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Published on: April 23, 2021
Patient-reported outcomes across cerebrovascular event types: More similar than different
Irene L Katzan1, Andrew Schuster2, Christopher Newey2
1From the Neurological Institute Center for Outcomes Research & Evaluation (I.L.K., A.S., B.L.) and Cerebrovascular Center (I.L.K. C.N., K.U.), Cleveland Clinic, OH. Katzani@ccf.org.
Insights
Patients with transient ischemic attack (TIA) experienced worse health outcomes across multiple domains compared to other stroke types. Physical function, social roles, and executive function were most impacted across all cerebrovascular events.
Area of Science:
- Neurology
- Public Health
- Health Outcomes Research
Background:
- Cerebrovascular events significantly impact patient health across various domains.
- Understanding differential health domain effects by stroke subtype is crucial for targeted interventions.
Purpose of the Study:
- To compare the impact of different cerebrovascular event types (ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, TIA) on 8 health domains.
- To identify factors associated with health domain scores across these event types.
Main Methods:
- Observational cohort study of 2,181 patients with ischemic stroke, ICH, SAH, or TIA.
- Utilized Quality of Life in Neurologic Disorders and Patient-Reported Outcomes Measurement Information System scales.
- Assessed physical function, social roles, executive function, fatigue, anxiety, depression, pain interference, and sleep disturbance.
Main Results:
- Ischemic stroke, ICH, and SAH showed similar health domain impacts after adjustment.
- Transient ischemic attack (TIA) patients had significantly worse adjusted scores in 5 of 8 health domains.
- Female sex, younger age, lower income, and recent events (<90 days) correlated with poorer outcomes.
Conclusions:
- Stroke subtype significantly influences health domain outcomes, with TIA patients experiencing worse adjusted results.
- Physical function, satisfaction with social roles, and executive function are the most affected domains across all cerebrovascular events.
- Findings suggest distinct outcome mechanisms for TIA and underscore the need for targeted interventions.
Objectives:
To compare the degrees to which 8 domains of health are affected across types of cerebrovascular events and to identify factors associated with domain scores in different event types.
Methods:
This was an observational cohort study of 2,181 patients with ischemic stroke, intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), or TIA in a cerebrovascular clinic from February 17, 2015, to June 2, 2017 who completed Quality of Life in Neurologic Disorders executive function and the following Patient-Reported Outcomes Measurement Information System scales as part of routine care: physical function, satisfaction with social roles, fatigue, anxiety, depression, pain interference, and sleep disturbance.
Results:
All health domains were affected to similar degrees in patients with ICH, SAH, and ischemic stroke after adjustment for disability and other clinical factors, whereas patients with TIA had worse adjusted scores for 5 of the 8 domains of health. Female sex, younger age, lower income, and event <90 days were associated with worse scores in multiple domains. Factors associated with health domain scores were similar for all cerebrovascular events. Most affected domains for all were physical function, satisfaction with social roles, and executive function.
Conclusions:
The subtype of stroke (ischemic stroke, ICH, and SAH) had similar effects in multiple health domains, while patients with TIA had worse adjusted outcomes, suggesting that the mechanisms for outcomes after TIA may differ from those of other cerebrovascular events. The most affected domains across all event types were physical function, satisfaction with social roles, and executive function, highlighting the need to develop effective interventions to improve these health domains in survivors of these cerebrovascular events.
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