Trial reportNeurology2023
Associations of Multimorbidity With Stroke Severity, Subtype, Premorbid Disability, and Early Mortality: Oxford Vascular Study.
Trial report in Neurology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
19 citing papers in PubMed, 28 citations in OpenAlex.
- Cost-effectiveness of the ABCStroke pathway in ischaemic stroke care: a UK pilot analysis.European heart journal. Quality of care & clinical outcomes · 2026Article
- The paradox of asymptomatic carotid atherosclerosis in women: gender differences.Journal of ultrasound · 2026Article
- Intrinsic capacity and stroke risk in a multiple cohort study.Nature communications · 2026Article
- Association Between High-Density Lipoprotein Cholesterol Levels and Prognoses in Patients With Stroke.Journal of the American Heart Association · 2026Observational
- Level of disability and associated factors among stroke survivors in Ethiopia: a multicenter cross-sectional study.BMC public health · 2026Article
- The impact of comorbidity burden on outcomes following endovascular thrombectomy for acute ischemic stroke: A nationwide prospective observational study.European stroke journal · 2026Observational
- Review
- Anesthesia Considerations in Older Adults Undergoing Emergency Mechanical Thrombectomy for Acute Ischaemic Stroke.Drugs & aging · 2025Review
- The impact of comorbidity burden on outcomes following endovascular thrombectomy for acute ischemic stroke: A nationwide prospective observational study.European stroke journal · 2025Article
- Five-Year Functional Outcomes Among Patients Surviving Aneurysmal Subarachnoid Hemorrhage.JAMA network open · 2025Article
- Impact of Acute Myocardial Injury on Short- and Long-Term Outcomes in Patients With Primary Intracerebral Hemorrhage.Journal of the American Heart Association · 2025Article
- Comorbidity and cost burden among ischemic stroke inpatients aged 60 years and older in middle-high-income region in China: a multicenter cross-sectional study.Frontiers in public health · 2025Article
- Predictive accuracy of comorbidity index models in assessing mortality risk among hemodialysis patients: A comprehensive single-center observational cohort study.Aging medicine (Milton (N.S.W)) · 2024Article
- The value of cardiopulmonary comorbidity in patients with acute large vessel occlusion stroke undergoing endovascular thrombectomy: a retrospective, observational cohort study.BMC neurology · 2024Observational
- Endovascular Thrombectomy in Patients With Preexisting Disability: A Review.Stroke (Hoboken, N.J.) · 2024Review
- Rhoa/ROCK, mTOR and Secretome-Based Treatments for Ischemic Stroke: New Perspectives.Current issues in molecular biology · 2024Review
- Sex Differences in the Role of Multimorbidity on Poststroke Disability: The Taiwan Stroke Registry.Neurology · 2024Article
- Association of multimorbidity with mortality after stroke stratified by age, severity, etiology, and prior disability.International journal of stroke : official journal of the International Stroke Society · 2024Article
- Endovascular thrombectomy in patients with acute ischemic stroke and prestroke mRS 3: a multicenter IPTW analysis focused on functional preservation.Frontiers in neurologyArticle
Corrections and comments
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Authors and funding
5 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
BACKGROUND AND
objectivesPatients with multimorbidity are underrepresented in clinical trials. Inclusion in stroke trials is often limited by exclusion based on premorbid disability, concerns about worse poststroke outcomes in acute treatment trials, and a possibly increased proportion of hemorrhagic vs ischemic stroke in prevention trials. Multimorbidity is associated with an increased mortality after stroke, but it is unclear whether this is driven by an increased stroke severity or is confounded by particular stroke subtypes or premorbid disability. We aimed to determine the independent association of multimorbidity with stroke severity taking account of these main potential confounders.
methodsIn a population-based incidence study (Oxford Vascular Study; 2002-2017), prestroke multimorbidity (Charlson Comorbidity Index [CCI]; unweighted/weighted) in all first-in-study strokes was related to postacute severity (≈24 hours; NIH Stroke Scale [NIHSS]), stroke subtype (hemorrhagic vs ischemic; Trial of Org 10172 in Acute Stroke Treatment [TOAST]), and premorbid disability (modified Rankin scale [mRS] score ≥2) using age-adjusted/sex-adjusted logistic and linear regression models and to 90-day mortality using Cox proportional hazard models.
resultsAmong 2,492 patients (mean/SD age = 74.5/13.9 years; 1,216/48.8% male; 2,160/86.7% ischemic strokes; mean/SD NIHSS = 5.7/7.1), 1,402 (56.2%) had at least 1 CCI comorbidity, and 700 (28.1%) had multimorbidity. Although multimorbidity was strongly related to premorbid mRS ≥2 (adjusted odds ratio [aOR] per CCI comorbidity 1.42, 1.31-1.54, DISCUSSION: Multimorbidity is common in patients with stroke and is strongly related to premorbid disability but is not independently associated with an increased ischemic stroke severity. Greater inclusion of patients with multimorbidity is unlikely therefore to undermine the effectiveness of interventions in clinical trials but would increase external validity.
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