Advertisement

Translational Stroke Research

, Volume 6, Issue 5, pp 375–383 | Cite as

Quality of Life Predictors in Chronic Stable Post-Stroke Patients and Prognostic Value of SF-36 Score as a Mortality Surrogate

  • Lenka Kielbergerová
  • Otto MayerJr
  • Jiří Vaněk
  • Jan Bruthans
  • Peter Wohlfahrt
  • Renata Cífková
Original Article

Abstract

Perceived quality of life (QoL) and psychological well-being represents an important target of secondary prevention practice in post-stroke patients. We aimed to identify the major covariates of impaired QoL in stable post-stroke patients and whether impaired QoL itself represents independent mortality predictor.

The study consisted of a cross-sectional and a prospective part. Three hundred forty-one patients [mean age 69.0 (SD 9.1)] were interviewed at least 6 months after discharge from hospital for their first-ever ischemic stroke. QoL was objectivized using 36-Item Short-Form Health Survey (SF-36) scoring. Standard health-related questionnaires, including Hospital Anxiety and Depression Scale (HADS), risk factors, and biochemical markers, were assessed. To estimate the 5-year all-cause and cardiovascular mortality, we ascertained the vital status and declared cause of death.

Anxiety, depression (HADS score ≥11), brain natriuretic peptide levels ≥100 ng/mL, residual motor impairment at interview, Rankin Scale ≥4 at discharge from hospitalization, and raised blood pressure were identified as main determinants of impaired QoL in the cross-sectional part. The 5-year all-cause and cardiovascular mortality rates were 25.8 and 19.9 %, respectively. After adjustment for potential covariates, patients with an SF-36 score ≤40 at baseline had more than a twofold higher risk of all-cause and cardiovascular mortality (with HRRs 2.01 (95 % CI 1.21–3.32), p < 0.007 and 2.32 (95 % CI 1.32–4.09), p < 0.003, respectively) during the 5 years of follow-up.

In conclusion, anxiety, depression, and raised brain natriuretic peptide levels were the most important covariates of impaired QoL in post-stroke patients. Moreover, a decreased SF-36 score (≤40) represents an independent surrogate of increased additive mortality risk.

Keywords

Ischemic stroke Quality of life, anxiety Depression SF-36 score Mortality 

Notes

Acknowledgments

We would like to acknowledge the hard work of all investigators in the Czech Republic who participated in the EUROASPIRE III stroke survey. Several data were extracted from hospitalization records- the authors are grateful to medical staff of Department of Neurology, 1st and 2nd Department of Internal Medicine, University Hospital Pilsen and  Department of Neurology, Thomayer Hospital, Prague providing medical care during hospitalization for index event.

Sponsorship

The present study was supported by the Internal Grant Agency of Ministry of Health (grant NT12102) and by the Charles University Research Fund (project P36).

Conflicts of Interests

None.

Compliance with Ethical Standards

All procedures performed in the study were in accordance with the Good Clinical Practice principles and ethical standards by 1964 Helsinki Declaration and its later amendments. Local Ethical Committee of the University Hospital in Pilsen approved the study protocol. Written informed consent was obtained from all individual participants included in the study. The data were stored and evaluated under the provisions of the Czech Data Protection Act. The authors declare that they have no conflict of interest.

References

  1. 1.
    Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, et al. Heart disease and stroke statistics—2013 update: a report from the American Heart Association. Circulation. 2013;127:e6–245.Google Scholar
  2. 2.
    Kjellström T, Norrving B, Shatchkute A. Helsingborg Declaration 2006 on European stroke strategies. Cerebrovasc Dis. 2007;23:231–41.PubMedGoogle Scholar
  3. 3.
    Adams Jr HP, del Zoppo G, Alberts MJ, Bhatt DL, Brass L, Furlan A, et al. American Heart Association; American Stroke Association Stroke Council; Clinical Cardiology Council; Cardiovascular Radiology and Intervention Council; Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups. Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Stroke. 2007;38:1655–711.CrossRefPubMedGoogle Scholar
  4. 4.
    Kernan WN, Ovbiagele B, Black HR, Bravata DM, Chimowitz MI, Ezekowitz MD, et al. American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, and Council on Peripheral Vascular Disease. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45:2160–236.CrossRefPubMedGoogle Scholar
  5. 5.
    De Backer G, Ambrossioni E, Borch-Johnsen K, Brotons C, Cifkova R, Dallongeville J, et al. European guidelines on cardiovascular disease prevention on clinical practice. Third joint Task Force of European and other societies on cardiovascular disease prevention in clinical practice. Eur Heart J. 2003;24:1601–10.CrossRefPubMedGoogle Scholar
  6. 6.
    Carod-Artal FJ. Determining quality of life in stroke survivors. Expert Rev Pharmacoecon Outcomes Res. 2012;12:199–211.CrossRefPubMedGoogle Scholar
  7. 7.
    De Ryck A, Brouns R, Fransen E, Geurden M, Van Gestel G, Wilssens I, et al. A prospective study on the prevalence and risk factors of poststroke depression. Cerebrovasc Dis Extra. 2013;3:1–13.PubMedCentralCrossRefPubMedGoogle Scholar
  8. 8.
    Heuschmann PU, Kircher J, Nowe T, Dittrich R, Reiner Z, Cifkova R, et al. Control of main risk factors after ischaemic stroke across Europe: data from the stroke-specific module of the EUROASPIRE III survey. Eur J Prev Cardiol. 2014 Aug 19. [Epub ahead of print]Google Scholar
  9. 9.
    The World Health Organization. The WHO Steps Manual. The WHO stepwise approach to the stroke surveillance. Geneva, Switzerland. 2006, available at: http://www.who.int/chp/steps/Manual.pdf
  10. 10.
    Bruno A, Shah N, Lin C, Close B, Hess DC, Davis K, et al. Improving modified Rankin Scale assessment with a simplified questionnaire. Stroke. 2010;41:1048–50.CrossRefPubMedGoogle Scholar
  11. 11.
    Gresham GE, Phillips TF, Labi ML. ADL status in stroke: relative merits of three standard indexes. Arch Phys Med Rehabil. 1980;61:355–8.PubMedGoogle Scholar
  12. 12.
    Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361–70.CrossRefPubMedGoogle Scholar
  13. 13.
    Ware Jr JE, Kosinski M, Gandek B. SF-36 Health Survey: manual and interpretation guide. Lincoln RI: QualityMetric Inc; 2002.Google Scholar
  14. 14.
    Brenden CK, Hollander JE, Guss D, McCullough PA, Nowak R, Green G, et al. Gray zone BNP levels in heart failure patients in the emergency department: results from the Rapid Emergency Department Heart Failure Outpatient Trial (REDHOT) multicenter study. Am Heart J. 2006;151:1006–11.CrossRefPubMedGoogle Scholar
  15. 15.
    Bukan RI, Møller AM, Henning MA, Mortensen KB, Klausen TW, Waldau T. Preadmission quality of life can predict mortality in intensive care unit—a prospective cohort study. J Crit Care. 2014;29:942–7.CrossRefPubMedGoogle Scholar
  16. 16.
    Hofhuis JG, Spronk PE, van Stel HF, Schrijvers AJ, Bakker J. Quality of life before intensive care unit admission is a predictor of survival. Crit Care. 2007;11:78–9.CrossRefGoogle Scholar
  17. 17.
    Welsh CH, Thompson KRN, Long-Krug S. Evaluation of patient-perceived health status using the Medical Outcomes Survey Short-Form 36 in an intensive care unit population. Crit Care Med. 1999;27:1466–71.CrossRefPubMedGoogle Scholar
  18. 18.
    Gardner RS, Ozalp F, Murday AJ, Robb SD, McDonagh TA. N-terminal pro-brain natriuretic peptide A new gold standard in predicting mortality in patients with advanced heart failure. Eur Heart J. 2003;24:1735–43.CrossRefPubMedGoogle Scholar
  19. 19.
    Richards AM, Doughty R, Nicholls MG, MacMahon S, Sharpe N, Murphy J, et al. Australia-New Zealand Heart Failure Group. Plasma N-terminal pro-brain natriuretic peptide and adrenomedullin: prognostic utility and prediction of benefit from carvedilol in chronic ischemic left ventricular dysfunction. Australia-New Zealand Heart Failure Group. J Am Coll Cardiol. 2001;37:1781–7.CrossRefPubMedGoogle Scholar
  20. 20.
    de Lemos JA, Morrow DA, Bentley JH, Omland T, Sabatine MS, McCabe CH, et al. The prognostic value of B-type natriuretic peptide in patients with acute coronary syndromes. N Engl J Med. 2001;345:1014–21.CrossRefPubMedGoogle Scholar
  21. 21.
    Mayer Jr O, Šimon J, Plášková M, Cífková R, Trefil L. N-terminal pro B-type natriuretic peptide as prognostic marker for mortality in coronary patients without clinically manifest heart failure. Eur J Epidemiol. 2009;24:363–8.CrossRefPubMedGoogle Scholar
  22. 22.
    Wang TJ, Larson MG, Levy D, Benjamin EJ, Leip EP, Omland T, et al. Plasma natriuretic peptide levels and the risk of cardiovascular events and death. N Engl J Med. 2004;350:655–63.CrossRefPubMedGoogle Scholar
  23. 23.
    Nigro N, Wildi K, Mueller C, Schuetz P, Mueller B, Fluri F, et al. BNP but not s-cTnln is associated with cardioembolic aetiology and predicts short and long term prognosis after cerebrovascular events. PLoS One. 2014;9:e102704.PubMedCentralCrossRefPubMedGoogle Scholar
  24. 24.
    Shibazaki K, Kimura K, Iguchi Y, Aoki J, Sakai K, Kobayashi K. Plasma brain natriuretic peptide predicts death during hospitalization in acute ischaemic stroke and transient ischaemic attack patients with atrial fibrillation. Eur Neurol. 2011;18:165–9.CrossRefGoogle Scholar
  25. 25.
    Whiteley W, Wardlaw J, Dennis M, Lowe G, Rumley A, Sattar N, et al. The use of blood biomarkers to predict poor outcome after acute transient ischemic attack or ischemic stroke. Stroke. 2012;43:86–91.CrossRefPubMedGoogle Scholar
  26. 26.
    Rost NS, Biffi A, Cloonan L, Chorba J, Kelly P, Greer D, et al. Brain natriuretic peptide predicts functional outcome in ischemic stroke. Stroke. 2012;43:441–5.PubMedCentralCrossRefPubMedGoogle Scholar
  27. 27.
    Pompili M, Venturini P, Campi S, Seretti ME, Montebovi F, Lamis DA, et al. Do stroke patients have an increased risk of developing suicidal ideation or dying by suicide? An overview of the current literature. CNS Neurosci Ther. 2012;18:711–21.CrossRefPubMedGoogle Scholar
  28. 28.
    Vuletić V, Sapina L, Lozert M, Lezaić Z, Morović S. Anxiety and depressive symptoms in acute ischemic stroke. Acta Clin Croat. 2012;51:243–6.PubMedGoogle Scholar
  29. 29.
    Campbell Burton CA, Murray J, Holmes J, Astin F, Greenwood D, Knapp P. Frequency of anxiety after stroke: a systematic review andmeta-analysis of observational studies. Int J Stroke. 2013;8:545–59.Google Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Department of Neurosurgery and Department of NeurologyUniversity HospitalPilsenCzech Republic
  2. 2.2nd Department of Internal MedicineMedical Faculty of Charles University and University HospitalPlzeňCzech Republic
  3. 3.Biomedical CenterMedical Faculty of Charles UniversityPilsenCzech Republic
  4. 4.Centre for Cardiovascular Prevention of the First Faculty of MedicineCharles University and Thomayer HospitalPragueCzech Republic
  5. 5.International Clinical Research Centre, St. Anne’s University HospitalBrnoCzech Republic

Personalised recommendations