2026 American Academy of Neurology Abstract Website

Michael Kinkata¹, Aparna Nutakki², William Tembo³, Sarah Braun¹, Melody Asukile¹, Lorraine Chishimba¹, Mulenga Chilando¹, Mashina Chomba⁴, Musisye Luchembe¹, Dominique Mortel⁵, Dickson Munkombwe¹, Julia Mwamba¹, Naluca Mwendaweli¹, Frighton Mutete⁶, Coolwe Namangala¹, Alexandra Peloso¹, Faith Simushi¹, Leroy Yankae¹, Stanley Zimba¹, Madalitso Nthere⁷, Emmanuel Mukambo¹, Theresa Shankanga⁴, Diwell Mwansa⁴, Musisye Luchembe⁷, Taonga Msimuko⁷, Tamia Banda⁷, Ndonji Chiwaya⁷, Deanna Saylor⁸
¹University Teaching Hospital, Lusaka, Zambia, ²Johns Hopkins Hospital, ³University of Minnesota, ⁴The University of Zambia, ⁵Phoebe Neurology, ⁶Livingstone University Teaching Hospital, ⁷University teaching hospital, Lusaka, Zambia, ⁸University of North Carolina School of Medicine

Objective:

To identify the factors that contribute to the high post discharge mortalities in a Zambia stroke cohort.

Background:

Improving post-discharge outcomes for people with stroke requires an

understanding of adverse events that occur during this period. We identified

causes of death amongst adults with stroke in Zambia.

Design/Methods:

We conducted a prospective cohort study of individuals with stroke admitted

to the University Teaching Hospital in Lusaka. Patients were called every

three months post-discharge for one year, and vital status was ascertained.

For those who died, caregivers were asked to answer questions on

symptoms prior to and circumstances of death and cause of death as the

caregiver understood it. Of note, adjudication of causes of death was not

possible.

Results:

83 deaths occurred during the post-discharge period. Causes of death were

provided for 68 (82%) and comprised of complications of stroke (25%, n=17),

recurrent stroke (18%, n=12),aspiration pneumonia (16%, n=11), cardiac

disease (7%, n=5), kidney failure (7%, n=5), decubitus ulcers (4%, n=3),

sepsis (4%, n=3), poorly controlled hypertension (4%, n=3), diabetes (4%,

n=3), failure to feed (3%, n=2), anemia (3%, n=2), COVID (1%, n=1), and liver

failure (1%, n=1). Nearly one-quarter (n=19, 23%) of participants developed

new or distressing symptoms prior to death, including refractory

hypertension, decubitus ulcers, heart disease, deep vein thrombosis, kidney

failure, insomnia, failure to thrive, severe headache, hypotension,

uncontrolled pain, and diarrhea. Half of deaths (n=25, 49%) occurred at

home because caregivers reported deaths were sudden or unexpected.

Conclusions:

Nearly two-thirds of post-discharge deaths were preventable, and three-

quarters of distressing end-of-life symptoms were preventable and/or

manageable with adequate medical care. A high percentage of at-home

deaths potentially suggests caregivers are unaware of warning signs of

deterioration or when to seek care. Improving post-discharge medical services for individuals with stroke could substantially improve long-term stroke outcomes in Zambia.