Quality-Adjusted Survival Low Five Years After Stroke
Ramon Luengo-Fernandez, DPhil, from the University of Oxford in the United Kingdom, and colleagues evaluated the five-year impact of stroke (748 individuals) and TIA (440 individuals) among patients participating in the Oxford Vascular Study. The EuroQol-5 Dimensions (EQ-5D) was used to assess quality of life with responses converted into utilities ranging from −0.59 (worse than death) to 1 (perfect health). Matched controls were identified from the 2006 Health Survey for England. A combination of utility and survival information was used to estimate five-year quality-adjusted life-years.
The researchers found that utility remained constant at approximately 0.78 over the five years after TIA and improved from 0.64 one month after stroke to 0.7 at six months, and remained at about 0.7 thereafter. Considerably higher utility levels were seen in the matched controls compared to stroke/TIA patients (0.85). Decreased long-term utility was significantly predicted by event severity and recurrent stroke. After TIA and stroke, five-year quality-adjusted life expectancy was 3.32 and 2.21 quality-adjusted life-years, respectively, although considerable variance was seen by severity (minor, 2.94; moderate, 1.65; and severe, 0.7).
"There remains considerable scope for improvements in acute treatment and secondary prevention to improve the quality of life after TIA and stroke," the authors write.