TY - JOUR
T1 - Quality of life declines after first ischemic stroke
T2 - The Northern Manhattan Study
AU - Dhamoon, M. S.
AU - Moon, Y. P.
AU - Paik, M. C.
AU - Boden-Albala, B.
AU - Rundek, T.
AU - Sacco, R. L.
AU - Elkind, M. S V
N1 - Funding Information:
Dr. Dhamoon and Y.P. Moon report no disclosures. Dr. Paik serves as Statistical Editor for the Journal of General Internal Medicine and receives royalties from the publication of Statistical Methods for Rates and Proportions (Wiley, 2003). Dr. Boden-Albala serves on a scientific advisory board for Lundbeck, Inc. and receives research support from the American Heart Association and the National Stroke Association. Dr. Rundek serves on the editorial board of Neurology ®; served on the speakers' bureau of Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership; and receives research support from the NIH (NINDS R37 NS 029993-11 [Co-I] and NINDS K24 NS 062737 [PI]). Dr. Sacco has served as a consultant to Boehringer Ingelheim, Sanofi-Aventis, and GlaxoSmithKline and receives research support from the NIH [NINDS R37 NS29993 (PI), NINDS R01 NS 040807 (PI), NINDS R01 047655 (Co-I), and NHLBI HC-98-08-HC-83169701 (Co-I)]. Dr. Elkind serves as Resident and Fellow Section Editor for Neurology ®; serves as a consultant to Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership, GlaxoSmithKline, Jarvik Heart, Tethys Bioscience, Inc., and Daiichi-Sankyo; serves on speakers' bureaus for Boehringer-Ingelheim, Inc. and Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership; and receives research support from diaDexus, Inc., Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership, and the NIH/NINDS [R01 NS050724 (PI), NS048134 (PI), P50 NS049060 (Project PI), R37 NS029993 (Co-PI), R01 NS55809 (Co-I), and R01 NS062820 (Co-I)]; and has given expert testimony on behalf of Merck Serono (Vioxx® litigation), Pfizer Inc. (Shiley valve and Celebrex®/Bextra® litigation), and Novartis (Zelnorm® and stroke litigation).
PY - 2010/7/27
Y1 - 2010/7/27
N2 - OBJECTIVES: Quality of life (QOL) after stroke is poorly characterized. We sought to determine long-term natural history and predictors of QOL among first ischemic stroke survivors without stroke recurrence or myocardial infarction (MI). METHODS: In the population-based, multiethnic Northern Manhattan Study, QOL was prospectively assessed at 6 months and annually for 5 years using the Spitzer QOL index (QLI), a 10-point scale. Functional status was assessed using the Barthel Index (BI) at regular intervals, and cognition using the Mini-Mental State Examination at 1 year. Generalized estimating equations estimated the association between patient characteristics and repeated QOL measures over 5 years. Follow-up was censored at death, recurrent stroke, or MI. RESULTS: There were 525 incident ischemic stroke patients â‰1-40 years (mean age 68.6 ± 12.4 years). QLI declined after stroke (annual change-0.10, 95% confidence interval-0.17 to-0.04), after adjusting for age, sex, race-ethnicity, education, insurance, depressed mood, stroke severity, bladder continence, and stroke laterality. This decline remained when BI â‰1-95 was added to the model as a time-dependent covariate, and functional status also predicted QLI. Changes in QLI over time differed by insurance status (p for interaction = 0.0017), with a decline for those with Medicaid/no insurance (p < 0.0001) but not Medicare/private insurance (p = 0.98). CONCLUSIONS: In this population-based study, QOL declined annually up to 5 years after stroke among survivors free of recurrence or MI and independently of other risk factors. QLI declined more among Medicaid patients and was associated with age, mood, stroke severity, urinary incontinence, functional status, cognition, and stroke laterality.
AB - OBJECTIVES: Quality of life (QOL) after stroke is poorly characterized. We sought to determine long-term natural history and predictors of QOL among first ischemic stroke survivors without stroke recurrence or myocardial infarction (MI). METHODS: In the population-based, multiethnic Northern Manhattan Study, QOL was prospectively assessed at 6 months and annually for 5 years using the Spitzer QOL index (QLI), a 10-point scale. Functional status was assessed using the Barthel Index (BI) at regular intervals, and cognition using the Mini-Mental State Examination at 1 year. Generalized estimating equations estimated the association between patient characteristics and repeated QOL measures over 5 years. Follow-up was censored at death, recurrent stroke, or MI. RESULTS: There were 525 incident ischemic stroke patients â‰1-40 years (mean age 68.6 ± 12.4 years). QLI declined after stroke (annual change-0.10, 95% confidence interval-0.17 to-0.04), after adjusting for age, sex, race-ethnicity, education, insurance, depressed mood, stroke severity, bladder continence, and stroke laterality. This decline remained when BI â‰1-95 was added to the model as a time-dependent covariate, and functional status also predicted QLI. Changes in QLI over time differed by insurance status (p for interaction = 0.0017), with a decline for those with Medicaid/no insurance (p < 0.0001) but not Medicare/private insurance (p = 0.98). CONCLUSIONS: In this population-based study, QOL declined annually up to 5 years after stroke among survivors free of recurrence or MI and independently of other risk factors. QLI declined more among Medicaid patients and was associated with age, mood, stroke severity, urinary incontinence, functional status, cognition, and stroke laterality.
UR - http://www.scopus.com/inward/record.url?scp=77955132106&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=77955132106&partnerID=8YFLogxK
U2 - 10.1212/WNL.0b013e3181ea9f03
DO - 10.1212/WNL.0b013e3181ea9f03
M3 - Article
C2 - 20574034
AN - SCOPUS:77955132106
VL - 75
SP - 328
EP - 334
JO - Neurology
JF - Neurology
SN - 0028-3878
IS - 4
ER -