Despite advances in prevention, acute care, and rehabilitation the prognosis after acute stroke remains poor: 20-30% of patients die within a month and 13% of survivors are discharged to institutional care.1 2 In the accompanying prospective cohort study, Bruin Slot and colleagues report that functional status at six months after stroke is associated with long term survival.3 The median survival of patients who were independent at this stage was 9.7 years compared with 6.0 years for those who were dependent. The effect of functional outcome at six months on mortality was independent of age and stroke subtype. The study gives no details about the causes of death or whether secondary prevention was optimised, but these survival data again emphasise the impact of stroke. They also suggest that early treatment known to reduce dependency at six months may have a substantial longer term effect.

Stroke care and the evidence base on which services are developed have improved considerably since 1981, when one of …