scholarly journals The Benefit of Endovascular Thrombectomy for Stroke on Functional Outcome Is Sustained at 12 Months

2021 ◽  
pp. 81-86
Author(s):  
Balaki Parameshwaran ◽  
Dennis Cordato ◽  
Mark Parsons ◽  
Andrew Cheung ◽  
Nathan Manning ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Functional Outcome ◽  
Health Utility Index ◽  
Health Utility ◽  
Functional Independence ◽  
Place Of Residence ◽  
Endovascular Thrombectomy ◽  
Comprehensive Stroke Center ◽  
Stroke Center

<b><i>Background and Purpose:</i></b> The short-term benefits of endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) have been widely documented, yet there is limited evidence to show that this is sustained in the long term. We aimed to determine whether the benefit of EVT on functional outcome at 3 months is maintained at 12 months and the factors correlating with functional independence and quality of life. <b><i>Methods:</i></b> Data for analysis came from a prospective registry of consecutive patients undergoing EVT at a single Comprehensive Stroke Center (Oct 2018–Sep 2019). A phone interview was conducted for 12-month patient outcomes. Functional outcome was assessed by the modified Rankin Scale (mRS). Quality of life was determined by return to usual place of residence, work, or driving and calculation of a health utility index using the European Quality of Life-5 Dimensions questionnaire (EQ-5D-3L). <b><i>Results:</i></b> Of the 151 patients who underwent EVT during the study period, 12-month follow-up was available for 145 (96%). At 12 months, 44% (<i>n</i> = 64) of patients were functionally independent (mRS 0–2) compared to 48% at 3 months. Mortality at 12 months was 26% compared to 17% at 3 months. Significant predictors of functional independence at 12 months were younger age and lower baseline National Institutes of Health Stroke Scale. Better quality of life significantly correlated with return to usual place of residence and driving. <b><i>Conclusion:</i></b> Three-month functional independence was sustained at 12 months, indicating that EVT remains beneficial for patients with AIS in the longer term.

Long-term Neurological Outcome and Quality of Life after World Federation of Neurosurgical Societies Grades IV and V Aneurysmal Subarachnoid Hemorrhage in an Interdisciplinary Treatment Concept

Neurosurgery ◽  
2017 ◽  
Vol 80 (6) ◽  
pp. 967-974 ◽  
Author(s):  
Christoph Schwartz ◽  
Thomas Pfefferkorn ◽  
Caroline Ebrahimi ◽  
Caroline Ottomeyer ◽  
Gunther Fesl ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Functional Outcome ◽  
Short Form ◽  
Functional Independence ◽  
World Federation ◽  
Long Term Survivors ◽  
Short Form Health

Abstract BACKGROUND: Detailed data on long-term functional outcome of patients with World Federation of Neurosurgical Societies (WFNS) grades IV and V aneurysmal subarachnoid hemorrhages (aSAH) are still scarce. OBJECTIVE: Assessment of long-term outcome of WFNS IV and V aSAH patients. METHODS: Functional outcome and quality of life were assessed by the modified Rankin scale (mRS) and the 36-item short-form health survey in consecutively treated aSAH WFNS IV and V patients between 2005 and 2010. Scores from the 36-item short-form health survey were compared to a healthy German population. Prognostic factors were analyzed by uni- and multivariate models. RESULTS: One hundred and seven eligible patients (median age: 53.0 years) were identified. After interdisciplinary consensus on optimal treatment, aneurysms were obliterated either by clipping (n = 35) or by coiling (n = 72). Ten patients were lost to long-term follow-up; the median clinical follow-up period was 3.2 years for the remaining 97 cases. Twenty-five of 97 died during the acute hospital phase and another 10 patients over the follow-up period leaving 62 long-term survivors. At the end of clinical follow-up, 40/97 patients, including 40/62 of long-term survivors, reached functional independence (mRS ≤ 2). Twelve of 97 patients were moderately (mRS = 3), 10/97 patients were severely disabled (mRS ≥ 4). Younger age (≤ 53 years; P = .001) and radiological absence of cerebral infarction (P = .03) were the strongest predictors for favorable outcome. Quality of life was perceived to be only moderately reduced compared to the healthy control group. CONCLUSION: Poor-grade aSAH is not necessarily associated with poor long-term functional outcome; after aneurysm repair ∼60% of patients survived and among long-term survivors ∼ 60% regained functional independence.

TO011HEALTH UTILITY BUT NOT UREMIC TOXINS ARE ASSOCIATED WITH ONE YEAR MORTALITY IN HD PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Wim Van Biesen ◽  
Amaryllis Van Craenenbroeck ◽  
Daniel Abramowicz ◽  
Holvoet Els ◽  
Veys Nic ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Nutritional Status ◽  
Association Studies ◽  
Objective Assessment ◽  
Health Utility Index ◽  
Health Utility ◽  
Uremic Toxins ◽  
Serum Concentrations ◽  
Prospective Longitudinal

Abstract Background and Aims Patient centred care is progressively gaining importance. Standardized outcomes should take into account patient relevant outcomes, such as mortality and quality of life. It is unknown whether the health utility index EQ5D, an objective assessment of quality of life, is associated with mortality in haemodialysis patients. Serum concentrations of different uremic toxins have been associated with survival. We intended to explore whether EQ5D rather than concentrations of representative uraemic toxins (UT) was associated with mortality. Method Prospective longitudinal multicentric cohort study of all haemodialysis patients at 5 representative dialysis centres in Flanders. Total and free concentrations of representative uraemic toxins indoxyl sulfate (IxS), p-cresyl sulfate (pCS), p-cresyl glucuronide (pCG), indole acetic acid (IAA), 3-carboxy-4-methyl-5-propyl-2-furanpropionic acid (CMPF), hippuric acid (HA) and uric acid (UA) were determined at baseline. Mini Nutritional Assessment (MNA) and EQ5D were assessed by dedicated nurses. Mortality was assessed from administrative or medical records. A Cox regression model was built, both fixed and as conditional forward including clinical parameters, MNA, EQ5D and serum concentrations of the different uraemic toxins. Results 216 prevalent patients (62%male, age 67.2 ± 15.7) all on high flux haemodialysis were included. Over the observation period, 59 patients (27%) died. Health utility as assessed by EQ5D was 0.69±0.28; perceived health by visual analogue scale (VAS) (0-100) was 59.6±18.6. Adjusting for age, gender and MNA score, free but not total concentrations of IxS, pCS and IAA and EQ5D score were associated with overall survival in the forced entry model. However, neither in the fixed entry, the forward or backward model were serum concentrations of uraemic toxins retained, and only age, gender, BMI, EQ5D and VAS were consistently associated with survival. Conclusion Measures of health utility, such as EQ5D, and quality of life, such as a simple VAS score, are more predictive of survival in patients on regular haemodialysis than serum concentrations of a panel of relevant uraemic toxins. Health utility and QoL are thus not only directly relevant to patients, but also indirectly through an association with improved survival. The concept of dialysis adequacy has been challenged over the last decade, mainly because it was focusing on small solute clearance. Different authors reported that concentrations of middle molecular and protein bound solutes were more representative. In our study, free but not total solute concentrations were associated with survival. However, adjusting additionally for health utility and/or health perception and/or assessment of nutritional status abolishes this association. Studies assessing interventions to enhance solute removal should not only include solute concentrations as outcome, but also consider EQ5D, VAS and nutritional status as important outcomes to enhance patient centeredness of their findings.

Abstract TP160: Degree of Functional Independence After an Ischemic Stroke Affects Quality of Life Similarly in Men and Women

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Stacie L Demel ◽  
Jane Khoury ◽  
Charles J Moomaw ◽  
Heidi Sucharew ◽  
Kathleen Alwell ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Ischemic Stroke ◽  
Functional Outcome ◽  
Retrospective Chart Review ◽  
Functional Independence ◽  
Stroke Severity ◽  
Men And Women ◽  
Related Data ◽  
Proxy Responses

Background: Women have worse quality of life (QoL) after an ischemic stroke (IS) compared with men for unclear reasons. We hypothesized that men and women may value functional independence differently. We assessed the association between sex, functional outcome, and quality of life within a large prospective cohort of ischemic stroke patients. Methods: Within the Greater Cincinnati/Northern Kentucky catchment area of 1.3 million we prospectively screened local hospital stroke admission diagnoses in 2005 and 2010. A subset of physician-confirmed IS patients were interviewed at baseline and followed longitudinally. Medical history and stroke-related data were collected through standardized retrospective chart review. Pre-stroke and 3-month modified Rankin Scale (mRS) was assessed, and European Quality of Life (EQ-5D) was administered at 3 months. Multiple regression analysis was used to compare QoL between men and women across mRS categories, adjusted for age, race, baseline mRS, stroke severity history of depression, diabetes, and use of proxy responses. Results: The GCNK follow-up cohorts from 2005 and 2010 included 964 adult IS patients, of which 797 were interviewed at 3 months post stroke. Women comprised 50% of the cohort and were older than men on average (68.4 ± 14.2 vs. 65.2 ± 13, p<.001) years at the time of their stroke. Women had worse functional outcomes (median mRS 3 vs. 2, p=.02) and quality of life (EQ-5D 0.55 vs. 0.65, p=.03), even after adjustment for the covariates listed above. The EQ-5D index was no different in men and women for each point on the mRS spectrum (i.e., there was no interaction between sex and 3-month mRS; Figure). Conclusion: In this cohort study, we confirmed worse functional outcome and worse quality of life in women after stroke. However, at each level on the mRS spectrum, men and women valued their quality of life similarly. Further research is needed on the reasons for worse outcomes in women than men.

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