Long-term recovery of disabling ischemic stroke: five-year follow-up of a prospective cohort study

Background Research on long-term functional recovery after stroke remains limited. This study aims to investigate the long-term functional recovery among ischemic stroke patients with functional disabilities in China. Methods This prospective cohort study used data from the China National Stroke Registry III, which had 15,166 patients consecutively enrolled across 201 hospitals in China between August 2015 and March 2018. We included 4086 patients with disabling ischemic stroke at discharge (the modified Rankin Scale [mRS] score of ≥2) after excluding 19 patients (0.47%) lost to follow-up by the 5-year endpoint, our final cohort included 4067 patients. The main outcome was 5-year functional recovery, defined as a ≥1-point reduction in the mRS score between discharge and 5-year follow-up. Multivariable Cox proportional hazards regression models were used to determine the factors of recovery. Results Among 4067 patients, the mean±SD age was 63.3±11.5 years and 1416(34.8%) were female. The functional recovery rate was 86.8% within 5 years(n=3531/4067). In multivariable analysis, older age (adjusted hazard ratio [aHR], 0.86, [95% CI 0.84–0.89]), current alcohol use (aHR, 0.91, [95% CI 0.83–0.99]), history of stroke (aHR, 0.88, [95% CI 0.81–0.95]), higher National Institutes of Health Stroke Scale score at discharge (aHR, 0.96, [95% CI 0.95–0.97]) and stroke recurrence (aHR, 0.88, [95% CI 0.81–0.96]) were independently associated with reduced likelihood of 5-year functional recovery. Patients with small artery occlusion (aHR, 1.11, [95% CI 1.01–1.22]), without atrial fibrillation (aHR, 1.31, [95% CI 1.09–1.58]) and discharged with anticoagulant medication (aHR, 1.35, [95% CI 1.06–1.71]) were independently associated with increased likelihood of 5-year functional recovery. Conclusion In this cohort study of patients with disabling ischemic stroke, long-term functional recovery rates were high, and key factors associated with recovery outcomes were identified, which may help guide personalized rehabilitation strategies.