Dhamoon MS, et al. - Physicians designed this study to examine whether the increase in long-term disability was steeper after than before the event for ischemic stroke but not myocardial infarction (MI). After a stroke, a trajectory of increasing disability became significantly steeper but not after MI. Therefore, an ischemic stroke could also be correlated with potentially treatable long-term adverse effects on the brain that led to an accelerated functional decline, in addition to the acute brain injury and consequent impairment.

• The physicians conducted longitudinal follow-up for a mean (SD) of 13 (6.2) years in the population-based, prospective cohort Cardiovascular Health Study (1989-2013).
• They used follow-up data until September 1, 2013.
• From August 1, 2013, to June 1, 2016, data analysis was performed.
• Models based on generalized estimating equations adjusted for baseline covariates and included a test for different slopes of disability before and after the event.
• 5,888 Medicare-eligible individuals 65 years or older were selected for this study, who were not institutionalized, expected to reside in the area for 3 or more years, and able to provide informed consent.
• Exclusions were requirement of a wheelchair, receiving hospice care, and undergoing radiotherapy or chemotherapy.
• The main measures included annual assessments with a disability scale (measuring activities of daily living [ADLs] and instrumental ADLs).
• The number of ADLs and instrumental ADLs (range, 0-12) that the participant could not perform was examined continuously.

• The mean (SD) age of the entire cohort (n=5888) was 72.8 (5.6) years; 2495 (42.4%) were male.
• After the event, 382 (6.5%) participants had ischemic stroke and 395 (6.7%) had MI with 1 or more disability assessment, during follow-up.
• Before stroke, there was a mean of 3.7 (2.4) visits and 3.7 (2.3) visits were noted after stroke.
• Before MI, there was a mean of 3.8 (2.5) visits and 3.8 (2.4) visits were noted after MI.
• Compared to MI (0.20 points on the disability scale; 95% CI, 0.06 to 0.35; P=.006), the increase in disability near the time of the event was greater for stroke (0.88 points on the disability scale; 95% CI, 0.57 to 1.20; P < .001).
• After stroke, the annual increase in disability before stroke (0.06 points per year; 95% CI, 0.002 to 0.12; P=.04) more than tripled (0.15 additional points per year; 95% CI, 0.004 to 0.30; P=.04).
• After MI, the annual increase in disability before MI (0.04 points per year; 95% CI, 0.004 to 0.08; P=.03) did not change significantly (0.02 additional points per year; 95% CI, -0.07 to 0.11; P=.69).