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Long-term survival and prognostic determinants in stroke patients in western Iran: A retrospective cohort study using landmark analysis

Articles in Press

Document Type : Original Article

Authors

1 Department of Neurology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran

2 Modeling of Non-communicable Diseases Research Center, Institute of Health Sciences and Technology, Hamadan University of Medical Sciences, Hamadan, Iran Fertility and Infertility Research Center, Avicenna Institute of Clinical Sciences, Hamadan University of Medical Sciences, Hamadan, Iran

3 Department of Epidemiology, School of Health, Hamadan University of Medical Sciences, Hamadan, Iran Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran

4 School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran

5 Clinical Research Development Unit, Fatemieh Hospital, Hamadan University of Medical Sciences, Hamadan, Iran

6 Clinical Research Development Unit of Sina Hospital, Hamadan University of Medical Sciences, Hamadan, Iran

Abstract

Background: The purpose of this study was to estimate the long-term survival of patients with stroke and identify prognostic factors associated with mortality.
Methods: This retrospective cohort study included 2744 patients with stroke admitted to Farshchian (Sina) Hospital in Hamadan City, Iran, between 2014 and 2019, who were followed until 2022. Data on demographic characteristics, clinical history, vital signs at admission, post-stroke complications, and stroke severity were collected. The primary outcome was survival time from stroke admission to death. Two Cox proportional hazards models were developed: a baseline prognostic and a landmark analysis model.
Results: Of the 2744 patients included in the study, 1433 (52.22%) died during the follow-up period. The survival rates were 67.2% at 1 year (901 deaths), 51.3% at 5 years (1296 deaths), and 37.6% at 9 years (1433 deaths). 
In the landmark analysis, mortality risk was significantly higher for patients with acute kidney injury [adjusted hazard ratio (HR): 1.86; 95% confidence interval (CI): 1.28‒2.70], diabetes (adjusted HR: 1.29; 95% CI: 1.00‒1.68), and Glasgow Coma Scale (GCS) scores ≤ 8 (adjusted HR: 1.74; 95% CI: 1.09‒2.75) compared to the corresponding reference groups. Respiratory failure and pneumonia occurring after 7 days were associated with significantly increased mortality risk with adjusted HRs of 1.88 (95% CI: 1.33–2.67) and 2.00 (95% CI: 1.28–3.13), respectively.
Conclusion: The findings highlight the importance of secondary prevention and rehabilitation in improving long-term outcomes among stroke survivors. In addition, several potentially modifiable prognostic factors associated with mortality were identified. The results further suggest that landmark analysis may improve the accuracy and stability of risk estimates in stroke survival studies.
 

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Current Journal of Neurology

Articles in Press, Accepted Manuscript
Available Online from 23 August 2026
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