Analysis of one-year quality of life and influencing factors in patients with acute mild to moderate ischemic stroke_Chinese Journal of Evidence-Based Medicine

Authors：

MO Jiali , ZHANG Huiqin , LIU Xingyu , DU Huijie , LIU Zuting , YANG Xuezhi ,  KUANG Jie

Department of Epidemiology, School of Public Health, Jiangxi Medical College, Nanchang University; Jiangxi Provincial Key Laboratory of Disease Prevention and Public Health, Nanchang University, Nanchang 330006, P. R. China;

Corresponding author：

KUANG Jie, Email: kuangjie@ncu.edu.cn

Keywords：

Mild to moderate ischemic stroke; Quality of life (QOL); EQ-5D-5L; Influencing factors

DOI：

10.7507/1672-2531.202405073

Video：

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Objective To understand the quality of life of patients with acute mild to moderate ischemic stroke one year after stroke, analyze the factors affecting their quality of life, and provide a scientific basis for improving their health-related quality of life. Methods This study included patients who were diagnosed with acute mild to moderate ischemic stroke between March 2019 and March 2021 in four hospitals in Nanchang. Sociodemographic information and relevant clinical data were collected during hospitalization. The EQ-5D-5L questionnaire was administered to assess health-related quality of life one year after discharge. The Mann-Whitney U test (for two groups) and Kruskal-Wallis one-way ANOVA (for multiple groups) were used to analyze differences in utility scores among various factors. A Tobit regression model was built to investigate the factors influencing quality of life one-year post-stroke. Results A total of 1 181 patients participated in the study, including 791 males (66.98%) and 390 females (33.02%), with an average age of 63.7±10.9 years. Health-related quality of life data collected one year after the stroke revealed that 22.69% of patients experienced pain/discomfort, 17.27% suffered anxiety/depression, 15.66% had mobility issues, 10.33% had difficulties with daily activities, and 8.64% had trouble with self-care. Tobit regression results showed that age (β=−0.263, 95%CI −0.327 to −0.198), gender (β=−0.134, 95%CI −0.189 to −0.080), previous hypertension (β=−0.068, 95%CI −0.120 to −0.016), previous dyslipidemia (β=−0.068, 95%CI −0.126 to −0.011), admission NIHSS score (β=−0.158, 95%CI −0.198 to −0.118), and discharge mRS score (β=−0.193, 95%CI −0.250 to −0.136) were negatively associated with health utility values. Current employment status (β=0.141, 95%CI 0.102 to 0.181) and admission GCS score (β=0.209, 95%CI 0.142 to 0.276) were positively correlated with health utility values. Conclusion One year after an acute mild to moderate ischemic stroke, patients commonly face pain/discomfort and anxiety/depression. Factors affecting overall quality of life include age, sex, current employment status, previous hypertension, previous dyslipidemia, admission NIHSS score, admission GCS score, and discharge mRS score. Clinically, developing scientifically sound and reasonable rehabilitation plans post-discharge is crucial for improving long-term quality of life.

1.	《中国脑卒中防治报告2021》编写组. 《中国脑卒中防治报告2021》概要. 中国脑血管病杂志, 2023, 20(11): 783-793.
2.	刘乐, 余超, 廖逸文, 等. 1990-2019年中国缺血性脑卒中疾病负担变化分析. 中国循证医学杂志, 2022, 22(9): 993-998.
3.	Koton S, Pike JR, Johansen M, et al. Association of ischemic stroke incidence, severity, and recurrence with dementia in the atherosclerosis risk in communities cohort study. JAMA Neurol, 2022, 79(3): 271-280.
4.	Oluchi SE, Manaf RA, Ismail S, et al. Health related quality of life measurements for diabetes: a systematic review. Int J Environ Res Public Health, 2021, 18(17): 9245.
5.	李明晖, 罗南. 欧洲五维健康量表(EQ-5D)中文版应用介绍. 中国药物经济学, 2009, (1): 49-57.
6.	Luo N, Liu G, Li M, et al. Estimating an EQ-5D-5L value set for China. Value Health, 2017, 20(4): 662-669.
7.	郭梦寒, 唐艳艳, 徐娟. 适用于中国人群的EQ-5D-5L效用值积分体系测量性能评价. 医学与社会, 2021, 34(1): 61-64, 80.
8.	周华林, 李雪松. Tobit模型估计方法与应用. 经济学动态, 2012, (5): 105-119.
9.	罗淳. 关于人口年龄组的重新划分及其蕴意. 人口研究, 2017, 41(5): 16-25.
10.	Jensen M, Sehner S, Cheng B, et al. Patient-reported quality of life after intravenous alteplase for stroke in the WAKE-UP trial. Neurology, 2023, 100(2): e154-e162.
11.	Diegoli H, Magalhães PSC, Makdisse MRP, et al. Real-world populational-based quality of life and functional status after stroke. Value Health Reg Issues, 2023, 36: 76-82.
12.	Mei YX, Zhang ZX, Wu H, et al. Health-related quality of life and its related factors in survivors of stroke in rural China: a large-scale cross-sectional study. Front Public Health, 2022, 10: 810185.
13.	Delpont B, Blanc C, Osseby GV, et al. Pain after stroke: a review. Rev Neurol (Paris), 2018, 174(10): 671-674.
14.	Harrison RA, Field TS. Post stroke pain: identification, assessment, and therapy. Cerebrovasc Dis, 2015, 39(3-4): 190-201.
15.	Yang S, Chang MC. Poststroke pain. Semin Neurol, 2021, 41(1): 67-74.
16.	Bushnell CD, Reeves MJ, Zhao X, et al. Sex differences in quality of life after ischemic stroke. Neurology, 2014, 82(11): 922-931.
17.	Cao Y, Chen Y, Zhang X, et al. Analysis of prognostic risk factors for ischemic stroke in China: a multicentre retrospective clinical study: a national survey in China. Curr Neurovasc Res, 2022, 19(1): 117-126.
18.	Wang A, Meng X, Tian X, et al. Effect of hypertension on efficacy and safety of ticagrelor-aspirin versus clopidogrel-aspirin in minor stroke or transient ischemic attack. Stroke, 2022, 53(9): 2799-2808.
19.	Xu XR, Carrim N, Neves MA, et al. Platelets and platelet adhesion molecules: novel mechanisms of thrombosis and anti-thrombotic therapies. Thromb J, 2016, 14(Suppl 1): 29.
20.	Redfors B, Chen S, Ben-Yehuda O, et al. Association between hypertension, platelet reactivity, and the risk of adverse events after percutaneous coronary intervention (from the ADAPT-DES study). Am J Cardiol, 2019, 124(9): 1380-1388.
21.	Zhao W, Wei Z, Xin G, et al. Piezo1 initiates platelet hyperreactivity and accelerates thrombosis in hypertension. J Thromb Haemost, 2021, 19(12): 3113-3125.
22.	Xu T, Zhang JT, Yang M, et al. Dyslipidemia and outcome in patients with acute ischemic stroke. Biomed Environ Sci, 2014, 27(2): 106-110.
23.	Tse T, Binte Yusoff SZ, Churilov L, et al. Increased work and social engagement is associated with increased stroke specific quality of life in stroke survivors at 3 months and 12 months post-stroke: a longitudinal study of an Australian stroke cohort. Top Stroke Rehabil, 2017, 24(6): 405-414.
24.	Drentea P. Retirement and mental health. J Aging Health, 2002, 14(2): 167-194.
25.	Hassan Y, Al-Jabi SW, Aziz NA, et al. Effect of prestroke use of angiotensin-converting enzyme inhibitors alone versus combination with antiplatelets and statin on ischemic stroke outcome. Clin Neuropharmacol, 2011, 34(6): 234-240.
26.	Teasdale G, Maas A, Lecky F, et al. The Glasgow Coma scale at 40 years: standing the test of time. Lancet Neurol, 2014, 13(8): 844-854.
27.	Do Rego AM, Duloquin G, Sauvant M, et al. Quality of life in the first year after ischemic stroke treated with acute revascularization therapy. J Clin Med, 2022, 11(11): 3240.
28.	Arrarte Terreros N, Bruggeman AAE, van Voorst H, et al. Bifurcation occlusions and endovascular treatment outcome in acute ischemic stroke. J Neurointerv Surg, 2023, 15(4): 355-362.

1. 《中国脑卒中防治报告2021》编写组. 《中国脑卒中防治报告2021》概要. 中国脑血管病杂志, 2023, 20(11): 783-793.
2. 刘乐, 余超, 廖逸文, 等. 1990-2019年中国缺血性脑卒中疾病负担变化分析. 中国循证医学杂志, 2022, 22(9): 993-998.
3. Koton S, Pike JR, Johansen M, et al. Association of ischemic stroke incidence, severity, and recurrence with dementia in the atherosclerosis risk in communities cohort study. JAMA Neurol, 2022, 79(3): 271-280.
4. Oluchi SE, Manaf RA, Ismail S, et al. Health related quality of life measurements for diabetes: a systematic review. Int J Environ Res Public Health, 2021, 18(17): 9245.
5. 李明晖, 罗南. 欧洲五维健康量表(EQ-5D)中文版应用介绍. 中国药物经济学, 2009, (1): 49-57.
6. Luo N, Liu G, Li M, et al. Estimating an EQ-5D-5L value set for China. Value Health, 2017, 20(4): 662-669.
7. 郭梦寒, 唐艳艳, 徐娟. 适用于中国人群的EQ-5D-5L效用值积分体系测量性能评价. 医学与社会, 2021, 34(1): 61-64, 80.
8. 周华林, 李雪松. Tobit模型估计方法与应用. 经济学动态, 2012, (5): 105-119.
9. 罗淳. 关于人口年龄组的重新划分及其蕴意. 人口研究, 2017, 41(5): 16-25.
10. Jensen M, Sehner S, Cheng B, et al. Patient-reported quality of life after intravenous alteplase for stroke in the WAKE-UP trial. Neurology, 2023, 100(2): e154-e162.
11. Diegoli H, Magalhães PSC, Makdisse MRP, et al. Real-world populational-based quality of life and functional status after stroke. Value Health Reg Issues, 2023, 36: 76-82.
12. Mei YX, Zhang ZX, Wu H, et al. Health-related quality of life and its related factors in survivors of stroke in rural China: a large-scale cross-sectional study. Front Public Health, 2022, 10: 810185.
13. Delpont B, Blanc C, Osseby GV, et al. Pain after stroke: a review. Rev Neurol (Paris), 2018, 174(10): 671-674.
14. Harrison RA, Field TS. Post stroke pain: identification, assessment, and therapy. Cerebrovasc Dis, 2015, 39(3-4): 190-201.
15. Yang S, Chang MC. Poststroke pain. Semin Neurol, 2021, 41(1): 67-74.
16. Bushnell CD, Reeves MJ, Zhao X, et al. Sex differences in quality of life after ischemic stroke. Neurology, 2014, 82(11): 922-931.
17. Cao Y, Chen Y, Zhang X, et al. Analysis of prognostic risk factors for ischemic stroke in China: a multicentre retrospective clinical study: a national survey in China. Curr Neurovasc Res, 2022, 19(1): 117-126.
18. Wang A, Meng X, Tian X, et al. Effect of hypertension on efficacy and safety of ticagrelor-aspirin versus clopidogrel-aspirin in minor stroke or transient ischemic attack. Stroke, 2022, 53(9): 2799-2808.
19. Xu XR, Carrim N, Neves MA, et al. Platelets and platelet adhesion molecules: novel mechanisms of thrombosis and anti-thrombotic therapies. Thromb J, 2016, 14(Suppl 1): 29.
20. Redfors B, Chen S, Ben-Yehuda O, et al. Association between hypertension, platelet reactivity, and the risk of adverse events after percutaneous coronary intervention (from the ADAPT-DES study). Am J Cardiol, 2019, 124(9): 1380-1388.
21. Zhao W, Wei Z, Xin G, et al. Piezo1 initiates platelet hyperreactivity and accelerates thrombosis in hypertension. J Thromb Haemost, 2021, 19(12): 3113-3125.
22. Xu T, Zhang JT, Yang M, et al. Dyslipidemia and outcome in patients with acute ischemic stroke. Biomed Environ Sci, 2014, 27(2): 106-110.
23. Tse T, Binte Yusoff SZ, Churilov L, et al. Increased work and social engagement is associated with increased stroke specific quality of life in stroke survivors at 3 months and 12 months post-stroke: a longitudinal study of an Australian stroke cohort. Top Stroke Rehabil, 2017, 24(6): 405-414.
24. Drentea P. Retirement and mental health. J Aging Health, 2002, 14(2): 167-194.
25. Hassan Y, Al-Jabi SW, Aziz NA, et al. Effect of prestroke use of angiotensin-converting enzyme inhibitors alone versus combination with antiplatelets and statin on ischemic stroke outcome. Clin Neuropharmacol, 2011, 34(6): 234-240.
26. Teasdale G, Maas A, Lecky F, et al. The Glasgow Coma scale at 40 years: standing the test of time. Lancet Neurol, 2014, 13(8): 844-854.
27. Do Rego AM, Duloquin G, Sauvant M, et al. Quality of life in the first year after ischemic stroke treated with acute revascularization therapy. J Clin Med, 2022, 11(11): 3240.
28. Arrarte Terreros N, Bruggeman AAE, van Voorst H, et al. Bifurcation occlusions and endovascular treatment outcome in acute ischemic stroke. J Neurointerv Surg, 2023, 15(4): 355-362.

Chinese Journal of Evidence-Based Medicine

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