Open Access Highly Accessed Research article

Functional, cognitive and psychological outcomes, and recurrent vascular events in Pakistani stroke survivors: a cross sectional study

Maria Khan1, Bilal Ahmed2, Maryam Ahmed3, Myda Najeeb4, Emmon Raza5, Farid Khan5, Anoosh Moin5, Dania Shujaat6, Ahmed Arshad5 and Ayeesha Kamran Kamal78*

Author Affiliations

1 Fellow International Cerebrovascular Translational Clinical Research Program, FCPS Neurology, Stroke Service, Aga Khan University, Karachi, Pakistan

2 Dept. of Medicine, Aga Khan University, M Sc. Epidemiology and Biostatistics, Karachi, Pakistan

3 M.B.B.S., Sind Medical College, Karachi, Pakistan

4 M.B.B.S, Dow University of Health Sciences, Karachi, Pakistan

5 Medical College, Aga Khan University, Karachi, Pakistan

6 Ziauddin Medical College, Aga Khan University, Karachi, Pakistan

7 Aga Khan University, International Cerebrovascular Translational Clinical Research Program and Stroke Services, Karachi, Pakistan

8 Stroke Service and Clinical Research Programs, Aga Khan University, Karachi, Pakistan

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BMC Research Notes 2012, 5:89  doi:10.1186/1756-0500-5-89

Published: 9 February 2012



There is little direct data describing the outcomes and recurrent vascular morbidity and mortality of stroke survivors from low and middle income countries like Pakistan. This study describes functional, cognitive and vascular morbidity and mortality of Pakistani stroke survivors discharged from a dedicated stroke center within a nonprofit tertiary care hospital based in a multiethnic city with a population of more than 20 million.


Patients with stroke, aged > 18 years, discharged alive from a tertiary care centre were contacted via telephone and a cross sectional study was conducted. All the discharges were contacted. Patients or their legal surrogate were interviewed regarding functional, cognitive and psychological outcomes and recurrent vascular events using standardized, pretested and translated scales. A verbal autopsy was carried out for patients who had died after discharge. Stroke subtype and risk factors data was collected from the medical records. Subdural hemorrhages, traumatic ICH, subarachnoid hemorrhage, iatrogenic stroke within hospital and all other diagnoses that presented like stroke but were subsequently found not to have stroke were also excluded. Composites were created for functional outcome variable and depression. Data were analyzed using logistic regression.


309 subjects were interviewed at a median of 5.5 months post discharge. 12.3% of the patients had died, mostly from recurrent vascular events or stroke complications. Poor functional outcome defined as Modified Rankin Score (mRS) of > 2 and a Barthel Index (BI) score of < 90 was seen in 51%. Older age (Adj-OR-2.1, p = 0.01), moderate to severe dementia (Adj-OR-19.1, p < 0.001), Diabetes (Adj-OR-2.1, p = 0.02) and multiple post stroke complications (Adj-OR-3.6, p = 0.02) were independent predictors of poor functional outcome. Cognitive outcomes were poor in 42% and predictors of moderate to severe dementia were depression (Adj-OR-6.86, p < 0.001), multiple post stroke complications (Adj-OR-4.58, p = 0.01), presence of bed sores (Adj-OR-17.13, p = 0.01) and history of atrial fibrillation (Adj-OR-5.12, p < 0.001).


Pakistani stroke survivors have poor outcomes in the community, mostly from preventable complications. Despite advanced disability, the principal caretakers were family rarely supported by health care personnel, highlighting the need to develop robust home care support for caregivers in these challenging resource poor settings.