|Author(s):||K. H. Popova1|
|Affiliation(s):||1Faculty of Public Health, Medical University of Sofia, Sofia, Bulgaria|
|Keywords:||Stroke, practice guidelines, rehabilitation, secondary prevention, mortality risk|
Stroke is a leading cause of death and chronic disability in Bulgaria. The objective was to evaluate the risk for death and the factors associated with mortality in stroke patients a year later after the acute clinical phase of the study.
A total of three hundred eleven first-ever stroke patients were included in the analysis a year later after the acute stroke. Data collected included demographics, socioeconomic factors, stroke severity and comorbidities, risk factors, treatments. Data analysis consisted of descriptive statistics and the Kaplan-Meier method and log-rank test to estimate and compare survival curves between groups. Cox proportional hazards model and logistic regression were used to identify risk factors for mortality.
The elderly (75 years and more) are at a greater risk of stroke but also at the high risk of complications and death. The socially disadvantaged are at high risk for disability because of limited access to post-stroke care and rehabilitation. The influence of prognostic factors on survival was investigated by means of the Cox regression model. On multivariate Cox analysis only gender, stroke severity and time duration of hypertention and diabetis were significant independent predictors. This study emphasizes the need to develop integrated well structured and coordinated system for stroke care. Post-stroke care and rehabilitation would substantially reduce the number of deaths and prevention of recurrent stroke. It demonstrates an association between adherence to the principles and guidelines and stroke outcome in prevention, treatment, and rehabilitation of stroke. Implementation of guidelines offers a unique opportunity to identify and help address disparities in healthcare delivery.