Stroke patients: the years after

Over the years, the methods in stroke treatment, management and rehabilitation have greatly advanced. However, there is very little data available on the outcomes of stroke victims, years after recovery. This recent study indicates that the prognosis for stroke survivors can be poor as their functional abilities decline with time even they have been declared “fully rehabilitated.” This decline was evident even if the patients did not suffer a subsequent stroke or any other cardiovascular event.

Ischemic stroke is cause by blood clots in the brain and the first line of treatment is the clot-busting agent tissue plasminogen activator (tPA). With tPA use coupled with improved physiotherapeutic techniques, survival and rehabilitation rates have greatly improved and many patients are considered “functionally recovered six months after the stroke.”

What is less known is the fact that stroke victim’s functional ability actually deteriorate with time at a rate of about 9% per year for the first 5 years after recovery. The likelihood of becoming severely disabled increased by 11% per year.

This poor prognosis is due to many predictive factors. The patients most likely to suffer from functional decline and disability are:

• were older at the time of the stroke.

• had diabetes.

• were unmarried.

• had a more severe stroke.

• had a right-sided stroke.

• had urinary incontinence within a week of the stroke.

In addition, the type of health insurance seems to make a difference. Those uninsured and covered by Medicaid (state-run coverage for low-income groups) showed significantly faster functional decline. Those who are privately insured or covered by Medicare (state-run coverage for the elderly) showed lesser decline.

According to researcher Dr. Mandip Dhamoon

“Access to health care is not just important around the time of the stroke but in the years following, when those with poor access do worse in their functioning and ability to be independent. We can speculate that they may be less likely to get ongoing rehabilitation and may be less able to manage their blood pressure and other risk factors.”

Gender and race did not seem to influence outcomes.

The results of the study highlight the need for long-term follow up of stroke victims. It suggests that a 6-month rehabilitation program may not be sufficient to ensure that stroke victims have a good quality of life, years after a stroke attack.