Stroke has detrimental effects in multiple health domains not captured by routine scales. The International Consortium for Health Outcome Measurement has developed a standardized set for self-reported assessment to overcome this limitation. We aim to assess this set in acute stroke care.
We enrolled consecutive patients with acute ischemic stroke (AIS), transient ischemic attack (TIA), or intracerebral hemorrhage (ICH). Demographics, living situation and cardio-vascular risk factors were collected from medical records and interviews. 90 days after admission we conducted the Patient-reported Outcomes Measurement Information System 10-Question Short-Form (PROMIS-10) and Patient Health Questionnaire-4 (PHQ-4). We used linear and logistic regression analyses to identify predictors of outcome. The study is registered at ClinicalTrials.gov, NCT03795948.
1,064 patients were enrolled, mean age was 71.6 years, 51% were female, median NIHSS on admission was 3. Diagnosis was AIS in 74%, TIA in 20%, and ICH in 6%. 673 patients were available for outcome evaluation at 90 days, of these 90 (13%) had died. In survivors, T-scores of PROMIS-10 physical and mental health were 40.3±6.17 and 44.3±8.63, compared to 50±10 in healthy populations. 16% reported symptoms indicating depression or anxiety on the PHQ-4. Higher NIHSS, prior stroke, and requiring help pre-stroke predicted lower values in physical and mental health scores. Higher NIHSS and diabetes were associated with anxiety or depression.
Integrated in routine of acute stroke care, systematic assessment of patient-reported outcomes reveals impairments in physical and mental health. Main predictors are severity of stroke symptoms, and comorbidities as hypertension and diabetes.
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