Abstract
BackgroundWe aimed to identify groups of patients with similar health status after stroke, assessed by patient reported outcome measures (PROMs), to improve initial risk stratification.MethodsIn a prospective study, inpatients were recruited during acute stroke treatment. Demographics, history, and cardio-vascular risk factors were assessed at baseline. Self-reported functional status, physical and mental health as well as anxiety and depressive symptoms were assessed 3 and 12 months after stroke and used to identify latent classes. The association of patient characteristics with latent class membership was investigated with multinomial logistic regression.ResultsOf the 650 patients included with a mean age of 75 years and 48% female, 70% had ischemic, 6% hemorrhagic strokes, and 24% transient ischemic attacks. Median NIHSS on admission was 2 (IQR:0,5). Values of PROMs remained comparable at 3 and 12 months. A three-class model was developed, differentiating between patients with mildly (75%), moderately (17%), and severely (8%) impaired self-reported health status. Adjusted for univariately significant baseline characteristics, initial NIHSS distinguished mild- from moderate-, and moderate- from severe-class-membership (p < 0.001). Length of inpatient stay (p < 0.001;OR = 1.1), diabetes (p = 0.021;OR = 1.91), and atrial fibrillation (p = 0.004;OR = 2.20) predicted allocation to the moderately vs. mildly affected class.ConclusionsGrading stroke patients by a standard set of PROMs up to 1 year after stroke allows to distinguish the diverse impact of baseline characteristics on differently affected groups. In addition to initial stroke severity, longer inpatient stay, presence of diabetes and atrial fibrillation correlate with greater impairment of self-reported health in the less affected groups.Trial registrationhttp://www.ClinicalTrials.gov; Unique identifier: NCT03795948.
Highlights
Prevention and improved treatment of acute stroke has led to a decline in stroke incidence and stroke-related mortality over the past decades
We aimed to grade this unselected clientele of patients recruited in a prospective observational study on stroke unit admission and identify latent classes according to health status assessed by PROMS 3 and 12 months after the event
Mean age was 75 years, 48% were female, and the median National Institutes of Health Stroke Scale (NIHSS) assessed on admission was 2.0 (IQR:0,5). 67% of patients lived without need of external support, and 59% lived with a partner
Summary
Prevention and improved treatment of acute stroke has led to a decline in stroke incidence and stroke-related mortality over the past decades. In mild to moderately affected stroke patients from an outpatient setting, a retrospective analysis showed promising results building distinct profiles or classes using the Patient-reported Outcomes Measurement Information System (PROMIS) [16]. Considering evidence of comparable risk profiles [31] and similar self-reported outcomes in patients with acute stroke and TIA, we decided to assess both, in order to adequately represent the heterogenous stroke unit clientele [4, 16]. We aimed to grade this unselected clientele of patients recruited in a prospective observational study on stroke unit admission and identify latent classes according to health status assessed by PROMS 3 and 12 months after the event. We aimed to identify groups of patients with similar health status after stroke, assessed by patient reported outcome measures (PROMs), to improve initial risk stratification
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