The outcome of stroke: A six month follow-up study


  • Kameran Hassan Ismail Department of Community Medicine, College of Medicine, Hawler Medical University, Erbil, Iraq.



Stroke, Case fatality, Recurrence, Functional outcome.


Background and objective: Stroke is an increasing problem in developing countries and is the principal cause of disability and dependency in the western world. This study aimed to find out the one- and six-month case fatality, dependency and recurrence rates of stroke in Erbil teaching hospitals.  

Methods: This hospital-based prospective study included 293 stroke patients hospitalized in Erbil teaching hospitals from January 1st, 2015 through December 31st, 2015. Stroke was diagnosed by a consultant internist or neurologist and confirmed by brain CT-scan and/or MRI. Patients were followed-up for six months, then one- and six-month outcomes were measured including case-fatality, dependency and recurrences rates.

Results: The one and six month case fatality rates were 28.3% and 37.5%, respectively. The rates in females (33.3%, 42.6%, respectively) were higher than that in males (23.7%, 32.9%, respectively), but there was no significant association between case-fatality rate and gender. A total of 74.3% and 45.4% of patients at one- and six-month were functionally dependent. The majority (88.9%) of diabetic patients were functionally dependent. Also, the one and six month recurrence rates of stroke patients were 15.7% and 23.2%, respectively. For both one and six month post stroke more recurrence occurred from ischemic (16.2%, 14.3%, respectively) than from hemorrhagic (24.5%, 19.5%, respectively) strokes, but there was no significant association between the recurrence and stroke subtype (P = 0.691, P = 0.367, respectively).

Conclusion: The reported outcomes are relatively comparable to that reported in other developing countries, although it is still more than the rates of developed countries. Outcome measures can help to give information and develop guidelines for clinical practice and research.


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Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJL. Global and regional burden of disease and risk factors, 2001: Systematic analysis of population health data. Lancet 2006; 367(9524):1747-57.

Strong K, Mathers C, Bonita R. Preventing stroke: saving lives around the world. Lancet Neurol 2007; 6(2):182-7.

Beaglehole R, Ebrahim S, Reddy S, Voute J, Leeder S. Prevention of chronic diseases: A call to action. Lancet 2007; 370 (9605):2152-7.

Bousser MG, Bogousslavsky J. Advances in stroke prevention. Cerebrovasc Dis 2003; 16 (suppl 1):1-2.

Sarti C, Stegmayr B, Tolonen H, Mahonen M, Tuomilehto J, Asplund K. Are changes in mortality from stroke caused by changes in stroke event rates or case fatality? Results from the WHO MONICA Project. Stroke 2003; 34(8):1833-40.

Sarti C, Rastenyte D, Cepaitis Z, Tuomilehto J. International trends in mortality from stroke, 1968 to 1994. Stroke 2000; 31(7):1588-601.

Park K. Park's textbook of preventive and social medicine. 23rd ed. Jabalpur (India): Banarsidas Bhanot Publishers; 2015.

Banks JL, Marotta CA. Outcomes validity and reliability of the modified Rankin scale: Implications for stroke clinical trials: A literature review and synthesis. Stroke 2007; 38:1091-6.

Nencini P, Nesi M. Neurological functional scales: National institute of health stroke scale (NIHSS), modified rankin scale, glasgow scale. Cerebrovasc Dis 2008; 26 (suppl 2):1-29.

Allen CMC, Lueck CJ, Dennis M. Neurological diseases. In: Colledge NR, Walker BR, Ralston SH. Davidson's principles and practice of medicine. 21st ed. Edinburgh: Churchill Livingstone; 2010.

Dewey HM, Thrift AG, Mihalopoulos C, Carter R, Macdonell RA, McNeil JJ, et al. The cost of stroke in Australia from a societal perspective: Results from the north east Melbourne stroke incidence study (NEMESIS). Stroke 2001; 32:2409-16.

Ismail KH, Al-Tawil NG, Al-Hadithi TS. Case fatality rate of first-ever stroke in Erbil city. Zanco J Med Sci 2010; 14 (Special issue 1):14-9.

Sridharan SE, Unnikrishnan JP, Sajith S, Sylaja PN, Dinesh NS, Sankara SP, et al. Incidence, types, risk factors, and outcome of stroke in a developing country: The Trivandrum, Kerala, India. Stroke 2009; 40 (4):1212-8.

Mihalka L, Smolanka V, Bulecza B, Mulesa S, Bereczki D. A population study of stroke in West Ukraine: Incidence, stroke services, and 30-day case fatality. Stroke 2001; 32:2227-31.

Ong TZ, Raymond AA. Risk factors for stroke and predictors of one-month mortality. Singapore Med J 2002; 43:517-21.

Oveisgharan S, Sarrafzadegan N, Shirani S, Hosseini S, Hasanzadeh P, Khosravi A. Stroke in Isfahan, Iran: Hospital admission and 28-day case fatality rate. Cerebrovasc Dis 2007; 24:495-9.

Sagui E, M’Baye PS, Dubecq C, Fall KB, Niang A, Gning S, et al. Ischemic and hemorrhagic strokes in Dakar, Senegal: A hospital-based study. Stroke 2005; 36:1844-7.

Wang Y, Levi CR, Attia JR, D'Este CA, Spratt N, Fisher J. Seasonal variation in stroke in the Hunter region, Australia: A 5-year hospital-based study, 1995-2000. Stroke 2003; 34:1144-50.

Hallström B, Jönsson AC, Nerbrand C, Norrving B, Lindgren A. Stroke incidence and survival in the beginning of the 21st century in Southern Sweden. Comparisons with the late 20th century and projections into the future. Stroke 2008; 39:10-5.

Musolino R, La Spina P, Serra S, Postorino P, Calabró S, Savica R, et al. First-ever stroke incidence and 30-day case fatality in the Sicilian Aeolian Archipelago, Italy. Stroke 2005; 36 (12): 2738-41.

Minino AM, Heron MP, Murphy SL, Kochanek KD. Deaths: Final data for 2004. Natl Vital Stat Rep 2007; 55 (19):1-119.

Smadja D, Cabre P, May F, Fanon J, Renee-Corail P, Riocreux C, et al. Epidemiology of stroke in Martinique, French West Indies. Part I. Methodology, incidence, and 30-day case fatality rate. Stroke 2001; 32:2741-7.

Ivanusa M, Ivanusa Z. Risk factors and in-hospital outcomes in stroke and myocardial infarction patients. BMC Public Health 2004; 4:26.

Heikinheimo T, Chimbayo D, Kumwenda JJ, Kampondeni S, Allain TJ. Stroke outcomes in Malawi, a country with high prevalence of a prospective follow-up study. PLoS One 2012; 7(3):e33765.

Muli G, Rhoda A. Quality of life amongst young adults with stroke living in Kenya. Afr Health Sci 2013; 13(3):632-8.

Srikanth VK, Anderson JF, Donnan GA, Saling MM, Didus E, Alpitsis R, et al. Progressive dementia after first-ever stroke. A community-based follow-up study. Neurology 2004; 63:785-92.

Bogousslavsky J. Long-term effects of stroke. Marcel Dekker, Inc.: New York. Bassel; 2002.

Lee AH, Somerford PJ, Yau KKW. Risk factors for ischaemic stroke recurrence after hospitalisation. MJA 2004; 181(5):244-6.

Joubert J, Reid C, Barton D, Cumming T, Mc Lean A, Joubert L, et al. Integrated care improves risk-factor modification after stroke: Initial results of the integrated care for the reduction of secondary stroke model. J Neurol Neurosurg Psychiatry 2009; 80:279-84.




How to Cite

Ismail, K. H. (2018). The outcome of stroke: A six month follow-up study. Zanco Journal of Medical Sciences (Zanco J Med Sci), 22(1), 82–88.



Original Articles