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Stroke / Ischemic Stroke · Journal article
Annals of Medicine · July 27, 2026
Reinforces what was already believed, rather than introducing something new.
This is a large national retrospective cohort study of 888,003 ischemic stroke patients in Thailand over 18 years, documenting mortality rates and causes of death across three time windows: in-hospital, ≤30 days, and >30 days post-discharge. The study confirms that stroke is the dominant cause of early death, while complications and comorbidities drive long-term mortality, consistent with established understanding from other high-income settings but adding evidence from a lower-middle-income context.
Retrospective descriptive cohort study (national hospital database). All patients hospitalized with ischemic stroke (ICD-10 I63) in Thailand between 2004 and 2022, without age or sex exclusions.. n = 888,003. Thailand (nationwide hospital database).
Overall mortality was 47.6% (in-hospital 6.4%, ≤30 days post-discharge 8.2%, >30 days post-discharge 33.1%) Stroke caused 58.6% of in-hospital deaths and 29.1% of short-term deaths (≤30 days) Long-term mortality (>30 days) was driven by complications (30.7%) and comorbidities (30.5%)
Descriptive study with no comparator group; cannot assess effectiveness of interventions or temporal trends in cause-specific mortality. Overall mortality was 47.6% (in-hospital 6.4%, ≤30 days post-discharge 8.2%, >30 days post-discharge 33.1%)
Clinicians should recognize that post-discharge stroke mortality is driven increasingly by preventable infections (pneumonia, sepsis) and comorbidity management rather than recurrent stroke, suggesting integrated discharge planning, infection prevention protocols, and chronic disease management are critical to improving long-term outcomes after ischemic stroke.
Large national retrospective cohort with 18-year follow-up describing mortality patterns in ischemic stroke; confirms known temporal shifts in cause-of-death profiles but is descriptive, not comparative, and provides no intervention effect.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians should recognize that post-discharge stroke mortality is driven increasingly by preventable infections (pneumonia, sepsis) and comorbidity management rather than recurrent stroke, suggesting integrated discharge planning, infection prevention protocols, and chronic disease management are critical to improving long-term outcomes after ischemic stroke.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Background. Ischemic stroke (IS) remains a major cause of mortality and disability worldwide, although the causes of death after stroke have changed. Long-term mortality data from low- and middle-income countries are limited. We investigated the fatality rates and causes of death in patients with IS in Thailand within and beyond 30 days post-discharge.Methods. We conducted a retrospective descriptive study using national hospital database records from 2004-2022. Patients with IS (ICD-10 code I63) were included without age or sex restrictions, with death status followed through 2022. The causes of death included stroke, complications, comorbidities, accidents, suicide, and unknown causes. Mortality was analyzed during hospitalization and ≤30 and >30 days post-discharge.Results. Among 888,003 patients with IS, the overall mortality was 47.6%: in-hospital 6.4%; ≤30 days post-discharge 8.2%; and >30 days post-discharge 33.1%. Mortality rates increased notably with age, exceeding 80% in those aged > 85 years. Stroke caused most in-hospital (58.6%) and short-term deaths (29.1%), whereas long-term mortality was primarily due to complications (30.7%) and comorbidities (30.5%). The leading comorbid causes were heart disease, dementia, and neoplasm; while pneumonia and sepsis were the primary fatal complications. Age-related debility, COVID-19 infection, and cardiovascular collapse were other major causes.Conclusion. This nationwide study revealed dynamic changes in post-IS causes, with stroke predominating early deaths, while complications and comorbidities determined long-term outcomes. These findings highlight the need for integrated acute and post-discharge stroke care strategies targeting infection prevention, comorbidity management, and elder care.
Taken from the source record, never inferred. Follow any of these and new work involving them reaches your briefing.