{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T17:46:31Z","timestamp":1793641591138,"version":"4.5.1"},"reference-count":42,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T00:00:00Z","timestamp":1755129600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010414","name":"Health Research Board","doi-asserted-by":"publisher","award":["SPHeRE\/2022\/1"],"award-info":[{"award-number":["SPHeRE\/2022\/1"]}],"id":[{"id":"10.13039\/100010414","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background and objectives<\/jats:title>\n                    <jats:p>Stroke is one of the leading causes of death and disability worldwide. People with stroke face a significant risk of recurrence, however, there is a lack of consensus on the risk factors for stroke recurrence. Previous systematic reviews in this area are either outdated, focus exclusively on clinical risk factors, or are limited by geographical region, stroke subtype or age group. This review aims to systematically identify clinical and lifestyle risk factors associated with stroke recurrence and mortality in people with stroke.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic search will be conducted in four electronic databases (PubMed, EMBASE, CINAHL and PsycINFO) and grey literature sources. Only prospective cohort studies that estimate the association between risk factors and stroke recurrence and\/or mortality in adults with ischemic and haemorrhagic stroke will be included. The exposures of interest are clinical and lifestyle risk factors, including vascular and cardiac factors such as hypertension or atrial fibrillation, and behavioural factors such as physical activity, nutrition, or smoking. Two independent reviewers will conduct screening, data extraction, and risk of bias assessment using the ROBINS-E tool, while the GRADE approach will be used to evaluate the certainty of evidence. A meta-analysis using a random-effects model will be used to determine the overall effect for each exposure on stroke recurrence and\/or mortality. However, if a meta-analysis is not justified, a narrative synthesis will instead be conducted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Recurrent strokes are associated with greater mortality and poorer functional prognosis than first-time events, imposing greater economic burden on healthcare services. This review will identify factors that increase one\u2019s risk for recurrence, thereby informing the development and refinement of clinical guidance for secondary stroke prevention; a key priority for both those living with stroke and the wider health service.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0329932","type":"journal-article","created":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T17:38:50Z","timestamp":1755193130000},"page":"e0329932","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Factors associated with stroke recurrence and mortality in ischemic and haemorrhagic stroke: Protocol for a systematic review and meta-analysis"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6695-1330","authenticated-orcid":true,"given":"Simone","family":"Ryan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katie","family":"Robinson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rose","family":"Galvin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9984-9204","authenticated-orcid":true,"given":"Margaret","family":"O\u2019Connor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"McCabe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleanor","family":"Fallon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Hayes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,8,14]]},"reference":[{"issue":"1","key":"pone.0329932.ref001","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1177\/17474930211065917","article-title":"World Stroke organization (WSO): Global stroke fact sheet 2022","volume":"17","author":"VL Feigin","year":"2022","journal-title":"Int J Stroke"},{"issue":"5","key":"pone.0329932.ref002","doi-asserted-by":"crossref","first-page":"1330","DOI":"10.1161\/STROKEAHA.122.040073","article-title":"Projected Global Trends in Ischemic Stroke Incidence, Deaths and Disability-Adjusted Life Years From 2020 to 2030","volume":"54","author":"L Pu","year":"2023","journal-title":"Stroke"},{"issue":"5","key":"pone.0329932.ref003","doi-asserted-by":"crossref","first-page":"1489","DOI":"10.1161\/STROKEAHA.110.602615","article-title":"Risk and cumulative risk of stroke recurrence: a systematic review and meta-analysis","volume":"42","author":"KM Mohan","year":"2011","journal-title":"Stroke"},{"issue":"8","key":"pone.0329932.ref004","doi-asserted-by":"crossref","first-page":"1917","DOI":"10.1016\/j.jstrokecerebrovasdis.2015.05.008","article-title":"Epidemiologic Trends in Hospitalized Ischemic Stroke from 2002 to 2010: Results from a Large Italian Population-Based Study","volume":"24","author":"P Santalucia","year":"2015","journal-title":"J Stroke Cerebrovasc Dis"},{"issue":"1","key":"pone.0329932.ref005","doi-asserted-by":"crossref","first-page":"60","DOI":"10.5853\/jos.2015.01326","article-title":"Trends in Incident and Recurrent Rates of First-Ever Ischemic Stroke in Taiwan between 2000 and 2011","volume":"18","author":"M Lee","year":"2016","journal-title":"J Stroke"},{"issue":"8","key":"pone.0329932.ref006","doi-asserted-by":"crossref","first-page":"2046","DOI":"10.1161\/STROKEAHA.117.016815","article-title":"One-Year Incidence, Time Trends, and Predictors of Recurrent Ischemic Stroke in Sweden From 1998 to 2010: An Observational Study","volume":"48","author":"L Bergstr\u00f6m","year":"2017","journal-title":"Stroke"},{"issue":"21","key":"pone.0329932.ref007","doi-asserted-by":"crossref","first-page":"2209","DOI":"10.1161\/CIRCULATIONAHA.108.191092","article-title":"The American Heart Association\u2019s 2008 Statement of Principles for Healthcare Reform","volume":"118","author":"RJ Gibbons","year":"2008","journal-title":"Circulation"},{"issue":"10467","key":"pone.0329932.ref008","doi-asserted-by":"crossref","first-page":"2077","DOI":"10.1016\/S0140-6736(24)02317-1","article-title":"Worldwide trends in diabetes prevalence and treatment from 1990 to 2022: a pooled analysis of 1108 population-representative studies with 141 million participants","volume":"404","author":"(NCD-RisC) NCD Risk Factor Collaboration","year":"2024","journal-title":"Lancet"},{"issue":"4","key":"pone.0329932.ref009","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1038\/s41581-019-0244-2","article-title":"The global epidemiology of hypertension","volume":"16","author":"KT Mills","year":"2020","journal-title":"Nat Rev Nephrol"},{"issue":"10250","key":"pone.0329932.ref010","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1016\/S0140-6736(20)31752-9","article-title":"WSO and WHF joint position statement on population-wide prevention strategies","volume":"396","author":"World Stroke Organization","year":"2020","journal-title":"Lancet"},{"issue":"2","key":"pone.0329932.ref011","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1177\/2396987318816136","article-title":"Availability of secondary prevention services after stroke in Europe: An ESO\/SAFE survey of national scientific societies and stroke experts","volume":"4","author":"A Webb","year":"2019","journal-title":"Eur Stroke J"},{"key":"pone.0329932.ref012","volume-title":"Secondary prevention of heart attack and stroke in Europe: consensus report","author":"K Budig","year":"2021"},{"issue":"4","key":"pone.0329932.ref013","doi-asserted-by":"crossref","DOI":"10.1212\/WNL.0000000000013118","article-title":"Risks of Stroke Recurrence and Mortality After First and Recurrent Strokes in Denmark: A Nationwide Registry Study","volume":"98","author":"N Skajaa","year":"2022","journal-title":"Neurology"},{"issue":"6","key":"pone.0329932.ref014","doi-asserted-by":"crossref","first-page":"106438","DOI":"10.1016\/j.jstrokecerebrovasdis.2022.106438","article-title":"Clinical Outcomes and Costs of Recurrent Ischemic Stroke: A Systematic Review","volume":"31","author":"SR Ferrone","year":"2022","journal-title":"J Stroke Cerebrovasc Dis"},{"issue":"4","key":"pone.0329932.ref015","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1016\/S1474-4422(22)00044-8","article-title":"Research priorities to improve stroke outcomes","volume":"21","author":"G Hill","year":"2022","journal-title":"Lancet Neurol"},{"issue":"3","key":"pone.0329932.ref016","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1161\/CIRCRESAHA.116.308398","article-title":"Stroke risk factors, genetics, and prevention","volume":"120","author":"AK Boehme","year":"2017","journal-title":"Circ Res"},{"issue":"7","key":"pone.0329932.ref017","doi-asserted-by":"crossref","DOI":"10.1161\/STR.0000000000000375","article-title":"2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack: A guideline from the American Heart Association\/American Stroke Association","volume":"52","author":"DO Kleindorfer","year":"2021","journal-title":"Stroke"},{"issue":"3","key":"pone.0329932.ref018","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1017\/cjn.2021.127","article-title":"Canadian Stroke Best Practice Recommendations: Secondary Prevention of Stroke Update 2020","volume":"49","author":"DJ Gladstone","year":"2022","journal-title":"Can J Neurol Sci"},{"key":"pone.0329932.ref019","unstructured":"Royal College of Physicians. National Clinical Guideline for Stroke for the United Kingdom and Ireland: 2023 Edition. 2023."},{"key":"pone.0329932.ref020","unstructured":"Stroke Foundation. Australian and New Zealand Living Clinical Guidelines for Stroke Management. https:\/\/informme.org.au\/en\/Guidelines\/Clinical-Guidelines-for-Stroke-Management. Accessed 2025 July 1."},{"key":"pone.0329932.ref021","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.jocn.2018.10.026","article-title":"Impact of risk factors for recurrence after the first ischemic stroke in adults: A systematic review and meta-analysis","volume":"60","author":"S Zheng","year":"2019","journal-title":"J Clin Neurosci"},{"key":"pone.0329932.ref022","doi-asserted-by":"crossref","first-page":"101240","DOI":"10.1016\/j.cegh.2023.101240","article-title":"Non-modifiable and modifiable factors contributing to recurrent stroke: A systematic review and meta-analysis","volume":"20","author":"RD Nindrea","year":"2023","journal-title":"Clin Epidemiol Glob Health"},{"issue":"8","key":"pone.0329932.ref023","doi-asserted-by":"crossref","first-page":"105935","DOI":"10.1016\/j.jstrokecerebrovasdis.2021.105935","article-title":"Recurrent ischemic stroke \u2013 a systematic review and meta-analysis","volume":"30","author":"M Kolmos","year":"2021","journal-title":"J Stroke Cerebrovasc Dis"},{"issue":"3","key":"pone.0329932.ref024","doi-asserted-by":"crossref","DOI":"10.1016\/j.heliyon.2023.e13949","article-title":"Lifestyle, clinical, and occupational risk factors of recurrent stroke among the working-age group: A systematic review and meta-analysis","volume":"9","author":"A Chiangkhong","year":"2023","journal-title":"Heliyon"},{"key":"pone.0329932.ref025","doi-asserted-by":"crossref","first-page":"783","DOI":"10.2147\/NDT.S442507","article-title":"Stroke Recurrence Rate and Risk Factors Among Stroke Survivors in Sub-Saharan Africa: A Systematic Review","volume":"20","author":"SN Mbalinda","year":"2024","journal-title":"Neuropsychiatr Dis Treat"},{"key":"pone.0329932.ref026","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions version 6.5 (updated August 2024)","author":"J Higgins","year":"2024"},{"key":"pone.0329932.ref027","article-title":"Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation","volume":"350","author":"L Shamseer","year":"2015","journal-title":"BMJ"},{"key":"pone.0329932.ref028","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.1016\/j.envint.2018.07.015","article-title":"Identifying the PECO: A framework for formulating good questions to explore the association of environmental and other exposures with health outcomes","volume":"121","author":"RL Morgan","year":"2018","journal-title":"Environ Int"},{"issue":"1","key":"pone.0329932.ref029","first-page":"113","article-title":"Cerebrovascular disease in the community: results of a WHO collaborative study","volume":"58","author":"K Aho","year":"1980","journal-title":"Bull World Health Organ"},{"issue":"8","key":"pone.0329932.ref030","doi-asserted-by":"crossref","first-page":"2435","DOI":"10.1161\/STROKEAHA.120.028992","article-title":"Risk and Secondary Prevention of Stroke Recurrence: A Population-Base Cohort Study","volume":"51","author":"C Flach","year":"2020","journal-title":"Stroke"},{"issue":"9","key":"pone.0329932.ref031","doi-asserted-by":"crossref","first-page":"1012","DOI":"10.1136\/jnnp.2008.170456","article-title":"Frequency and predictors for the risk of stroke recurrence up to 10 years after stroke: the South London Stroke Register","volume":"80","author":"KM Mohan","year":"2009","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"1","key":"pone.0329932.ref032","doi-asserted-by":"crossref","first-page":"17151","DOI":"10.1038\/s41598-022-22090-7","article-title":"Risk factors for stroke recurrence in patients with hemorrhagic stroke","volume":"12","author":"Y-S Wong","year":"2022","journal-title":"Sci Rep"},{"issue":"2","key":"pone.0329932.ref033","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0001278","article-title":"Predictors of in-hospital mortality in stroke patients","volume":"3","author":"VS Ranasinghe","year":"2023","journal-title":"PLOS Glob Public Health"},{"key":"pone.0329932.ref034","article-title":"A guide to systematic review and meta-analysis of prognostic factor studies","volume":"364","author":"RD Riley","year":"2019","journal-title":"BMJ"},{"key":"pone.0329932.ref035","article-title":"Completing \u2018Summary of findings\u2019 tables and grading the certainty of the evidence.","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions","author":"HJ Sch\u00fcnemann","year":"2024"},{"key":"pone.0329932.ref036","volume-title":"GRADE handbook","author":"HJ Sch\u00fcnemann","year":"2013"},{"issue":"4","key":"pone.0329932.ref037","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1177\/1355819619841647","article-title":"Development of the ACTIVE framework to describe stakeholder involvement in systematic reviews","volume":"24","author":"A Pollock","year":"2019","journal-title":"J Health Serv Res Policy"},{"issue":"8","key":"pone.0329932.ref038","doi-asserted-by":"crossref","first-page":"818","DOI":"10.1177\/1747493019873706","article-title":"Multi-level community interventions for primary stroke prevention: A conceptual approach by the World Stroke Organization","volume":"14","author":"M Brainin","year":"2019","journal-title":"Int J Stroke"},{"issue":"3","key":"pone.0329932.ref039","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.119.014494","article-title":"What Is the Best Mix of Population-Wide and High-Risk Targeted Strategies of Primary Stroke and Cardiovascular Disease Prevention?","volume":"9","author":"VL Feigin","year":"2020","journal-title":"J Am Heart Assoc"},{"issue":"4","key":"pone.0329932.ref040","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1177\/2396987318808719","article-title":"Action Plan for Stroke in Europe 2018\u20132030","volume":"3","author":"B Norrving","year":"2018","journal-title":"European Stroke Journal"},{"key":"pone.0329932.ref041","year":"2022"},{"issue":"1","key":"pone.0329932.ref042","doi-asserted-by":"crossref","first-page":"15245","DOI":"10.1038\/s41598-021-94121-8","article-title":"Cardiovascular risk factors associated with acute myocardial infarction and stroke in the MADIABETES cohort","volume":"11","author":"MA Salinero-Fort","year":"2021","journal-title":"Sci Rep"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0329932","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T17:38:58Z","timestamp":1755193138000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0329932"}},"subtitle":[],"editor":[{"given":"Eyob Alemayehu","family":"Gebreyohannes","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,8,14]]},"references-count":42,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,8,14]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0329932","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,14]]}}}