Different Stroke Subtypes Consistently Affect Several Patient-Reported Health Domains
Most affected domains for all were physical function, satisfaction with social roles, and executive function.
After ischemic stroke, transient ischemic attack (TIA), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH), patients report that anxiety, depression, fatigue, physical function, satisfaction with social roles, and pain interference are affected most frequently, according to a study in Neurology. The researchers found that TIA affects these health domains to a greater degree than SAH, ICH, and ischemic stroke.
A total of 2181 people with ischemic stroke (n=1407), TIA (n=360), ICH (n=215), or SAH (n=199) who were seen at a cerebrovascular clinic between 2015 and 2017 were enrolled. Participants completed the Quality of Life in Neurologic Disorders executive function questionnaire as well as the Patient-Reported Outcomes Measurement Information System (PROMIS) scales. The PROMIS scales measured several different health domains affected by stroke, including anxiety, depression, fatigue, physical function, satisfaction with social roles, pain interference, and sleep disturbance.
Participants with TIA had significantly worse mean physical function (55.9±9.2 vs 58.4±10.6 vs 60.2±11.9 vs 57.3±10.6; P <.001), satisfaction with social roles (52.2±11.1 vs 54.8±11.4 vs 56.9±11.4 vs 53.8±11.7; P <.001), and pain interference (52.7±10.1 vs 52.3 ±10.7 vs 53.7±10.7 vs 54.4±10.6; P =.052) PROMIS scores compared with patients with ischemic stroke, ICH, and SAH, respectively, in the unadjusted analysis. In the analysis adjusted for disability and other prior-determined covariates, all health domains were affected in people who had ICH, SAH, or ischemic stroke.
Factors associated with worse PROMIS scores in several domains included female sex, lower income, younger age, and events occurring <90 days previously.
Limitations of the study included the enrollment of patients from a single US center who resided mainly in suburban or urban areas.
The findings from this study suggest “that the brain injury from these different stroke subtypes has a comparable effect on these outcome domains and that it is reasonable to implement a uniform approach to assess these outcomes in patients with these stroke subtypes,” the researchers wrote.
Katzan IL, Schuster A, Newey C, Uchino K, Lapin B. Patient-reported outcomes across cerebrovascular event types: more similar than different. Neurology. 2018;91(23):e2182-e2191.