1. Long-term mortality after acute stroke  Stroke is a leading cause of mortality: 6 million fatal events annually worldwide.  Mainly affects elderly, but 10% of strokes are in patients younger than 50 years.  Prognosis of stroke is usually considered benign in the young population when compared with older patients who have a higher short-term rate of mortality.  But… there is no direct evaluation of the impact of stroke in patients younger than 50 years old compared with age-matched individuals from the general population.

2. The FUTURE study  Follow-Up of Transient ischemic attack and stroke patients and Unelucidated Risk factor Evaluation (FUTURE): a prospective cohort study. 1  Objective: to investigate long-term mortality and cause of death after acute stroke in adults aged 18 through 50 years and to compare this with age and sex- matched mortality rates in the Netherlands.  959 Consecutives’ patients with first-ever transient ischemic attack (TIA, n=262), ischemic stroke (n=606), and intracerebral hemorrhage (ICH, n=91), followed up over a mean duration of 11.1 years. Population distribution 1- Rutten-Jacobs LC, Arntz RM, Maaijwee NA et al. Long-term mortality after stroke among adults aged 18 to 50 years. JAMA. 2013;309(11):1136-1144.

3. Observed rate of death in the FUTURE study  During follow-up, 192 patients died.  Case-fatality 43 Patients died during the first 30 days, providing a 30-day case-fatality rate of 0.4% after TIA, 3.6% after ischemic stroke, and 22% after ICH.  Long-term mortality in 30-day survivors Cumulative mortality over 20 years in young patients were respectively 24.9% (95% confidence interval [CI], 16-33.7) after TIA, 26.8% (95% CI, 21.9-31.8) after ischemic stroke, and 13.7% (95% CI, 3.6-23.9) after ICH.

4.  Mortality after ischemic stroke remained increased compared with the expected mortality during the entire follow-up: For TIA: 24.9% (95% CI, 16-33.7) vs 8.5% For ischemic stroke: 26.8% (95% CI, 21.9-31.8) vs 7.6% For ICH: 13.7% (95% CI, 3.6-23.9) vs 5.6%  The standardized mortality ratio (SMR) reflected the increased mortality observed in all subgroups compared with expected values. PatientsPatient-yearsObservedExpected SMR (95% CI) P value TIA 26126862911.2 2.6 (1.8-3.7) P<0.001 Ischemic stroke 584717111128.6 3.9 (3.2-4.7) P<0.001 ICH 7176892.3 3.9 (1.9-7.2) P<0.001 Long-term consequence of stroke on death rate

5. Conclusion  Patients experiencing a stroke between the ages of 18 and 50 years remain at significantly higher risk of death compared with the general population during the 20 following years.  Half of the deaths were attributable to a vascular event, suggesting that the underlying disease causing stroke at a young age continues to be active throughout life.  Among stroke subtypes, cardioembolic stroke (part of the ischemic stroke group) was the most important predictor of mortality.