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• W2143673532 abstract "Background Survival after stroke has improved, but little is known about the long-term risk of new vascular events and the functioning of long-term survivors. The main objective of this thesis was to evaluate the long-term perspective of these patients. Methods Two longitudinal studies were carried out in patients with TIA or minor stroke (LiLAC) and in patients with major stroke (MOVE). LiLAC studied survival and recurrent vascular events, functioning and quality of life after TIA and minor stroke. Survival status and new vascular events were evaluated in 2473 participants of the Dutch TIA Trial (recruitment 1986 – 1989; arterial cause of cerebral ischaemia). Outcomes were all-cause mortality and the composite from all vascular causes, nonfatal stroke, nonfatal myocardial infarction. The same events were also studied in 186 patients with a cardiac origin of their ischaemia (European Atrial Fibrillation Trial, recruitment 1988-1992). Next we studied functional and mental status, use of healthcare facilities and quality of life of a random sample of survivors (n=200) and evaluated associations with baseline and follow-up characteristics. MOVE evaluated change in mobility status over the second and third year after inpatient rehabilitation in 148 patients with a single first-ever stroke. Results After 10 years follow-up in LiLAC, 1489 patients had died and 1336 had had at least one vascular event. The ten-year risks of death and a vascular event were 43% (41-45) and 44% (42-46). After a decline during the first three years, the annual risk of a vascular event increased over time. Strongest predictors were age, history of diabetes, claudication or peripheral vascular surgery, and Q-waves on the ECG. The risk of death or recurrent vascular event was about 1.5 times higher in patients with a cardiac origin than in patients with an arterial origin. For the second part of LiLAC the follow-up of patients was extended to about 15.6 years. One third of survivors interviewed at home experienced a residual disability (Barthel Index < 20), 26% was moderately to severely handicapped (Rankin 3-5) and one third used any kind of professional care. Factors associated with poor functional status were advanced age, presence of infarct on baseline CT scan, recurrence of a new major stroke and presence of comorbidity of locomotion. In the MOVE-study mobility decline was found in 12% (1st –2nd year) and 20% (1st – 3rd year) of the patients. Inactivity, the presence of cognitive problems, fatigue and depression at 1 year after stroke were significant predictors of mobility decline. Conclusions A TIA or minor stroke is an acute on chronic disease and patients and their physicians should stay alert even on the long term. We advocate a larger role for comorbidity in stroke outcome research (LiLAC). In patients who had had inpatient rehabilitation after stroke, the mobility status had not stabilized over the second and third year post-stroke. Mental factors played an important role in the prediction of a decline in mobility, which warrants special attention for depression and cognition in chronic stroke care (MOVE)." @default.
• W2143673532 created "2016-06-24" @default.
• W2143673532 creator A5032181119 @default.
• W2143673532 date "2000-01-01" @default.
• W2143673532 modified "2023-09-28" @default.
• W2143673532 title "TIA and Stroke: the long-term perspective" @default.
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