Health-related quality of life after ischemic stroke: impact of sociodemographic and clinical factors

Abstract

Background and aims: Ischemic stroke (IS) is one of the leading causes of death and long-term disability in Bulgaria. IS affects different aspects of the patient's life and results in loss of independence and poor health-related quality of life (HR-QoL). We aimed to analyze the impact of IS on HR-QoL and to identify possible associations with sociodemographic, clinical features, and vascular risk factors (RF).

Methods: A prospective, hospital-based study was undertaken from 1 July 2019 to 31 June 2020, at a tertiary care referral center for neurological disorders in Bulgaria. A total of 150 patients with acute IS - 50 with thrombolytic and 100 with non-thrombolytic therapy - were included. Thorough clinical and sociodemographic data were collected. The NIHSS scale determined stroke severity, and HR-QoL was assessed with the Stroke Impact Scale Version 3.0 (SIS 3.0) during the first 3 months.

Results: The overall HR-QoL improved during the observation period, but still, it remained significantly worse. The major predictors of a marked reduction in HR-QoL were age, female sex, lower education level, and actively working at stroke onset, high NIHSS score, anterior circulation stroke, and more extended hospital. Atrial fibrillation and heart failure were significantly associated with poor HR-QoL. The other investigated vascular risk factors were associated with different extends with poorer HR-QoL, except for dyslipidemia.

Conclusion: Stroke survivors have significantly reduced HR-QoL. Multiple interacting factors are associated with an unfavorable outcome after IS. Early detection of these factors would help to improve the care for IS patients, to reduce disabilities and improve HR-QoL.

Keywords: Balkan region; Bulgaria; Health-related quality of life; clinical factors; ischemic stroke; prospective study; quality of life; sociodemographic factors; stroke.