Very low quality of life after acute stroke: data from the Efficacy of Nitric Oxide in Stroke trial

Abstract

Background and purpose: Health-related quality of life, a key outcome after stroke, plays a role in the analysis of treatment cost-effectiveness. Some measures of health-related quality of life allow for a quality of life worse than death; the characteristics of such patients have not been well described.

Methods: Data from the Efficacy of Nitric Oxide in Stroke (ENOS) trial were used to explore health-related quality of life after stroke. The EuroQol questionnaire (EQ-5D) was performed at day 90, and a health utility score (HUS) was calculated. HUS was defined as follows: poor-good HUS>0, death HUS=0, and very poor HUS<0. The characteristics and outcomes of patients with HUS<0 were then explored.

Results: Of the 2569 patients, 303 (11.8%) died, and of the 2238 with quality of life data available, of whom 724 (32.3%) were completed by a proxy, 1959 (87.5%) had an HUS>0 and 279 (12.5%) had an HUS<0. Patients with HUS<0 were more likely to be older, women, have severe stroke, have proxy responders, and be institutionalized. Dominant hemisphere strokes were more likely to have proxy responders but not HUS<0. HUS was strongly correlated with dependency (modified Rankin Scale, r=-0.78) and disability (Barthel index, r=0.84) and moderately correlated with mood (Zung depression score, r=-0.59) and baseline severity (r=0.51). All but 1 patient with modified Rankin Scale of 5 had an HUS<0.

Conclusions: Very low health-related quality of life is relatively common after stroke, particularly in patients with mobility problems or who are dependent on help for usual activities, and is related to poor functional outcome measures.

Clinical trial registration url: http://www.controlled-trials.com/. Unique identifier: ISRCTN99414122.

Keywords: health care economics and organizations; outcome assessment (health care); quality of life; stroke.