Article Text

Download PDFPDF
Health-related quality of life after thrombectomy in young-onset versus older stroke patients: a multicenter analysis
  1. Milani Deb-Chatterji1,
  2. João Pinho2,
  3. Fabian Flottmann3,
  4. Lukas Meyer3,
  5. Gabriel Broocks3,
  6. Caspar Brekenfeld3,
  7. Arno Reich2,
  8. Jens Fiehler3,
  9. Christian Gerloff1,
  10. Goetz Thomalla1
  11. on behalf of the GSR-ET Investigators
  1. 1Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
  2. 2Department of Neurology, RWTH Aachen University, Aachen, Nordrhein-Westfalen, Germany
  3. 3Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
  1. Correspondence to Dr Milani Deb-Chatterji, Neurology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany; m.deb-chatterji{at}uke.de

Abstract

Background Information is lacking on self-reported health-related quality of life (HRQoL) as a complementary outcome measure in addition to the modified Rankin scale (mRS) in young patients with ischemic stroke after endovascular thrombectomy (EVT) compared with older patients.

Methods Data on consecutive patients with stroke who underwent thrombectomy (June 2015–2019) from a multicenter prospective registry (German Stroke Registry) were analyzed. HRQoL was measured by the European QoL-5 dimension questionnaire utility index (EQ-5D-I; higher values indicate better HRQoL) 3 months after stroke in patients aged ≤55 and >55 years. Multivariate regression analyses identified predictors of better HRQoL.

Results Of 4561 included patients, 526 (11.5%) were ≤55 years old. Young-onset patients had a better outcome assessed by mRS (mRS 0–2: 64.3% vs 31.8%, p<0.001) and EQ-5D-I (mean 0.639 vs 0.342, p<0.001). Young survivors after EVT had fewer complaints in the EQ-5D domains mobility (p<0.001), self-care (p<0.001), usual activities (p<0.001) and pain/discomfort (p=0.008), whereas no difference was observed in anxiety/depression (p=0.819). Adjusted regression analysis for 90-day mRS showed no difference in HRQoL between the two subgroups of patients. Lower age, National Institutes of Health Stroke Scale score and pre-stroke mRS, a higher Alberta Stroke Program Early CT Score, concomitant intravenous thrombolysis therapy and successful recanalization were associated with better HRQoL in both patient subgroups.

Conclusions Young-onset stroke patients have a better HRQoL after EVT than older patients. Their higher HRQoL is mainly explained by less physical disability assessed by mRS. Depressive symptoms should be actively assessed and targeted in rehabilitation therapies of young-onset stroke patients to improve quality of life after stroke.

  • intervention
  • stroke
  • thrombectomy

Data availability statement

Data are available upon reasonable request.

Statistics from Altmetric.com

Data availability statement

Data are available upon reasonable request.

View Full Text

Footnotes

  • Twitter @Fie0815

  • Contributors MD-C: Substantial contributions to the conception and design of the work; acquisition, analysis and interpretation of data; drafting the work and revising it critically for important intellectual content. FF, LM, GB, CB: Acquisition of data; revising the work critically for important intellectual content. JP, AR, JF, CG: Analysis and interpretation of data; revising the work critically for important intellectual content. GT: Substantial contributions to the conception and design of the work; analysis and interpretation of data; drafting the work and revising it critically for important intellectual content. All authors gave their final approval of the version published and have agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests MD-C has received research grants from the Werner Otto Stiftung. JP has received funding for travel and/or speaker honoraria from Bayer, Pfizer/Bristol Myers Squibb, Janssen-Cilag and Bial. JF receives research support from the German Ministry of Science and Education (BMBF), German Ministry of Economy and Innovation (BMWi), German Research Foundation (DFG), European Union (EU), Hamburgische Investitions- und Förderbank (IFB), Medtronic, Microvention, Philips, Stryker; and serves as a consultant for Acandis, Boehringer Ingelheim, Cerenovus, Evasc Neurovascular, MD Clinicals, Medtronic, Medina, Microvention, Penumbra, Route92, Stryker, Transverse Medical; and serves as an Editorial Board member (Associate Editor) of the Journal of NeuroInterventional Surgery. CG serves on scientific advisory boards for Bayer Vital, Boehringer Ingelheim, Acticor Biotech, Amgen, and Prediction Biosciences; has received funding for travel and/or speaker/consulting honoraria from Bayer Vital, Boehringer Ingelheim, Sanofi Aventis, Amgen, EBS Technologies, GlaxoSmithKline, Lundbeck, Pfizer, Silk Road Medical, and UCB, and Abbott; serves on editorial boards for INFO Neurologie & Psychiatrie and Aktuelle Neurologie and as editor of textbook Therapie und Verlauf neurologischer Erkrankungen; has received grants to supporting employees/scientists of his clinic from Merz Pharmaceuticals, Allergan, Novartis, and NeuroConn; and receives research support from Deutsche Forschungsgesellschaft, the European Union, Wegener Foundation, Schilling Foundation, and Werner-Otto-Foundation. GT has received personal fees as consultant or lecturer from Acandis, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb/Pfizer, Daichi Sankyo, Stryker, and research grants from Bayer, Federal Ministry for Economic Affairs and Energy (BMWi), Corona-Foundation, German Research Foundation (DFG), Else Kröner-Fresenius Foundation, European Union (Horizon 2020), German Innovation Fund.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.