Objective: We investigated health-related quality of life (HRQOL) in patients with TIA and minor ischemic stroke (MIS) using Neuro-QOL, a validated, patient-reported outcome measurement system.Methods: Consecutive patients with TIA or MIS who had (1) modified Rankin Scale (mRS) score of 0 or 1 at baseline, (2) initial NIH Stroke Scale score of #5, (3) no acute reperfusion treatment, and (4) 3-month follow-up, were recruited. Recurrent stroke, disability by mRS and Barthel Index, and Neuro-QOL scores in 5 prespecified domains were prospectively recorded. We assessed the proportion of patients with impaired HRQOL, defined as T scores more than 0.5 SD worse than the general population average, and identified predictors of impaired HRQOL using logistic regression.Results: Among 332 patients who met study criteria (mean age 65.7 years, 52.4% male), 47 (14.2%) had recurrent stroke within 90 days and 41 (12.3%) were disabled (mRS .1 or Barthel Index ,95) at 3 months. Any HRQOL impairment was noted in 119 patients (35.8%). In multivariate analysis, age (adjusted odds ratio [OR] 1.02, 95% confidence interval [CI] 1.01-1.04), initial NIH Stroke Scale score (adjusted OR 1.39, 95% CI 1.17-1.64), recurrent stroke (adjusted OR 2.10, 95% CI 1.06-4.13), and proxy reporting (adjusted OR 3.94, 95% CI 1.54-10.10) were independent predictors of impaired HRQOL at 3 months.Conclusions: Impairment in HRQOL is common at 3 months after MIS and TIA. Predictors of impaired HRQOL include age, index stroke severity, and recurrent stroke. Future studies should include HRQOL measures in outcome assessment, as these may be more sensitive to mild deficits than traditional disability scales. Neurology ® 2015;85:1957-1963 GLOSSARY BI 5 Barthel Index; CI 5 confidence interval; DWI 5 diffusion-weighted imaging; HRQOL 5 health-related quality of life; MIS 5 minor ischemic stroke; mRS 5 modified Rankin Scale; NIHSS 5 NIH Stroke Scale; OR 5 odds ratio.Patients with TIA and minor ischemic stroke (MIS) account for the majority of stroke patients who present for emergency care in the United States.1 Mild symptoms on presentation is a common reason for exclusion from IV tissue plasminogen activator administration.2 Acute ischemic stroke leads to decreases in health-related quality of life (HRQOL), even among those who have no or minimal poststroke disability.3 Although the outcomes of most patients with minor symptoms, defined by a low NIH Stroke Scale (NIHSS) score, are favorable, approximately 25% of such patients become disabled. 2Stroke outcomes traditionally have utilized disability scales of functional status, which often fail to represent the full effect of disease and treatment. The modified Rankin Scale (mRS) and Barthel Index (BI) are the most frequently used tools to measure disability and handicap after stroke. 4 With National Institute of Neurological Disorders and Stroke funding to address these limitations, Neuro-QOL was developed as a clinically robust and validated patient-reported HRQOL assessment tool for adults and children wit...

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Background and Purpose Since the SAMMPRIS trial, aggressive medical management (AMM), which includes dual antiplatelet therapy (DAPT) and high-dose statin (HDS) therapy, is recommended for patients with symptomatic ICAD. However, limited data on the “real-world” application of this regimen exist. We hypothesized that recurrent stroke risk among patients treated with AMM is similar to the medical arm of the SAMMPRIS cohort. Methods Using a prospective registry, we identified all patients admitted between August 2012 and March 2015 with 1) confirmed ischemic stroke (IS) or transient ischemic attack (TIA); 2) independently adjudicated symptomatic ICAD; and 3) follow-up at 30 days. We analyzed 30-day risk of recurrent IS stratified by treatment: 1) AMM: DAPT plus HDS therapy, 2) HDS alone, and 3) DAPT alone. We also assessed 30-day risk among patients who met prespecified SAMMPRIS eligibility criteria. Results Among 99 patients who met study criteria (51.5% male, 54.5% black, mean age 68.2 ± 11.2 years), 49 (48.5%) patients were treated with AMM, 69 (69.7%) with DAPT, and 73 (73.7%) with HDS therapy. At 30 days, 20 (20.2%) patients had recurrent strokes in the territory of stenosis. Compared to the risk in the medical arm of SAMMPRIS (4.4%), the 30-day risk of recurrent stroke was 20.4% in AMM patients, 21.5% in HDS patients, 22.4% in DAPT patients, and 23.2% in SAMMPRIS-eligible patients (all p<0.001). Conclusions Recurrent stroke risk within 30 days in patients with symptomatic ICAD was higher than that observed in the medical arm of SAMMPRIS even in the subgroup receiving aggressive medical management. Replication of the SAMMPRIS findings requires further prospective study.

Background and Purpose Limited data exist regarding the relationship between acute infarct volume and health-related quality of life (HRQOL) measures after ischemic stroke. We evaluated whether acute infarct volume predicts domain-specific Neuro-Quality of Life (Neuro-QOL) scores at 3 months after stroke. Methods Between 2012 and 2014, we prospectively enrolled consecutive patients with ischemic stroke and calculated infarct volume. Outcome scores at 3 months included modified Rankin score (mRS) and Neuro-QOL T-scores. We evaluated whether volume organized by quartiles predicted mRS and HRQOL scores at 3 months using logistic and linear regression as appropriate, adjusting for relevant covariates. We calculated variance accounted for (R2) overall and by volume for each domain of HRQOL. Results Among 490 patients (mean age 64.2 ± 15.86 years; 51.2% male; 63.3% Caucasian) included for analysis, 58 (11.8%) were disabled (mRS score >2) at 3 months. In unadjusted analysis, the highest volume quartile remained a significant predictor of one HRQOL domain, applied cognition-general concerns (R2 0.06, p<0.001). Our fully-adjusted prediction model explained 32–51% of the variance in HRQOL: upper extremity (R2 0.32), lower extremity (R2 0.51), executive function (R2 0.45), and general concerns (R2 0.34). Conclusions Acute infarct volume is a poor predictor of HRQOL domains after ischemic stroke, with the exception of the cognitive domain. Overall, clinical and imaging variables explained <50% of the variance in HRQOL outcomes at 3 months. Our data imply that a broad range of factors, some known and others undiscovered, may better predict post-stroke HRQOL than what is currently available.