LONG-TERM OUTCOMES AMONG NIGERIAN STROKE SURVIVORS - DATA FROM THE CogFAST-NIGERIA STUDY

Abstract

<h3>Background</h3> Africa faces a rising burden of stroke with rising incidence and prevalence but little is known about the profile and trajectory of long-term stroke outcomes This study aimed to explore the profile, trajectory and determinants of long-term outcomes up to four years among a cohort of stroke survivors recruited into the CogFAST-Nigeria study. <h3>Methods</h3> The data analysed were collected in a longitudinal study of stroke survivors who were prospectively recruited from the Federal Medical Centre, Abeokuta and University College Hospital, Ibadan Nigeria. Subjects with subarachnoid haemorrhage, neurologic illness, or any systemic disease that could impair cognition were excluded from the study. Cognitive function was assessed using the vascular neuropsychological battery, depression through the Geriatric Depression Scale-short form, and functional dependency through the Barthel Index tool. Baseline enrolment was done three months after stroke (2010 -2011) and the stroke survivors were thereafter followed up for a period of four years (2014-2015). <h3>Results</h3> Of the 253 stroke survivors recruited into the study, the overall mean age was 60.2 (±9.8) <i>years</i>, 62.6% males, and overall mean number of years of formal education was 10.21 (±5.3). The proportion of stroke survivors with cognitive impairment was 53.2% at six months, 56.9%, 58.7%, 60.9 %, and 66.7 % at one, two, three, and four years, respectively, while depression was 39.3 % at three months, 35.2 %, 35.5 %, 26.7 %, and 36.1 % at one, two, three, and four years respectively. At six months after a stroke, the case fatality rate was 7.5 % (95 % C.I = 4.82-11.4), and 24.8 % (95 % C.I = 19.93-30.6), 39.4 % (95 % CI=3.65-45.7), and 45.3 % (95 % CI=39.42-51.6) at 1, 3 and 4 years respectively. Factors associated with mortality at 10% significance level include professional occupation (OR= 0.49; 90% CI=0.27-0.92; p-value=0.063) and those living with spouse/spouse and children (OR=0.57; 90%CI=0.35-0.93 p-value=0.058) while previous stroke was associated with functional dependency (OR=2.17; 95% C.I = 1.19-3.95, p-value 0.011). Older age (>70 yrs) (OR=23.47; 95%C.I=2.71-203.44, p-value=0.004), higher education (OR=0.17 95%C.I=0.04-0.69, p-value=0.013), professional occupation (OR=13.25; 95%C.I=1.04-168.55; p-value=0.046), previous stroke (OR=7.03 95%C.I=1.30-37.96, p-value=0.023), and caregiver burden (OR=3.51; 05% C.I=1.53-8.05, p-value=0.003) were predictors of cognitive impairment among the stroke survivors. <h3>Conclusion</h3> The study findings re-emphasize the importance of educational attainment, secondary stroke prevention and rich social network as a way of improving stroke outcomes.