Divergent Causes of Death After Ischemic and Hemorrhagic Stroke in the Reperfusion Era: A Contemporary Cohort Study
- 1Cedars-Sinai Health System
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.
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BibTeX
@misc{kadiyala2026divergent,
title = {{Divergent Causes of Death After Ischemic and Hemorrhagic Stroke in the Reperfusion Era: A Contemporary Cohort Study}},
author = {V. Kadiyala and A. N. Simpkins and H. Chugh and R. Czarny and A. Uy-Evanado and N. Bosson and N. Tatonetti and K. Reinier and S. S. Chugh},
howpublished = {medRxiv},
year = {2026},
month = nov,
doi = {10.64898/2026.11.03.26367230},
url = {https://www.medrxiv.org/content/10.64898/2026.11.03.26367230v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Divergent Causes of Death After Ischemic and Hemorrhagic Stroke in the Reperfusion Era: A Contemporary Cohort Study
AU - V. Kadiyala
AU - A. N. Simpkins
AU - H. Chugh
AU - R. Czarny
AU - A. Uy-Evanado
AU - N. Bosson
AU - N. Tatonetti
AU - K. Reinier
AU - S. S. Chugh
PY - 2026
DA - 2026/11/03
PB - medRxiv
DO - 10.64898/2026.11.03.26367230
UR - https://www.medrxiv.org/content/10.64898/2026.11.03.26367230v1
AB - 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.
ER -