Quality of Life Predictors in Chronic Stable Post-Stroke Patients and Prognostic Value of SF-36 Score as a Mortality Surrogate
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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.
KeywordsIschemic stroke Quality of life, anxiety Depression SF-36 score Mortality
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.
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
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.
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