Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Disability Trajectories Before and After Stroke, MI

JAMA Neurol; ePub 2017 Oct 23; Dhamoon, et al

In a recent large, population-based study, a trajectory of increasing disability became significantly steeper after stroke but not after myocardial infarction (MI). In the population-based, prospective cohort Cardiovascular Health Study (1989-2013), longitudinal follow-up was conducted for a mean (SD) of 13 (6.2) years. Participants included 5,888 Medicare-eligible individuals aged ≥65 years who were not institutionalized, expected to reside in the area for ≥3 years, and able to provide informed consent. Exclusions were needing a wheelchair, receiving hospice care, and undergoing radiotherapy or chemotherapy. Researchers found:

  • During follow-up, 382 (6.5%) participants had ischemic stroke and 395 (6.7%) had MI with ≥1 disability assessment after the event.
  • There was a mean of 3.7 (2.4) visits before stroke and 3.7 (2.3) visits after stroke; there was a mean of 3.8 (2.5) visits before MI and 3.8 (2.4) visits after MI.
  • The increase in disability near the time of the event was greater for stroke than MI.
  • The annual increase in disability before stroke more than tripled after stroke.
  • The annual increase in disability before MI did not change significantly after MI.


Dhamoon MS, Longstreth Jr. WT, Bartz TM, Kaplan RC, Elkind MSV. Disability trajectories before and after stroke and myocardial infarction. The Cardiovascular Health Study. [Published online ahead of print October 23, 2017]. JAMA Neurol. doi:10.1001/jamaneurol.2017.2802.

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