Patient outcomes up to 15 years after stroke: Survival, disability, quality of life, cognition and mental health

Background: The global epidemiological shift of disease burden towards long term conditions means understanding long-term outcomes of cardiovascular disease is increasingly important. More people are surviving stroke to experience it's long term consequences, but outcomes in people living more >10 years after stroke have not been described in detail. 
Methods: Data were collected for the population-based South London Stroke Register, with participants followed up annually until death. Outcomes were survival, disability, activity, cognitive impairment, quality of life, depression and anxiety. Findings Of 2625 people having first-ever stroke, 262(21%) survived to 15 years. By 15 years, 61%(95% CI 55- 67%) of the survivors were male, with a median age of stroke onset of 58 years (IQR 48-66). 87% of the 15 year survivors were living at home and 33.8%(26.2-42.4%) had mild disability, 14.3% (9.2-21.4%) moderate disability and 15.0%(9.9-22.3%) severe disability. The prevalence of disability increased with time but one in ten of the 15 year survivors had lived with moderate-severe disability since their stroke. At 15 years, the prevalence of cognitive impairment was 30.0%(19.5-43.1%), depression 39.1%(30.9-47.9%) and anxiety 34.9%(27.0-43.8%) and survivors reported greater loss of physical than mental quality of life. 
Conclusions: One in five people live at least 15 years after a stroke and poor functional, cognitive and psychological outcomes affect a substantial proportion of these long term survivors. As the global population of individuals with cardiovascular long term conditions grows, research and health services will need to increasingly focus on preventing and managing the long term consequences of stroke.