For every 5 quality years of life, 3 are taken away for people who have had a stroke, long-term research has found – a loss of 60%.
The study, published in Neurology, the journal of the American Academy of Neurology, involved 1,188 patients – 748 who had a stroke and 440 who had a transient ischemic attack (TIA). Researchers followed these patients for 5 years.
The researchers used a measure called utility, which put a numerical value on the desirability of various health outcomes for patients responding to a questionnaire.
Utility represents quality of life in single numbers along a continuum, extending from 0.0 (death) to 1.0 (“perfect health”). A negative value represents a state “worse than death.”
The authors note that “utilities can be combined with life expectancy to generate quality-adjusted life-years (QALYs).”
The study determined the 5-year QALYs for the participants. This was calculated by multiplying the time spent in a health state by the value assigned to that particular health state.
Out of a possible 5 years of perfect health, people who had a stroke lost 1.71 years due to earlier death and another 1.08 years due to a reduced quality of life.
This combination of factors resulted in a reduction of 2.79 quality-adjusted life-years for stroke patients.
Study author Peter Rothwell, a professor with the UK’s John Radcliffe Hospital in Oxford, says:
“These results highlight the severe toll that stroke takes on millions of people every year.”
“This is the first study since the 1990s to look at long-term quality of life after stroke,” Prof. Rothwell adds. It is also the first population-based study to assess patients’ quality of life over the long term after transient ischemic attack.
The results varied greatly, depending on severity of the stroke.
People having a minor stroke experienced 2.06 fewer quality-adjusted life-years, moderate stroke meant a reduction of 3.35 years, and severe stroke, 4.3 years. Transient ischemic attacks, meanwhile, gave 1.68 fewer quality-adjusted life-years.
Prof. Rothwell puts out a call for action to support people who have had a stroke:
“Our study should serve as a wake-up call that we need more funding and research for stroke treatments and secondary stroke prevention measures to improve quality of life in stroke survivors.”
In the study conclusions, the authors write: “This study has shown that 5-year quality-adjusted survival after stroke and transient ischemic attack is substantially reduced.”
Lower quality-of-life utility scores were independently predicted by the following risk factors, they add:
- Being older
- Being female
- Having a moderate to severe stroke
- Having subsequent strokes.
The authors conclude: “Consequently, there remains considerable scope for improvements in acute treatment and secondary prevention to improve quality of life after transient ischemic attack and stroke.”
On the findings for transient ischemic attack, the researchers note that because it leaves “little or no permanent damage to the brain,” TIA might be expected to have little impact on quality of life. However, they warn that a number of factors, in fact, do affect quality of life after a transient ischemic attack:
- Anxiety about experiencing subsequent events
- Impact on working life.
The authors cite other researchers’ work finding that 1 month after a transient ischemic attack, “patients who were clinically considered to have made a full recovery had quality-of-life scores below population norms, with 27% having anxiety symptoms.”
In the present study, the researchers found that having subsequent strokes during the period between TIA onset and 1-month follow-up also reduced utility scores.
The study was funded by numerous research bodies and charities, including the National Institute for Health Research, the Medical Research Council, the Wellcome Trust and the UK Stroke Association.
In other research published in Neurology in September 2013, vitamin B may reduce risk of stroke, according to an analysis of 14 randomized clinical trials involving a total of 54,913 participants.
Another study in the journal, published in August 2013, found an increasing stroke risk in young people, with 15% of the most common types of stroke happening in young people and adolescents.