Factors influencing survival after stroke in Western Australia

Objective: To determine the factors influencing survival among patients admitted to Western Australian hospitals for the first time with stroke or transient ischaemic attack (TIA). Design, setting and patients: Linked hospitalisation and death records of 7784 patients admitted to hospital for first-ever stroke or TIA between July 1995 and December 1998 were retrieved retrospectively to determine survival; effects of risk factors on death due to stroke were assessed using the Cox proportional hazards regression model. Main outcome measures: All-cause stroke survival; short- and long-term stroke survival probabilities. Results: Survival at 28 days was lowest for haemorrhagic stroke. However, following the first month after admission survival after haemorrhagic stroke was similar to, if not higher than, after ischaemic stroke. Among all patients, significant predictors of death were age (all subtypes of stroke), atrial fibrillation (intracerebral haemorrhage and ischaemic stroke), other cardiac conditions (ischaemic stroke and TIA), and sex and diabetes (TIA). Further predictors of death were residence in rural or remote areas (ischaemic stroke), and Aboriginality (TIA). Among 28-day survivors of ischaemic stroke, additional predictors of death were sex, diabetes and urinary incontinence still present 7 days after admission. Conclusion: Use of linked hospitalisation and death data allowed us to increase the scope and size of our study compared with previous studies of survival after stroke and TIA in WA. We confirmed the importance of type of stroke, age and comorbidities to this survival, and found that Aboriginality and place of residence are also important.