predictors of increased mortality. Hyperlipidaemia (HR = 0.66, 95% CI: 0.46–0.94), and higher BI6mths (HR = 0.98, 95% CI: 0.97–0.99) were independent predictors of decreased mortality. Five-year survival probability was 0.85 (95% CI: 0.80–0.89) for patients in BI6mthsclass: 95–100, 0.72 (95% CI: 0.63–0.79) in BI6mths-class: 65–90 and 0.50 (95% CI: 0.40–0.60) in BI6mths-class: 0–60 (p < 0.0001). Conclusion: Nearly one-third of rehabilitation patients died during the first 5 years following stroke. Functional status at 6 months was a powerful predictor of long-term mortality. Maximum functional independence at 6 months post-stroke should be promoted through medical interventions and rehabilitation. Future studies are recommended to evaluate the direct effect of rehabilitation on long-term survival.