Health-Related Quality of Life Among Patients With Acute Ischemic Stroke and Large Vessel Occlusion in the ESCAPE Trial

Abstract

Background and Purpose: Endovascular thrombectomy (EVT) reduces 90-day disability in patients following acute ischemic stroke due to large vessel occlusion. Patient-reported outcome measures after EVT, such as health-related quality of life and specific functional domains, are less well described. Methods: We report outcomes on the EuroQol-5D (EQ-5D) from the ESCAPE (Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times) randomized controlled trial at 90 days after stroke. Death was assigned an index value of 0 for EQ-5D. We used quantile regression to evaluate the association between EVT and EQ-5D index scores and logistic regression for the association between EVT and symptom-free status among 90-day survivors for each EQ-5D dimension (self-care, usual activities, mobility, pain/discomfort, and anxiety/depression), assessing for modification by age or sex and adjusting for baseline factors including stroke severity, affected hemisphere, and receipt of alteplase. Lastly, the association between severe disability at 90 days and EQ-5D was evaluated with assessment for modification by EVT, age, and sex. Results: There were 165 patients randomized to EVT and 150 patients randomized to control. Median EQ-5D was significantly higher for those who received EVT compared with best medical management (0.80 versus 0.60; P <0.001). After accounting for the greater number of deaths in the elderly, there was evidence of modification of treatment effect by age, with older age associated with a larger effect size difference in EQ-5D with EVT. Those receiving EVT had higher odds of symptom-free status in self-care, usual activities, mobility for those aged 60 to 79 years, and pain/discomfort for women, but there was no association with anxiety/depression. Severe disability at 90 days was associated with lower EQ-5D in older compared with younger individuals, and the association was not modified by EVT. Conclusions: Patients treated with EVT report substantially improved health-related quality of life, with relatively greater impact in older individuals and observed benefit across multiple dimensions.

Feasibility of the EQ-5D in the elderly population: a systematic review of the literature

“…Two recent systematic reviews provide a reference value of 5% missing values for both the EQ-5D-3L and EQ-5D-5L [22,23]. This upper value largely seems to hold for the included studies with only a marginal excess effect in missing values in the elderly population, which was already described elsewhere [30,[51][52][53]. Even though the proportion of missing values seems to increase slightly with higher age, the EQ-5D compared more favourably in terms of missing values when compared to other instruments that are commonly applied with the elderly such as the SF-36 [20,40], the AQoL [43] or ICECAP-O [54].…”

Changes of Health-Related Quality of Life Within the 1st Year After Stroke–Results From a Prospective Stroke Cohort Study

“…With respect to HRQoL, patients in the therapy group had a significantly lower EQ VAS compared to the stroke patients without acute therapy, but after adjustment for confounding variables, patients having profited from recanalization therapies did not have a significantly different EQ VAS compared to the patients with stroke unit therapy only, neither in the subacute phase nor in the follow-up period. At first glance, this was rather surprising, as another study could detect a prominent treatment effect, especially for endovascular therapy ( 23 ). As functional deficits and HRQoL correlate in stroke patients ( 24 ), the strong functional improvement during hospitalization in our treated patients might explain the low treatment effect in the statistical analysis of the present cohort.…”

Clinical and Economic Evaluation of Impella Treatment for Fulminant Myocarditis ― A Preliminary Retrospective Cohort Study in Japan ―

“…Furthermore, Group I patients had longer hospital stays and more hospital visits than Group E patients, factors that are closely related to (Supplementary Table 3). [11][12][13][14][15][16][17][18][19][20][21] No study directly measured FM-related utility. The obtained utility values were extrapolated to the Monte Carlo simulations, and QALY was calculated for each disease occurrence or treatment in each sample, which was also a measure against selection and uncertainty level.…”