Real-World Populational-Based Quality of Life and Functional Status After Stroke

• Published in: Value in health regional issues 2023-07, Vol.36, p.76-82
• Main Authors: Diegoli, Henrique, Magalhães, Pedro S.C., Makdisse, Márcia R.P., Moro, Carla H.C., França, Paulo H.C., Lange, Marcos C., Longo, Alexandre L.
• Format: Article
• Language: English
• Subjects: Female; functional outcome; Functional Status; health-related quality of life; Humans; Hypertension; modified Rankin scale; predictive factors; Quality of Life; Retrospective Studies; stroke; Stroke - therapy
• ISSN: 2212-1099; 2212-1102
• DOI: 10.1016/j.vhri.2023.02.005

This study aimed to describe health-related quality of life (HRQoL) 3 months and 1 year after stroke, compare HRQoL between dependent (modified Rankin scale [mRS] 3-5) and independent (mRS 0-2) patients, and identify factors predictive of poor HRQoL. Patients with a first ischemic stroke or intraparenchymal hemorrhage from the Joinville Stroke Registry were analyzed retrospectively. Using the 5-level version of the EuroQol-5D questionnaire, HRQoL was calculated for all patients 3 months and 1 year after stroke, stratified by mRS score (0-2 or 3-5). One-year HRQoL predictors were examined using univariate and multivariate analyses. Three months after a stroke, data from 884 patients were analyzed; 72.8% were categorized as mRS 0-2 and 27.2% as mRS 3-5, and the mean HRQoL was 0.670 ± 0.256. At 1-year follow-up, 705 patients were evaluated; 75% were classified as mRS 0-2 and 25% as mRS 3-5, and the mean HRQoL was 0.71 ± 0.249. An increase in HRQoL was observed between 3 months and 1 year (mean difference 0.024, P < .0001), both in patients with 3-month mRS 0-2 (0.013, P = .027) and mRS 3-5 (0.052, P < .0001). Increasing age, female sex, hypertension, diabetes, and a high mRS were associated with poor HRQoL at 1 year. This study described the HRQoL after a stroke in a Brazilian population. This analysis shows that the mRS was highly associated with HRQoL after stroke. Age, sex, diabetes, and hypertension were also associated with HRQoL, although not independently of mRS. •Health-related quality of life (HRQoL) utility after stroke is currently unknown in Brazil. Using population-based data, we found that the 1-year HRQoL after stroke is 0.71, significantly lower in dependent (0.40) than independent patients (0.81).•These real-world findings are helpful for many future studies, such as those examining the burden of stroke and economic evaluations that include stroke as an outcome or seek to improve functional status after stroke.•The study also confirms that the modified Rankin scale (mRS) is a reliable HRQoL surrogate and provides mapping scores to convert mRS to utility, which is helpful for stroke studies that include the mRS but not the EQ-5D.