Abstract T MP93: High 1- to 5-Year Mortality and Morbidity in Stable Patients Without Early Complications After Stroke or TIA
Bibliographic record
Abstract
Introduction: Stroke prevention efforts are increasingly focused on early risk after TIA/stroke to facilitate initiation of risk-modifying therapies. Few clinics can follow patients for years after an event, yet even stable patients may remain at high risk. Hypothesis: Patients discharged from hospitals with TIA/stroke who survive 90 days without complications, will remain at high risk of adverse outcomes for years after their event. METHODS: We analyzed data from the Registry of the Canadian Stroke Network. We identified all patients discharged from hospital with a diagnosis of TIA or ischemic stroke from 2003-2011. We excluded patients with any event within 90 days of discharge: any hospitalization, stroke, TIA, myocardial infarct (MI), death, long-term care (LTC) admission. A composite outcome of stroke, MI, death or LTC admission was examined from 1 to 5 years after the first 90 days. RESULTS: 30% of patients (n=10, 293) were excluded for events in the first 90 days. Of the remaining 70% (n=24,011) event-free at 90 days, 53% were male and mean age was 69.9 +/- 14.1. 61% had ischemic stroke and 39% TIA. 86% were mild (Canadian Neurological Scale (CNS)>=8), 9.9% were moderate (CNS 5-7) and 4.1% were severe (CNS 0-4). The combined outcome (stroke, MI, LTC or death) occurred in 9.4% of this “mild” group one year AFTER the highest risk period was over and in 35% by 5 years. Death was the most common event (1 year: 5.4%; 5 years: 26.8%), followed by stroke (1 year: 2.6%; 5 years: 7.9%). Among those who survived the first year, the event rate remained at 5% per year at both 3- and 5-years. CONCLUSIONS: Patients who survive the initial 90-day period after TIA/stroke without events are similar to those seen routinely in stroke clinics. These patients remain at high risk of negative outcomes: almost 10% patients have died, or had a stroke, MI or LTC admission in the first year and 5% more occur per year, up to 5 years. Strategies for efficient and effective long-term follow-up to modify these risks are needed for stroke clinic patients.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.006 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".