Health related quality of life recovery one year after stroke onset in stroke survivors: insight from The Liverpool-Heart and bRain Project

Background

Stroke is associated with decline in health-related quality of health (HRQoL) often because of cognitive impairment, declined physical function, and psychological stress.

Purpose

This study aimed to evaluate changes in HRQoL in stroke survivors over one year of follow-up and to determine predictors of HRQoL recovery at 12-months.

Methods

Between September 2021 and December 2022, patients with ischaemic stroke were recruited from 35 participating hospitals. HRQoL was measured at baseline and 12-month follow-up using the EQ-5D-5L. Utility index score was calculated from the five domains (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) of the EQ-5D-5L.

Results

1,655 patients (median age: 71 [IQR: 61, 79]; 59% male) were recruited; 935 patients with complete EQ-5D-5L data were analysed. The mean utility score improved from 0.72 at baseline to 0.78 at 12-month follow-up (mean difference: 0.06; 95% CI: [0.05 – 0.08]; p<0.001) (Figure 1). From baseline to 12-month, four EQ-5D-5L domains, including mobility (2.42 vs 2.02, p<0.001), self-care (1.97 vs 1.59, p<0.001), usual activities (2.51 vs 2.03, p<0.001), and anxiety/depression (1.66 vs 1.56, p=0.004), showed significant improvement (Figure 1). Pain/discomfort worsened significantly over the first 12-months post-stroke (1.66 vs 1.87, p<0.001).

Multivariable linear regression identified cognitive function and psychological distress as key independent predictors of 12-month HRQoL recovery (Figure 2). Baseline utility score was the strongest predictor (β= -0.711, p< 0.001), reflecting a significant ceiling effect. Better baseline cognitive function (MoCA: β = 0.005, p= 0.007) was associated with greater utility gains. Conversely, baseline depression (PHQ-9: β= -0.007, p= 0.002) and anxiety (GAD-7: β= -0.004, p = 0.035) were significant barriers, independently predicting poorer recovery.

Conclusions

Stroke survivors experience a significant overall recovery in HRQoL driven primarily by functional and mobility-related gains. However, psychological stress including anxiety and depression hindered the overall recovery of HRQoL. Post-stroke HRQoL and mood should be assessed with target interventions to improve emotional well-being and HRQoL.Figure 2Figure 1