How Many Patients Become Functionally Dependent after a Stroke? A 3-Year Population-Based Study in Joinville, Brazil

<div><p>The decrease in stroke mortality will increase the burden of survivors with functional dependence (FD). The aim of this study was to evaluate how many patients become functionally dependent over 3 years after an incident event in Joinville, Brazil. The proportion of FD (defined as a modified Rankin score 3 to 5) among stroke survivors from the Joinville Stroke Registry was assessed using a validated telephone interview. Incidence of FD after stroke in Joinville in one year was 23.24 per 100,000 population. The overall proportion of FD among stroke survivors at discharge was 32.7%. Of 303 patients with first-ever ischaemic stroke (IS), one-third were FD at discharge, and 12%, 9% and 8%, respectively at 1, 2 and 3 years. Among 37 patients with haemorrhagic stroke (HS), 38% were dependent at discharge, 16% after 1 and 2 years and 14% after 3. Among 27 patients with subarachnoid haemorrhage (SAH), 19% were dependent at discharge and 4% from 1 to 3 years. Among IS subtypes, cardioembolic ones had the worst risk of FD. (RR 19.8; 95% CI: 2.2 to 175.9). Our results showed that one-third of stroke survivors have FD during the first year after stroke in Brazil. Therefore, a city with half a million people might expect 120 new stroke patients with FD each year.</p></div

Modified Rankin Scale (mRS) scores of 37 first-ever haemorrhagic stroke patients.

<p>Proportions of patients after hospital admission, 30 days and 1 to 3 years in Joinville, 2008 to 2010; Rankin score 0 to 2: functional Independence, 3 to 5:functional dependence and 6:death.</p

Modified Rankin Scale (mRS) scores of 27 first-ever sub-arachnoid haemorrages stroke patients.

<p>Proportions of patients after hospital admission, 30 days and 1 to 3 years in Joinville, 2008 to 2010; Rankin score 0 to 2: functional Independence, 3 to 5:functional dependence and 6:death.</p

Risk factors for functional dependence at 12, 24 and 36 months after first-ever IS stroke, adjusted relative risks, 95%confidence intervals and p-values (n = 303).

<p>Risk factors for functional dependence at 12, 24 and 36 months after first-ever IS stroke, adjusted relative risks, 95%confidence intervals and p-values (n = 303).</p

Evolution of functional status of 407 patients with all stroke types measured by Rankin scale over 3-years.

<p>Evolution of functional status of 407 patients with all stroke types measured by Rankin scale over 3-years.</p

Functional status of 303 patients after incident stroke measured by Rankin scale at 30 days and 3 years.

<p>Functional status of 303 patients after incident stroke measured by Rankin scale at 30 days and 3 years.</p

Modified Rankin Scale (mRS) scores of 303 first-ever ischaemic stroke patients.

<p>Proportions of patients after hospital admission, 30 days and 1 to 3 years in Joinville, 2008 to 2010; Rankin score 0 to 2: functional Independence, 3 to 5:functional dependence and 6:death.</p

Baseline characteristics of patients, risk factors, clinical severity and diagnosis.

<p>Baseline characteristics of patients, risk factors, clinical severity and diagnosis.</p

Joinville stroke biobank: study protocol and first year’s results

<div><p>ABSTRACT Aiming to contribute to studies that use detailed clinical and genomic information of biobanks, we present the initial results of the first Latin American Stroke Biobank. Methods: Blood samples were collected from patients included in the Joinville Stroke Registry and four Brazilian cities. Demographic socio-economic data, cardiovascular risk factors, Causative Classification System for Ischemic Stroke, Trial of Org 10172 in Acute Stroke Treatment and National Institutes of Health scores, functional stroke status (modified Rankin) and brain images were recorded. Additionally, controls from both geographic regions were recruited. High-molecular-weight genomic DNA was obtained from all participants. Results: A total of 2,688 patients and 3,282 controls were included. Among the patients, 76% had ischemic stroke, 12% transient ischemic attacks, 9% hemorrhagic stroke and 3% subarachnoid hemorrhage. Patients with undetermined ischemic stroke were most common according the Trial of Org 10172 in Acute Stroke Treatment (40%) and Causative Classification System for Ischemic Stroke (47%) criteria. A quarter of the patients were under 55 years of age at the first-ever episode. Conclusions: We established the Joinville Stroke Biobank and discuss its potential for contributing to the understanding of the risk factors leading to stroke.</p></div