Recurrent Stroke and Early Mortality in an Urban Medical Unit in Cameroon

Background Data on stroke mortality in recurrent strokes in the context of limited acute stroke care and secondary stroke prevention within Africa are very scant. We investigated the risk of in-hospital death in patients with recurrent stroke in the medical department of the Yaoundé Central Hospital in Cameroon. Methods Admission and discharge registries, and patient files for the period 1999-2012, were reviewed for evidence of admission for stroke, recurrent stroke, and in-hospital death. Mortality was compared between recurrent and first-ever stroke overall, and heterogeneities across major subgroups were assessed via interaction tests. Results Out of 1678 participants included in the final analytic sample, 243 (14.5%) had recurrent stroke. Our first-ever stroke participants were older (median age 65.0 years versus 62.0 years, P =.024), had a worse stroke risk profile (prevalent diabetes 17.5% versus 12.0%, P =.018; atrial fibrillation 3.7% versus 1.1%, P =.002; hypertension 91.7% versus 63.9%, P <.0001), and were smokers. Sixty-five deaths (20.6%) occurred among participants with recurrent stroke and 281 (19.6%) among first-ever stroke participants (P =.013). The adjusted odds ratio of mortality from recurrent stroke was 1.43 (95% CI: 1.03-1.99). Conclusion Stroke survivors have a 43% higher risk of dying after a recurrent stroke compared to those with first-ever stroke, against a background of unfavorable stroke risk profile.