Quality of life after TIA and stroke: ten-year results of the Oxford Vascular Study.
Ontology highlight
ABSTRACT: Objective
To evaluate the 5-year impact of stroke and TIA on utility and quality-adjusted survival.Methods
TIA and stroke patients from a UK population-based study (Oxford Vascular Study) were recruited from 2002 to 2007, and followed up until 2012. Quality of life was assessed over 5 years using the EQ-5D (EuroQol-5 Dimensions), with responses converted into utilities ranging from -0.59 (worse than death) to 1 (perfect health), using UK population valuations. Utilities for stroke and TIA patients were compared with those in matched controls obtained from the 2006 Health Survey for England. Five-year quality-adjusted life years were estimated by combining utility and survival information.Results
Four hundred forty TIA and 748 stroke patients were ascertained and included. Utility remained constant at approximately 0.78 over the 5 years after TIA. Utility improved from 0.64 one month after stroke to 0.70 at 6 months (p = 0.006), remaining at approximately 0.70 thereafter. Matched controls had considerably higher utility levels than stroke/TIA patients (0.85, p < 0.001). Event severity and recurrent stroke were significant predictors of decreased long-term utility. Five-year quality-adjusted life expectancy was 3.32 (95% confidence interval: 3.22-3.48) quality-adjusted life years after TIA and 2.21 (2.15-2.37) after stroke, varying considerably by severity (minor: 2.94; moderate: 1.65; and severe: 0.70).Conclusion
Quality-adjusted survival is low over the 5 years after stroke and TIA, with severity and recurrent stroke being major predictors. There remains considerable scope for improvements in acute treatment and secondary prevention to improve the quality of life after TIA and stroke.
SUBMITTER: Luengo-Fernandez R
PROVIDER: S-EPMC3806919 | biostudies-literature |
REPOSITORIES: biostudies-literature
Similar Datasets
Project description:OBJECTIVES:In patients after a transient ischaemic attack (TIA) or minor stroke, dysfunction is often underestimated by clinical measures due to invisible symptoms, including cognitive and emotional problems. Many of these patients need stroke care programme, but others do not. In this study, we aim to identify potential predictors of quality of life (QoL) in patients with TIA or minor stroke 1 year poststroke to be able to select which of these patients will need aftercare. DESIGN:Prospective observational cohort study. SETTING:Single-centre hospital in the Netherlands. PARTICIPANTS:120 patients, diagnosed with TIA or minor stroke and discharged without rehabilitation treatment, completed the study. PRIMARY AND SECONDARY OUTCOME MEASURES:QoL (RAND-36), anxiety and depressive symptoms (Hospital Anxiety and Depression scale), the degree of disability or functional dependence after stroke (modified Rankin Scale (mRS)) and symptoms of anxiety and depression specific to stroke (SSADQ) were assessed at baseline (2-6 weeks poststroke) and compared with follow-up at 1 year poststroke. RESULTS:Depression (B=-1.35, p<0.001) and anxiety (B=-0.57, p=0.041) at baseline predicted a worse mental component of QoL after 1 year. Depression (B=-1.100, p<0.001) at baseline, but also age (B=-0.261, p=0.002) and female sex (B=4.101, p=0.034) predicted a worse physical component of QoL after 1 year. CONCLUSION:With the identification of these predictors, we might be able to select more efficiently and timely the patients with TIA or minor stroke who need stroke aftercare.
| S-EPMC6830651 | biostudies-literature
Project description:BACKGROUND AND PURPOSE:Long-term outcome information after transient ischemic attack (TIA) and stroke is required to help plan and allocate care services. We evaluated the impact of TIA and stroke on disability and institutionalization over 5 years using data from a population-based study. METHODS:Patients from a UK population-based cohort study (Oxford Vascular Study) were recruited from 2002 to 2007 and followed up to 2012. Patients were followed up at 1, 6, 12, 24, and 60 months postevent and assessed using the modified Rankin scale. A multivariate regression analysis was performed to assess the predictors of disability postevent. RESULTS:A total of 748 index stroke and 440 TIA cases were studied. For patients with TIA, disability levels increased from 14% (63 of 440) premorbidly to 23% (60 of 256) at 5 years (P=0.002), with occurrence of subsequent stroke being a major predictor of disability. For stroke survivors, the proportion disabled (modified Rankin scale >2) increased from 21% (154 of 748) premorbidly to 43% (273 of 634) at 1 month (P<0.001), with 39% (132 of 339) of survivors disabled 5 years after stroke. Five years postevent, 70% (483 of 690) of patients with stroke and 48% (179 of 375) of patients with TIA were either dead or disabled. The 5-year risk of care home institutionalization was 11% after TIA and 19% after stroke. The average 5-year cost per institutionalized patient was $99,831 (SD, 67 020) for TIA and $125,359 (SD, 91 121) for stroke. CONCLUSIONS:Our results show that 70% of patients with stroke are either dead or disabled 5 years after the event. Thus, there remains considerable scope for improvements in acute treatment and secondary prevention to reduce postevent disability and institutionalization.
| S-EPMC4946627 | biostudies-literature
Project description:We investigated health-related quality of life (HRQOL) in patients with TIA and minor ischemic stroke (MIS) using Neuro-QOL, a validated, patient-reported outcome measurement system.Consecutive patients with TIA or MIS who had (1) modified Rankin Scale (mRS) score of 0 or 1 at baseline, (2) initial NIH Stroke Scale score of ?5, (3) no acute reperfusion treatment, and (4) 3-month follow-up, were recruited. Recurrent stroke, disability by mRS and Barthel Index, and Neuro-QOL scores in 5 prespecified domains were prospectively recorded. We assessed the proportion of patients with impaired HRQOL, defined as T scores more than 0.5 SD worse than the general population average, and identified predictors of impaired HRQOL using logistic regression.Among 332 patients who met study criteria (mean age 65.7 years, 52.4% male), 47 (14.2%) had recurrent stroke within 90 days and 41 (12.3%) were disabled (mRS >1 or Barthel Index <95) at 3 months. Any HRQOL impairment was noted in 119 patients (35.8%). In multivariate analysis, age (adjusted odds ratio [OR] 1.02, 95% confidence interval [CI] 1.01-1.04), initial NIH Stroke Scale score (adjusted OR 1.39, 95% CI 1.17-1.64), recurrent stroke (adjusted OR 2.10, 95% CI 1.06-4.13), and proxy reporting (adjusted OR 3.94, 95% CI 1.54-10.10) were independent predictors of impaired HRQOL at 3 months.Impairment in HRQOL is common at 3 months after MIS and TIA. Predictors of impaired HRQOL include age, index stroke severity, and recurrent stroke. Future studies should include HRQOL measures in outcome assessment, as these may be more sensitive to mild deficits than traditional disability scales.
| S-EPMC4664119 | biostudies-literature
Project description:Acute aortic dissection is a preventable life-threatening condition. However, there have been no prospective population-based studies of incidence or outcome to inform an understanding of risk factors, strategies for prevention, or projections for future clinical service provision.We prospectively determined incidence and outcomes of all acute aortic dissections in a population of 92 728 in Oxfordshire, United Kingdom, from 2002 to 2012. Among 155 patients with 174 acute aortic events, 54 patients had 59 thoracoabdominal aortic dissections (52 incident events: 6/100 000, 95% confidence interval, 4-7; 37 Stanford type A, 15 Stanford type B; 31 men, mean age=72.0 years). Among patients with type A incident events, 18 (48.6%) died before hospital assessment (61.1% women). The 30-day fatality rate was 47.4% for patients with type A dissections who survived to hospital admission and 13.3% for patients with type B dissections, although subsequent 5-year survival rates were high (85.7% for type A; 83.3% for type B). Even though 67.3% of patients were on antihypertensive drugs, 46.0% of all patients had at least 1 systolic BP ?180 mm Hg in their primary care records over the preceding 5 years, and the proportion of blood pressures in the hypertensive range (>140/90 mm Hg) averaged 56.0%. Premorbid blood pressure was higher in patients with type A dissections that were immediately fatal than in those who survived to admission (mean/standard deviation pre-event systolic blood pressure=151.2/19.3 versus 137.9/17.9; P<0.001).Uncontrolled hypertension remains the most significant treatable risk factor for acute aortic dissection. Prospective population-based ascertainment showed that hospital-based registries will underestimate not only incidence and case fatality, but also the association with premorbid hypertension.
| S-EPMC6016737 | biostudies-literature
Project description:Background:Patients with ischaemic stroke or transient ischaemic attack (TIA) are at high risk of recurrent stroke and other cardiovascular diseases and commonly suffer from reduced quality of life. We aimed to determine whether the disease management programme STROKE-CARD can prevent cardiovascular diseases and improve quality of life in these patients. Methods:In this pragmatic open-label two-centre randomised controlled trial with blinded outcome assessment, we randomly assigned patients with acute ischaemic stroke or TIA (ABCD2 score ?3) in a 2:1 ratio to receive STROKE-CARD care or standard care. STROKE-CARD care is a disease management programme by a multidisciplinary stroke team that comprises a standardised 3-month visit and access to a web-based patient portal targeting risk factor management, post-stroke complications, comorbidities and cardiovascular warning signs, rehabilitation demands, and patient education, counselling, and self-empowerment. Co-primary outcomes were analysed on an intention-to-treat basis and were: (i) major cardiovascular disease events defined as nonfatal ischaemic or haemorrhagic stroke, nonfatal myocardial infarction, or vascular death occurring between hospital discharge and 12 months; and (ii) health-related quality of life at 12 months quantified with the EuroQol-5-Dimensions-3-Levels (EQ-5D-3L) overall utility score. This trial is registered with ClinicalTrials.gov, number NCT02156778. Findings:Of 2149 patients enrolled between January 2014 and December 2017 (mean age 69 years, 41% female, 83% with ischaemic stroke, 17% with TIA), 1438 were assigned to STROKE-CARD care and 711 to standard care. Major cardiovascular disease events occurred in 78 patients in the STROKE-CARD care group (5.4%) and in 59 patients in the standard care group (8.3%) (hazard ratio, 0.63; 95% confidence interval: 0.45-0.88; P=0.007). STROKE-CARD care also led to a better EQ-5D-3L overall utility score at 12 months (P<0.001). Among pre-specified secondary outcomes, STROKE-CARD care improved all individual EQ-5D-3L dimensions and functional outcome on the modified Rankin Scale at 12 months. Post hoc explanatory analyses identified considerable demands for additional rehabilitation and refinement of preventive therapy regimes at the 3-month visit and high proportions of post-stroke complications and warning signs of imminent cardiovascular diseases within the first three months. Interpretation:The pragmatic and easily implementable STROKE-CARD care programme reduced cardiovascular risk and improved health-related quality of life and functional outcome in patients with acute ischaemic stroke or TIA. Funding:Tirol Kliniken, Tyrolean Health Insurance Company, Tyrol Health Care Funds, Boehringer Ingelheim, Nstim Services, Sanofi, Bayer Healthcare.
| S-EPMC7486330 | biostudies-literature
Project description:IntroductionSecondary stroke prevention depends on proper identification of the underlying etiology and initiation of optimal treatment after the index event. The aim of the NOR-FIB study was to detect and quantify underlying atrial fibrillation (AF) in patients with cryptogenic stroke (CS) or transient ischaemic attack (TIA) using insertable cardiac monitor (ICM), to optimise secondary prevention, and to test the feasibility of ICM usage for stroke physicians.Patients and methodsProspective observational international multicenter real-life study of CS and TIA patients monitored for 12 months with ICM (Reveal LINQ) for AF detection.ResultsICM insertion was performed in 91.5% by stroke physicians, within median 9 days after index event. Paroxysmal AF was diagnosed in 74 out of 259 patients (28.6%), detected early after ICM insertion (mean 48 ± 52 days) in 86.5% of patients. AF patients were older (72.6 vs 62.2; p < 0.001), had higher pre-stroke CHA₂DS₂-VASc score (median 3 vs 2; p < 0.001) and admission NIHSS (median 2 vs 1; p = 0.001); and more often hypertension (p = 0.045) and dyslipidaemia (p = 0.005) than non-AF patients. The arrhythmia was recurrent in 91.9% and asymptomatic in 93.2%. At 12-month follow-up anticoagulants usage was 97.3%.Discussion and conclusionsICM was an effective tool for diagnosing underlying AF, capturing AF in 29% of the CS and TIA patients. AF was asymptomatic in most cases and would mainly have gone undiagnosed without ICM. The insertion and use of ICM was feasible for stroke physicians in stroke units.
| S-EPMC10069172 | biostudies-literature
Project description:OBJECTIVE:To evaluate the effects of a multi-professional educational program in patients with knee osteoarthritis (KOA) . METHODS:Prospective randomized controlled trial with 195 KOA patients. One group was submitted to two-day lectures and received educational material about KOA (Class group), and the control group received the educational material only. Patients were evaluated at baseline, twelve and 24 months. At evaluation, patients answered pain and functional questionnaires (WOMAC, Lequesne, VAS and SF-36); reported the intensity of exercise per week; measured the body fat percentage, weight and height to estimate body mass index (BMI); and performed Timed Up & Go (TUG) and Five-Times-Sit-to-Stand (FTSST) tests . RESULTS:The groups presented similar results in all time points with respect to pain (VAS and WOMAC pain), WOMAC, BMI and body fat percentage (p>0.05). The Class group exhibited improved function according to the Lequesne questionnaire, whereas the control group worsened (p=0.02) during follow-up (p<0.02). TUG (p=0.01) and FTSST (p<0.001) improved in the Class group. A higher percentage of patients in the Class group performed regular physical activity (p=0.045) . CONCLUSIONS:The educational program with classes improved the consistency of physical activity and the subjective and objective function of patients with KOA. Level of evidence IA, Prospective Randomized Controlled Trial.
| S-EPMC5474397 | biostudies-literature
Project description:BACKGROUND: Numerous studies examining the prevalence and natural history of dyspepsia in the general population have been conducted. However, few have reported the effect of quality of life on the development of dyspepsia. A 10-year longitudinal follow-up study examining the effect of quality of life on subsequent dyspepsia was performed. METHODS: Individuals originally enrolled in a population-screening programme for Helicobacter pylori were contacted through a validated postal dyspepsia questionnaire. Baseline demographic data, quality of life at original study entry, and dyspepsia and irritable bowel syndrome (IBS) symptom data were already on file. Consent to examine primary-care records was sought, and data regarding non-steroidal anti-inflammatory drugs (NSAID) and aspirin use were obtained from these. RESULTS: Of 8407 individuals originally involved, 3912 (46.5%) provided symptom data at baseline and 10-year follow-up. Of 2550 (65%) individuals asymptomatic at study entry, 717 (28%) developed new-onset dyspepsia at 10 years, an incidence of 2.8% per year. After multivariate logistic regression, lower quality of life at study entry (OR 2.63; 99% CI 1.86 to 3.71), higher body mass index (OR per unit 1.05; 99% CI 1.02 to 1.08), presence of IBS at study entry (OR 3.1; 99% CI 1.51 to 6.37) and use of NSAIDs and/or aspirin (OR 1.32; 99% CI 0.99 to 1.75) were significant risk factors for new-onset dyspepsia. CONCLUSIONS: The incidence of new-onset dyspepsia was almost 3% per year. Low quality of life at baseline exerted a strong effect on the likelihood of developing dyspepsia at 10 years.
| S-EPMC1856829 | biostudies-other
Project description:Purpose:To compare phacocanaloplasty (PC) and phaco-non-penetrating deep sclerectomy (PDS). Methods:75 patients with uncontrolled glaucoma and cataract were randomized for PC (37 eyes) or PDS (38 eyes). Intraocular pressure (IOP) and number of medications (meds) were prospectively evaluated. Follow-up examinations were performed on days 1 and 7 and after 1, 3, 6, 12, 18, and 24 months. Surgical success was calculated. Complications and postoperative interventions were noted. Quality of life (QoL) was analyzed. Results:Preoperatively, mean IOP and meds were comparable (P > 0.05). After 24 months, IOP significantly decreased in PC from 19.4?±?5.9?mmHg (2.6?±?0.9 meds) to 13.8?±?3.3?mmHg (0.5?±?0.9 meds) and in PDS from 19.7?±?5.4?mmHg (2.9?±?0.9 meds) to 15.1?±?2.9?mmHg (1.1?±?1.2 meds). Statistically lower IOP was observed in PC in the 6th month and persisted until 24 months (P < 0.05). No difference was found in meds (except for month 18, in which less drugs were used in PC (P = 0.001)) or success rates (P > 0.05). The most frequent complication in PC was transient hyphema (46%), in PDS bleb fibrosis (24%). PC patients during postoperative period required only goniopuncture (22% of subjects), whereas PDS patients required, in order to maintain subconjuctival outflow, subconjunctival 5-fluorouracil injections in 95% of cases (median?=?3), suture lysis (34%), needling (24%), and goniopuncture (37%). NEI VFQ-25 mean composite score for PC was 78.04?±?24.36 points and for PDS 74.29?±?24.45 (P = 0.136). ? Cronbach's correlation coefficient was 0.913. Conclusions:PC leads to a more effective decrease in IOP than PDS in midterm observation with similar safety profiles. PDS patients required a vast number of additional procedures in contrast to PC patients, but this fact did not influence QoL.
| S-EPMC5845501 | biostudies-literature
Project description:Importance:Risk of major stroke is high during the hours and days after transient ischemic attack (TIA) and minor stroke but is substantially reduced by urgent medical treatment. Public education campaigns have improved the response after major stroke, but their association with behavior after TIA and minor stroke is uncertain. The number of potentially preventable early recurrent strokes in patients who delay or fail to seek medical attention is unknown. Objective:To investigate the association of public education with delays and failure in seeking medical attention after TIA and minor stroke. Design, Setting, and Participants:Prospective population-based study of all patients with TIA or stroke who sought medical attention between April 1, 2002, and March 31, 2014, registered at 9 general practices in Oxfordshire, United Kingdom. Data analysis took place from July 1, 2013, to March 2, 2015. Exposures:Face, Arm, Speech, Time (FAST) public education campaign in the United Kingdom. Main Outcomes and Measures:Number of early recurrent strokes in patients who delayed or failed to seek medical attention, as well as the odds of seeking urgent attention after TIA and minor stroke before vs after initiation of the public education campaign. Results:Among 2243 consecutive patients with first TIA or stroke (mean [SD] age, 73.6 [13.4] years; 1126 [50.2%] female; 96.3% of white race/ethnicity), 1656 (73.8%) had a minor stroke or TIA. After the FAST campaign, patients with major stroke more often sought medical attention within 3 hours (odds ratio [OR], 2.56; 95% CI, 1.11-5.90; P?=?.03). For TIA and minor stroke, there was no improvement in use of emergency medical services (OR, 0.79; 95% CI, 0.50-1.23; P for interaction?=?.03 vs major stroke) or time to first seeking medical attention within 24 hours (OR, 0.75; 95% CI, 0.48-1.19; P for interaction?=?.006 vs major stroke). Patient perception of symptoms after TIA and minor stroke was associated with more urgent behavior, but correct perception declined after the FAST campaign (from 37.3% [289 of 774] to 27.6% [178 of 645]; OR, 0.64; 95% CI, 0.51-0.80; P?<?.001). One hundred eighty-eight patients had a stroke within 90 days of their initial TIA or stroke, of whom 93 (49.5%) followed unheeded TIAs for which no medical attention was sought, similar before and after the FAST campaign (43 of 538 [8.0%] before vs 50 of 615 [8.1%] after, P?=?.93). Conclusions and Relevance:This study suggests that in contrast to major stroke, extensive FAST-based public education has not improved the response to TIA and minor stroke in the United Kingdom, emphasizing the need for campaigns that are tailored to transient and less severe symptoms.
| S-EPMC6233848 | biostudies-other