Objective:

To assess post-stroke outcomes between patients with and without pre-stroke disability (PSD) over time.

Background:

Previous trials of acute stroke therapies excluded patients with PSD. There is a paucity of data on post-stroke outcomes in these patients and whether they have changed with secular changes in stroke care systems over time. 

Design/Methods:

We included patients who were enrolled in the SITS-International Stroke Treatment Registry between 2003 and 2021 and received IV thrombolysis with or without endovascular therapy. Patients with PSD had a pre-stroke modified Rankin Scale (mRS) score ≥2. Primary outcome was return to pre-stroke mRS at 3 months. We performed logistic regression for dichotomous outcomes and linear regression for continuous outcomes adjusting for age, sex, year of stroke, stroke severity, and comorbidities. Time-trends were analyzed for each study year.

Results:

The mean age of patients with PSD (n=21,414) was 76.88±11.8 years and without PSD (n=140,410) was 68.7±13.2 years. Patients with PSD were less likely to return to their pre-stroke mRS (aOR=0.65 [95% CI:0.62,0.69]) and have higher mortality [aOR=1.31 (95% CI:1.23,1.39)]. The odds of death improved over time but return to pre-stroke mRS did not change over time even when adjusted from acute stroke intervention and secondary prevention. There were no differences in the odds for symptomatic intracranial hemorrhage and NIHSS score at 24 hours and 7 days. 

Conclusions:

In this observational registry-based study with its limitations, patients with PSD were less likely to return to their pre-stroke function at 3 months. This relationship did not change with time even when adjusted for acute stroke interventions and secondary prevention. They also have higher mortality although this has improved over the last 18 years. More research inclusive of patients with PSD and optimizing their functional outcome is needed.