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Title: 5-year survival and rehospitalization due to stroke recurrence among patients with hemorrhagic or ischemic strokes in Singapore
Authors: Sun, Y
Lee, S.H 
Heng, B.H
Chin, V.S
Keywords: age
brain hemorrhage
brain ischemia
cardiovascular mortality
cardiovascular risk
cause of death
cohort analysis
ethnic group
follow up
hospital readmission
ischemic heart disease
major clinical study
multicenter study
outcome assessment
recurrent disease
retrospective study
sex difference
stroke patient
Aged, 80 and over
Kaplan-Meier Estimate
Longitudinal Studies
Middle Aged
Odds Ratio
Proportional Hazards Models
Retrospective Studies
Issue Date: 2013
Citation: Sun, Y, Lee, S.H, Heng, B.H, Chin, V.S (2013). 5-year survival and rehospitalization due to stroke recurrence among patients with hemorrhagic or ischemic strokes in Singapore. BMC Neurology 13 : 133. ScholarBank@NUS Repository.
Rights: Attribution 4.0 International
Abstract: Background: Stroke is the 4th leading cause of death and 1st leading cause of disability in Singapore. However the information on long-term post stroke outcomes for Singaporean patients was limited. This study aimed to investigate the post stroke outcomes of 5-year survival and rehospitalization due to stroke recurrence for hemorrhagic and ischemic stroke patients in Singapore. The outcomes were stratified by age, ethnic group, gender and stroke types. The causes of death and stroke recurrence were also explored in the study.Methods: A multi-site retrospective cohort study. Patients admitted for stroke at any of the three hospitals in the National Healthcare Group of Singapore were included in the study. All study patients were followed up to 5 years. Kaplan-Meier was applied to study the time to first event, death or rehospitalization due to stroke recurrence. Cox proportional hazard model was applied to study the time to death with adjustment for stroke type, age, sex, ethnic group, and admission year. Cumulative incidence model with competing risk was applied for comparing the risks of rehospitalization due to stroke recurrence with death as the competing risk.Results: Totally 12,559 stroke patients were included in the study. Among them, 59.3% survived for 5 years; 18.4% were rehospitalized due to stroke recurrence in 5 years. The risk of stroke recurrence and mortality increased with age in all stroke types. Gender, ethnic group and admitting year were not significantly associated with the risk of mortality or stroke recurrence in hemorrhagic stroke. Male or Malay patient had higher risk of stroke recurrence and mortality in ischemic stroke. Hemorrhagic stroke had higher early mortality while ischemic stroke had higher recurrence and late mortality. The top cause of death among died stroke patients was cerebrovascular diseases, followed by pneumonia and ischemic heart diseases. The recurrent stroke was most likely to be the same type as the initial stroke among rehospitalized stroke patients.Conclusions: Five year post-stroke survival and rehospitalization due to stroke recurrence as well as their associations with patient demographics were studied for different stroke types in Singapore. Specific preventive strategies are needed to target the high risk groups to improve their long-term outcomes after acute stroke. © 2013 Sun et al.; licensee BioMed Central Ltd.
Source Title: BMC Neurology
ISSN: 14712377
DOI: 10.1186/1471-2377-13-133
Rights: Attribution 4.0 International
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