Quality of life declines after first ischemic stroke

Dhamoon, Mandip S.; Moon, Yumin; Paik, Myunghee Cho; Boden‐Albala, Bernadette; Rundek, Tatjana; Sacco, Ralph L.; Elkind, Mitchell S.V.

doi:10.1212/wnl.0b013e3181ea9f03

Cited by 91 publications

(78 citation statements)

References 39 publications

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“…The Northern Manhattan study highlights the linear relationship between the two, showing that disability increases with time even when there is no evidence of stroke recurrence. The follow-up for the NEMISIS study went on to show that even 7 years post stroke, survivors showed persistently low HRQOL [21,38]. It is surprising that we observed no preservation of the spiritual sphere of HRQOL in our stroke cohort as was observed in Ibadan, Nigeria, given that previous QOL studies done in Jamaica for other disease states used the spirituality of Jamaicans to account for their relatively preserved QOL.…”

Section: Discussionmentioning

confidence: 66%

“…This difference was not explained by co-morbidities as these were not different between the two groups. It is a phenomenon that has been repeatedly observed in the literature with studies showing that even in TIAs, where physi- cal disability has completely resolved, HRQOL continues to be less than population norms [19,38]. Some have attributed this to the fact that approximately 30% of patients with TIA and mild stroke have CT findings showing atherosclerotic changes in small vessels or white matter disease.…”

Section: Discussionmentioning

confidence: 96%

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Health-Related Quality of Life in Stroke Survivors at the University Hospital of the West Indies

et al. 2017

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Background: Stroke remains a major contributor to mortality and morbidity both locally and globally. To date, there has been no study examining the impact of stroke on quality of life (QOL) in the Jamaican population. Our study was the first to look at QOL among Jamaican stroke survivors across the vast spectrum of stroke severity ranging from mild to severe. We also aimed to identify variables that led to decreased QOL in this cohort when compared to healthy adults. Methods:This was a hospital-based case-control study comparing the QOL of 50 stroke patients admitted to the University Hospital of the West Indies (UHWI) in Jamaica between 2012 and 2013 to that of 50 apparently healthy adults (AHAs). Stroke severity was calculated using the National Institutes of Health stroke scale (NIHSS) at admission. The health-related quality of life in stroke patients (HRQOLISP) tool was used to attain the QOL score in each group. Results:Of the 108 patients that were coded as having an acute ischemic stroke in the year 2012, 38 (35.1%) were deceased and 20 (18.5%) were lost to follow-up at the time of the study. There was no statistical difference between the stroke group and the AHAs with regard to age, race and traditional risk factors for stroke. Within the stroke population, the mean age was 61 ± 17.8 years. The mean age among the AHAs was 60 ± 13.1 years. Of the stroke survivors, 25 (50%) were male and 25 (50%) were female. Forty-five (90%) patients were hypertensive. Health-related quality of life (HRQOL) was significantly reduced across most domains when compared to AHAs (P = 0.0001). Greater stroke severity, presence of depression and previous stroke were all significantly associated with worse QOL. Conclusions:In Jamaica, HRQOL among stroke survivors at the UHWI is consistently and significantly lower than that of healthy adults. Strategic interventions that target stroke severity, depression and non-adherence to secondary prevention regimens must be implemented in order to improve patient outcomes.

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Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 96%

Health-Related Quality of Life in Stroke Survivors at the University Hospital of the West Indies

et al. 2017

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“…26,27 Although no definitive trials address the impact of rehabilitation intensity on poststroke outcomes, the available evidence suggests that IRF utilization is associated with better outcomes than SNF utilization. 13,28,29 A systematic review showed that organized and coordinated postacute inpatient rehabilitation care following an acute stroke is associated with decreased mortality and dependence compared to alternative forms of rehabilitation.…”

Section: Discussionmentioning

confidence: 99%

Effect of insurance status on postacute care among working age stroke survivors

Skolarus¹,

Meurer

Burke³

et al. 2012

Neurology

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Objective: Utilization of postacute care is associated with improved poststroke outcomes. However, more than 20% of American adults under age 65 are uninsured. We sought to determine whether insurance status is associated with utilization and intensity of institutional postacute care among working age stroke survivors. Methods:A retrospective cross-sectional study of ischemic stroke survivors under age 65 from the 2004-2006 Nationwide Inpatient Sample was conducted. Hierarchical logistic regression models controlling for patient and hospital-level factors were used. The primary outcome was utilization of any institutional postacute care (inpatient rehabilitation or skilled nursing facilities) following hospital admission for ischemic stroke. Intensity of rehabilitation was explored by comparing utilization of inpatient rehabilitation facilities and skilled nursing facilities. Results:Of the 33,917 working age stroke survivors, 19.3% were uninsured, 19.8% were Medicaid enrollees, and 22.8% were discharged to institutional postacute care. Compared to those privately insured, uninsured stroke survivors were less likely (adjusted odds ratio [AOR] 0.53, 95% confidence interval [CI] 0.47-0.59) while stroke survivors with Medicaid were more likely to utilize any institutional postacute care (AOR ϭ 1.40, 95% CI 1.27-1.54). Among stroke survivors who utilized institutional postacute care, uninsured (AOR ϭ 0.48, 95% CI 0.36-0.64) and Medicaid stroke survivors (AOR ϭ 0.27, 95% CI 0.23-0.33) were less likely to utilize an inpatient rehabilitation facility than a skilled nursing facility compared to privately insured stroke survivors. Stroke is a leading cause of long-term disability. Conclusions:1 An estimated 7 million Americans have had a stroke.2 Approximately 20% of strokes occur among people younger than 65 years (working age).3 Largely due to lost wages and institutionalization, working age stroke patients account for around half of the estimated $2.2 trillion in US stroke-related cumulative expenditures projected over the next 4 decades. 4 Poststroke rehabilitation or postacute care (PAC) is associated with improved functional outcomes.5-7 PAC services occur in a range of settings, from private residences and outpatient facilities to institutional PAC services which include both inpatient rehabilitation facilities

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“…159 Moreover, NOMAS showed that those with no insurance or Medicaid are more likely than those with Medicare or private insurance to experience declines in function and quality of life after stroke, starting Ϸ3 years after the stroke. 170,171 Conversely, there are also substantial racial disparities among veterans with equal access to health care through the VA systems. For example, blacks or African Americans and Hispanics were less likely to use inpatient therapy services after a stroke than their white counterparts.…”

Section: Insurancementioning

confidence: 99%

Racial-Ethnic Disparities in Stroke Care: The American Experience

Cruz‐Flores¹,

Rabinstein²,

Biller³

et al. 2011

Stroke

433

261

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Purpose-Our goal is to describe the effect of race and ethnicity on stroke epidemiology, personal beliefs, access to care, response to treatment, and participation in clinical research. In addition, we seek to determine the state of knowledge on the main factors that may explain disparities in stroke care, with the goal of identifying gaps in knowledge to guide future research. The intended audience includes physicians, nurses, other healthcare professionals, and policy makers. Methods-Members of the writing group were appointed by the American Heart Association Stroke Council Scientific Statement Oversight Committee and represent different areas of expertise in relation to racial-ethnic disparities in stroke care. The writing group reviewed the relevant literature, with an emphasis on reports published since 1972. The statement was approved by the writing group; the statement underwent peer review, then was approved by the American Heart Association Science Advisory and Coordinating Committee. Results-There are limitations in the definitions of racial and ethnic categories currently in use. For the purpose of this statement, we used the racial categories defined by the US federal government: white, black or African American, Asian, American Indian/Alaskan Native, and Native Hawaiian/other Pacific Islander. There are 2 ethnic categories: people of Hispanic/Latino origin or not of Hispanic/Latino origin. There are differences in the distribution of the burden of risk factors, stroke incidence and prevalence, and stroke mortality among different racial and ethnic groups. In addition, there are disparities in stroke care between minority groups compared with whites. These disparities include lack of awareness of stroke symptoms and signs and lack of knowledge about the need for urgent treatment and the causal role of risk factors. There are also differences in attitudes, beliefs, and compliance among minorities compared with whites. Differences in socioeconomic status and insurance coverage, mistrust of the healthcare system, the relatively limitedThe findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on April 6, 2011. A copy of the document is available at http://my.americanheart.org/statements by selecting either the "By Topic" link or the "By Publication Date" link. To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@woltersklu...

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Quality of life declines after first ischemic stroke

Cited by 91 publications

References 39 publications

Health-Related Quality of Life in Stroke Survivors at the University Hospital of the West Indies

Health-Related Quality of Life in Stroke Survivors at the University Hospital of the West Indies

Effect of insurance status on postacute care among working age stroke survivors

Racial-Ethnic Disparities in Stroke Care: The American Experience

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