{
  "abstract": "Background: Contemporary data on long-term, cause-specific mortality among stroke survivors are sparse, and much of the existing evidence derives from studies performed before the modern reperfusion era. We sought to characterize long-term cause-specific mortality among stroke survivors to discharge (differentiated by stroke subtype) when compared to in-hospital stroke decedents treated under contemporary standards of care. Methods: Using a hybrid billing-code/imaging and large language model-assisted chart-review pipeline, we identified adults hospitalized for ischemic or hemorrhagic stroke in the Observational Study of Cardiac Arrest Risk (OSCAR) cohort (Cedars-Sinai Health System, Los Angeles) between 2017 and 2020, followed through June 30, 2025. Cause of death was determined and classified into 10 categories. Results: Among 1,344 stroke patients (mean age 74.0 {+/-} 14.9 years; ischemic n=1,036 [77.1%], hemorrhagic n=308 [22.9%]), 203 (15.1%) did not survive the index stroke. Of the 1,141 discharged survivors, 625 (54.8%) died over a median follow-up of 5.2 years. Cerebrovascular causes predominated during index stroke hospitalization (36.0%) but accounted for only 15.5% of post-stroke discharge deaths. Among ischemic stroke survivors, cardiac disease was the leading cause of death (31.6%), with sudden cardiac arrest alone accounting for 10.9% of deaths. Among hemorrhagic stroke survivors, cancer (38.9%) was the leading cause of death. Despite these divergent cause-of-death profiles, overall survival did not differ significantly by subtype (median 5.5 vs 5.8 years; P=0.90). Conclusions: In this contemporary, reperfusion-era cohort, causes of death shifted from cerebrovascular predominance in the acute phase to heart disease/cardiac arrest after ischemic stroke, and malignancy after hemorrhagic stroke. These findings argue for development of subtype-specific post-stroke surveillance, including structured longitudinal cardiac and sudden-death risk assessment for ischemic stroke survivors.",
  "abstract_shown": true,
  "affiliations": [
    "Cedars-Sinai Health System"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 9,
  "authors": [
    {
      "name": "V. Kadiyala"
    },
    {
      "name": "A. N. Simpkins"
    },
    {
      "affs": [
        0
      ],
      "name": "H. Chugh"
    },
    {
      "name": "R. Czarny"
    },
    {
      "name": "A. Uy-Evanado"
    },
    {
      "name": "N. Bosson"
    },
    {
      "name": "N. Tatonetti"
    },
    {
      "name": "K. Reinier"
    },
    {
      "affs": [
        0
      ],
      "name": "S. S. Chugh"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/29cvpqc8aqed1.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.11.03.26367230",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.11.03.26367230v1.full",
  "id": "29cvpqc8aqed1",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.11.03.26367230v1",
  "language": null,
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "neurology"
    ]
  ],
  "openalex": null,
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.11.03.26367230v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-11-03",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/29cvpqc8aqed1.ris",
  "sources": [
    {
      "first_seen": "2026-11-06T12:20:48Z",
      "native_id": "10.64898/2026.11.03.26367230",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.11.03.26367230v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:neurology",
      "subfield": "neurology"
    }
  ],
  "title": "Divergent Causes of Death After Ischemic and Hemorrhagic Stroke in the Reperfusion Era: A Contemporary Cohort Study",
  "title_text": "Divergent Causes of Death After Ischemic and Hemorrhagic Stroke in the Reperfusion Era: A Contemporary Cohort Study",
  "type": "preprint",
  "updated_at": "2026-11-07T00:20:54Z",
  "url": "https://research.draconitic.com/paper/29cvpqc8aqed1",
  "venue": "medRxiv",
  "versions": []
}