Changes in Long-Term Survival After Stroke Between 2013 and 2020: A Nationwide Cohort Study from the Swedish Stroke Register

IntroductionChanges in long-term survival after stroke at the population level are incompletely characterized, particularly using recent data and stratified by stroke type.Patients and MethodsThis nationwide, register-based cohort study used data from the Swedish Stroke Register (Riksstroke) and the Swedish Causes of Death Register. Adults (≥18 years) hospitalized with ischemic stroke or intracerebral hemorrhage in Sweden during either 2013 or 2020 were included. Patients were followed for 3 years after the index stroke. The primary outcome was difference in all-cause mortality within 3 years. Survival was assessed using Kaplan-Meier analyses and Cox proportional hazards regression, stratified by stroke type.ResultsThe study included 42 926 patients. Among patients with ischemic stroke, 3-year survival increased from 63.8% in 2013 to 69.3% in 2020, corresponding to an absolute difference of 5.5 percentage points, with survival differences increasing progressively during follow-up. Ischemic stroke in 2020 was associated with a lower risk of 3-year mortality compared with 2013 in both unadjusted (hazard ratio (HR), 0.83; 95% CI, 0.80-0.86) and multivariable analyses (adjusted HR, 0.92; 95% CI, 0.89-0.96). Survival improvements after ischemic stroke were most pronounced among patients aged 75 years or older. In contrast, long-term survival after intracerebral hemorrhage did not change between cohorts (3-year survival, 50.9% in both years; adjusted hazard ratio, 0.97; 95% CI, 0.89-1.05).ConclusionsIn this nationwide cohort study, 3-year survival after ischemic stroke improved between 2013 and 2020, particularly among patients aged 75 years or older, whereas long-term survival after intracerebral hemorrhage remained unchanged. These findings suggest a contemporary population-level improvement in long-term survival after ischemic stroke over a relatively short calendar period and indicate that survival differences between cohorts increased progressively over long-term follow-up.