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Lee YX, Auwerda ST, Jellema K, Vliet Vlieland TPM, Arwert HJ. Ethnic disparities in long-term outcomes and health care usage after stroke in the Netherlands. Disabil Health J 2024; 17:101582. [PMID: 38246799 DOI: 10.1016/j.dhjo.2024.101582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 01/02/2024] [Accepted: 01/10/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND Poststroke health-related quality of life (HRQOL) is an important outcome that may be influenced by ethnicity. OBJECTIVE To compare long-term HRQOL, mental health and healthcare utilization between stroke survivors with a European (EUB) and non-European background (NEUB) in a hospital population. METHODS In this retrospective cohort study patients completed questionnaires 2-5 years after stroke. Assessments included the EuroQol-5D-3L (EQ-5D), Short Form (SF-36, with physical and mental component summary scales, PCS and MCS), Hospital Anxiety and Depression Scale (HADS; scores ≥8 indicate clinically relevant complaints) and a questionnaire on the usage of services from physicians and/or healthcare professionals (HCP) in the past 6 months. Linear and logistic regression analysis was used, adjusted for age, sex, level of education and functional outcome. RESULTS We included 207 patients (169 EUB, 38 NEUB); mean age 63.8 years (SD 14.4); 60.4 % male; mean follow up 36.3 months (SD 9.9). The EQ-5D and the PCS were higher in EUB versus NEUB patients (42.9 vs 35.4, p < 0.01; 0.76 vs 0.60, p < 0.01). The MCS showed a comparable, non-significant trend. The percentage of patients with HADS depression ≥8 was higher in NEUB patients versus EUB patients (54.3 % vs 29.8 %; p > 0.01). Significantly more NEUB patients had visited two or more physicians in the past six months compared to EUB patients (52.0 % vs 26.0 %; p = 0.01) whereas the use of services from HCP was similar. CONCLUSIONS NEUB stroke patients had worse outcomes regarding HRQOL and depressive symptoms compared to EUB patients. NEUB patients visited more physicians.
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Affiliation(s)
- Y X Lee
- Haaglanden Medical Center, Department of Neurology, Lijnbaan 32, 2512 VA, The Hague, the Netherlands.
| | - S T Auwerda
- Basalt Rehabilitation Center, Vrederustlaan 180, 2543 SW, The Hague, the Netherlands.
| | - K Jellema
- Haaglanden Medical Center, Department of Neurology, Lijnbaan 32, 2512 VA, The Hague, the Netherlands.
| | - T P M Vliet Vlieland
- Leiden Universitary Medical Center, Department of Orthopaedics, Rehabilitation and Physical Therapy, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands.
| | - H J Arwert
- Haaglanden Medical Center, Department of Rehabilitation, Lijnbaan 32, 2512 VA, The Hague, the Netherlands; Basalt Rehabilitation Center, Lijnbaan 32, 2512 VA, The Hague, the Netherlands.
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Zhou J, Wei Q, Hu H, Liu W, Guan X, Ma A, Wang L. A systematic review and meta-analysis of health utility values among patients with ischemic stroke. Front Neurol 2023; 14:1219679. [PMID: 37731850 PMCID: PMC10507900 DOI: 10.3389/fneur.2023.1219679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/16/2023] [Indexed: 09/22/2023] Open
Abstract
Purpose Ischemic stroke (IS) has a considerable impact on the health-related quality of life (HRQoL) of patients. A systematic review was conducted to summarize and synthesize the HRQoL reported from IS patients. Methods An electronic search was performed in PubMed, Web of Science, ScienceDirect, Embase, and Cochrane Library databases from inception to February 2022 for studies measuring utility values in IS patients. Basic information about the studies, patient characteristics, measurement of the utility values, and utility values were extracted and summarized. Utility values were pooled according to the time of evaluation, and disease severity was classified with modified Rankin Scale (mRS) scores. The quality of the studies was assessed according to key criteria recommended by the National Institute for Health and Care Excellence. Results A total of 39 studies comprising 30,853 participants were included in the study. Measured with EQ-5D-3L, the pooled utility values were 0.42 [95% confidential interval (CI): 0.13 to 0.71], 0.55 (95% CI: 0.43 to 0.68), 0.65 (95% CI: 0.52 to 0.78), 0.60 (95% CI: 0.43 to 0.78), and 0.67 (95% CI: 0.60 to 0.74) for patients diagnosed with IS within 1, 3, 6, 12, and 24 months or above among poststroke patients. Four studies reported utility values classified by mRS scores where synthesized estimates stratified by mRS scores ranged from 0.91 (95% CI: 0.85 to 0.97) for patients with an mRS score of 1 to-0.04 (95% CI:-0.18 to 0.11) for those with an mRS score of 5. As for the health dimension profiles, usual activity was the most impacted dimension, while self-care was the least impacted one. Conclusion This study indicated that the utility values in IS patients kept increasing from stroke onset and became relatively stabilized at 6 months poststroke. Health utility values decreased significantly as mRS scores increased. These results facilitate economic evaluations in utility retrieval and selection. Further exploration was required regarding the factors that affect the HRQoL of IS patients.
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Affiliation(s)
| | | | | | | | | | - Aixia Ma
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
| | - Luying Wang
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
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Wang M, Yang Y, Wang Y, Luan M, Zhong M, Xu L, Zheng X. Comparative effectiveness of dual to single antiplatelet therapy after one year versus seven years in patients with acute ischemic stroke combined with cerebral microbleeds. J Clin Neurosci 2023; 112:73-79. [PMID: 37116338 DOI: 10.1016/j.jocn.2023.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 04/19/2023] [Accepted: 04/21/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND Cerebral microbleeds (CMBs) were thought to be associated with stroke. The relationship CMBs, antiplatelet therapy and prognosis is still unclear. Our aim here was to compare the long-term risk of stoke between dual and single antiplatelet therapies in patients of acute ischemic stroke (IS) combined with CMBs. METHOD We conducted a retrospective cohort study of 1017 acute IS patients received susceptibility weighted imaging (SWI) magnetic resonance imaging (MRI) sequences. We constructed a sample of patients received short-term dual antiplatelet therapy (DAPT) (n = 154) and received single antiplatelet therapy (SAPT) (n = 125), followed them for up to 7 years (median 33 months). DAPT was prescribed for at least 3 weeks, followed by using SAPT. The primary endpoint was a composite of all-cause death, recurrence IS or intracerebral hemorrhage (ICH). Secondary endpoints were a composite of recurrent IS or ICH, and the recurrent IS. RESULT At last follow-up, rated of the endpoints were similar in patients treated with SAPT and DAPT (P > 0.05). The IS risk was higher in patients treated with SAPT in the first year after the occurrence of acute IS (P = 0.035). And in 0-1 year or in 1-7 year, the risk of primary endpoint and main secondary endpoint were similar among patients treated with SAPT and DAPT (P > 0.05). CONCLUSION The study is limited due to different baseline characteristics. We initially consider that the short-term DAPT may be considered to potentially reduce the rate of recurrent IS in the first year. In patients of IS combined with CMBs, the short-term DAPT may be recommended to reduce the recurrent IS.
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Affiliation(s)
- Meng Wang
- Department of Geriatric Medicine, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, China.
| | - Yuyuan Yang
- Department of Geriatric Medicine, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, China.
| | - Yajuan Wang
- Department of Geriatric Medicine, The Qingdao Eighth People's Hospital, 84 Fengshan Road, Qingdao, China.
| | - Moxin Luan
- Department of Geriatric Medicine, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, China.
| | - Meixiang Zhong
- Department of Geriatric Medicine, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, China.
| | - Lulu Xu
- Department of Geriatric Medicine, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, China.
| | - Xueping Zheng
- Department of Geriatric Medicine, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, China.
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Chen X, Delcourt C, Sun L, Zhou Z, Yoshimura S, You S, Malavera A, Torii-Yoshimura T, Carcel C, Arima H, Hackett ML, Robinson T, Song L, Wang X, Lindley RI, Chalmers J, Anderson CS. Brain Imaging Signs and Health-Related Quality of Life after Acute Ischemic Stroke: Analysis of ENCHANTED Alteplase Dose Arm. Cerebrovasc Dis 2020; 49:427-436. [PMID: 32702699 DOI: 10.1159/000509226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/07/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND PURPOSE The influence of specific brain lesions on health-related quality of life (HRQoL) after acute ischemic stroke (AIS) is uncertain. We aimed to identify imaging predictors of poor HRQoL in alteplase-treated participants of the alteplase dose arm of the Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED). METHODS ENCHANTED was an international trial of low- versus standard-dose intravenous alteplase in AIS patients, with functional outcome (modified Rankin scale [mRS]) and HRQoL on the 5-dimension European Quality of Life Scale (EQ-5D) assessed at 90 days post-randomization. Brain images were analyzed centrally by trained assessors. Multivariable logistic regression was undertaken in the study population randomly divided (2:1) into training (development) and validation (performance) groups, with age (per 10-year increase), ethnicity, baseline National Institutes of Health Stroke Scale (NIHSS) score, diabetes mellitus, premorbid function (mRS score 0 or 1), and proxy respondent, forced into all models. Data are presented with odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Eight prediction models were developed and validated in 2,526 AIS patients (median age 67.5 years; 38.4% female; 61.7% Asian) with complete brain imaging and 90-day EQ-5D utility score data. The best performance model included acute ischemic changes in the right (OR 1.69, 95% CI: 1.24-2.29) and deep (OR 1.50, 95% CI: 1.03-2.19) middle cerebral artery (MCA) regions. Several background features of brain frailty - atrophy, white matter change, and old infarcts - were significantly associated with adverse physical but not emotional HRQoL domains. CONCLUSIONS In thrombolysed AIS patients, right-sided and deep ischemia within the MCA territory predict poor overall HRQoL, whilst features of old cerebral ischemia are associated with reduced physical HRQoL.
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Affiliation(s)
- Xiaoying Chen
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Candice Delcourt
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Neurology Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Lingli Sun
- The George Institute China at Peking University Health Science Centre, Beijing, China
| | - Zien Zhou
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia.,Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Sohei Yoshimura
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia.,Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Shoujiang You
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Alejandra Malavera
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia
| | - Takako Torii-Yoshimura
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia.,Division of Neurology, Department of Stroke and Cerebrovascular Diseases, National Cerebral and Cardiovascular Center, Osaka, Japan.,Department of Neurology and Neuroscience, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Cheryl Carcel
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Neurology Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Fukuoka University, Fukuoka, Japan
| | - Maree L Hackett
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Faculty of Health and Wellbeing, University of Central Lancashire, Preston, United Kingdom
| | - Thompson Robinson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom.,NIHR Biomedical Research Centre, Leicester, United Kingdom
| | - Lili Song
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,The George Institute China at Peking University Health Science Centre, Beijing, China
| | - Xia Wang
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia
| | - Richard I Lindley
- Westmead Applied Research Centre, University of Sydney, Sydney, New South Wales, Australia
| | - John Chalmers
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia
| | - Craig S Anderson
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia, .,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia, .,Neurology Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia, .,The George Institute China at Peking University Health Science Centre, Beijing, China, .,Heart Health Research Center, Beijing, China,
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