Abstract TMP43: Patient Reported Outcomes and Mood Disorders Differences According to Sex and Gender After Stroke

Abstract

Sex/gender differences in stroke outcomes have been reported with conflicting results. Patient reported outcomes (PROMs) are key in value-based healthcare and may identify gender disparities unnoticed by clinicians. We aimed to evaluate sex-focused outcomes after acute ischemic stroke. Methods: Consecutive acute stroke patients admitted to 5 University Hospitals participating in HARMONICS (an EU-funded High-value Stroke care project) discharged home or to socio-rehabilitation centers were offered a harmonized multimodal digital follow-up by a PROMs-through-App program (NORA, NoraHealth Barcelona Spain). PROMs recollection at 90 days included: HADs (anxiety/depression), PROMIS-10 (global physical and mental health) and global health quality (GHQ 0-100). Modified Rankin scale (mRS) was also determined at 3 months. Gender-differences were evaluated and adjusted by potential confounders. Results: From 2020, 2268 patients followed the NORA program, 42.5% female, median age 74y. Women were older (78 vs 71y), had worse pre-stroke mRS (1 vs 0), higher medical record of depression (15.3 vs 4.9%), baseline NIHSS (4 vs 3), and discharge/3months mRS (3 vs 2)(p<0.05 for all). Females showed worse PROMS globally and for each mRS score (Figure). Post-stroke depression at 3mo was reported in 21.3% of women and 14.8% of men (p=0.04). In logistic regression adjusted by age, stroke severity and discharge mRS, female sex emerged as an independent predictor of all poor PROMs except depression (PROMIS-physical: OR 2.4, IC 1.6-3.6; PROMIS-mental: OR 1.8, IC 1.2-2.8; HADs-anxiety: OR 2.3, IC 1.3-3.8, p<0.05 for all; HADs-depression: OR 1.1, IC 0.9-2.5, p=0.15). Conclusion: Sex differences in outcomes reported by clinicians and patients were detected in our series. Post-stroke depression is a very frequent complication in both sexes. Whether specific interventions following sex or gender-perspective may reduce disparities warrants evaluation.