Abstract
Background: Stroke is a leading cause of death and disability worldwide. We aimed to assess stroke outcomes in Fiji, where prior research on stroke is limited.
Method: A 6-month prospective observational study conducted amongst stroke patients admitted at Colonial War Memorial (CWM) hospital from 13th November 2023 to 13thMay 2024 and followed up at 30 days and 60 days post-acute stroke.
Results: Among the 249 patients, mean (standard deviation) age was 60.7 (11.9) years, 128 (51.4%) were male, 173 (69.5%) had ischemic stroke. Risk factors included hypertension (73%), diabetes (37%), kava (37%), ischemic heart disease (22%), and smoking (22%). Average length of stay was 7.6 days. Mortality rate was 27.7% as inpatient, 34.1% at 30- and 38.2% at 60 days. Predictors of inpatient mortality (p-value; odds ratio (95% confidence interval)) included hypertension (0.008; 14.7(2.0–06.7)), NIHSS>15 (0.032;12.3(1.2–121.2)), hemorrhagic stroke (0.023; 35.5(1.7–761.7)), white blood cell count >11000 g/dL (0.038; 4.6(1.1–19.2)), aspiration pneumonia (<0.001;122.9(15.3–985.6)), and urinary incontinence (0.032; 6.7 (1.2–38.4)). Additional predictors of 30- and/or 60-day mortality included self-reported kava use; discharge mRS 3–5, age 60–80 years, single/widow/divorced, and admission SBP>190.
Conclusions: Stroke mortality among Fijians admitted to CWM hospital is very high at all measured time points compared with high-income South Pacific countries, but comparable to other low-income countries globally. The young median age impacts society, however, identified mortality predictors will guide future service improvements. This study was conducted before thrombolysis was introduced in 2024, and its implementation, along with other stroke initiatives, is expected to reduce the high mortality rate.
Oral presentation.