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Abstract

Objective:

To evaluate the 5-year impact of stroke and TIA on utility and quality-adjusted survival.

Methods:

TIA and stroke patients from a UK population-based study (Oxford Vascular Study) were recruited from 2002 to 2007, and followed up until 2012. Quality of life was assessed over 5 years using the EQ-5D (EuroQol-5 Dimensions), with responses converted into utilities ranging from −0.59 (worse than death) to 1 (perfect health), using UK population valuations. Utilities for stroke and TIA patients were compared with those in matched controls obtained from the 2006 Health Survey for England. Five-year quality-adjusted life years were estimated by combining utility and survival information.

Results:

Four hundred forty TIA and 748 stroke patients were ascertained and included. Utility remained constant at approximately 0.78 over the 5 years after TIA. Utility improved from 0.64 one month after stroke to 0.70 at 6 months (p = 0.006), remaining at approximately 0.70 thereafter. Matched controls had considerably higher utility levels than stroke/TIA patients (0.85, p < 0.001). Event severity and recurrent stroke were significant predictors of decreased long-term utility. Five-year quality-adjusted life expectancy was 3.32 (95% confidence interval: 3.22–3.48) quality-adjusted life years after TIA and 2.21 (2.15–2.37) after stroke, varying considerably by severity (minor: 2.94; moderate: 1.65; and severe: 0.70).

Conclusion:

Quality-adjusted survival is low over the 5 years after stroke and TIA, with severity and recurrent stroke being major predictors. There remains considerable scope for improvements in acute treatment and secondary prevention to improve the quality of life after TIA and stroke.

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Supplementary Material

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Information & Authors

Information

Published In

Neurology®
Volume 81Number 18October 29, 2013
Pages: 1588-1595
PubMed: 24107865

Publication History

Received: March 28, 2013
Accepted: August 5, 2013
Published online: October 9, 2013
Published in print: October 29, 2013

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Disclosure

R. Luengo-Fernandez receives funding from a UK National Institute for Health Research/Medical Research Council/Economic and Social Research Council postdoctoral fellowship in Health Economics. A.M. Gray is in receipt of an NIHR Senior Investigator Award. L. Bull, S. Welch, and F. Cuthbertson report no disclosures. P.M. Rothwell is in receipt of an NIHR Senior Investigator Award and Wellcome Trust Senior Investigator Award. Go to Neurology.org for full disclosures.

Study Funding

R.L.-F. is funded from an Economic and Social Research Council/Medical Research Council/National Institute for Health Research (NIHR) early career fellowship in economics of health. The research was supported by the NIHR Oxford Biomedical Research Centre Programme. OXVASC is funded by the UK Medical Research Council, the Dunhill Medical Trust, Wellcome Trust, and the Stroke Association. The Health Economics Research Centre obtains part of its funding from the NIHR.

Authors

Affiliations & Disclosures

Ramon Luengo-Fernandez, DPhil
From the Health Economics Research Centre (R.L.-F., A.M.G.), Nuffield Department of Population Health, University of Oxford; and the Stroke Prevention Research Unit (L.B., S.W., F.C., P.M.R), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
R. Luengo-Fernandez received funding from a UK National Institute for Health Research/Medical Research Council/Economic and Social Research Council post-doctoral fellowship in Health Economics.
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Alastair M. Gray, PhD
From the Health Economics Research Centre (R.L.-F., A.M.G.), Nuffield Department of Population Health, University of Oxford; and the Stroke Prevention Research Unit (L.B., S.W., F.C., P.M.R), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK.
Disclosure
Scientific Advisory Boards:
1.
Served on National Institute of Clinical Excellence scientific advice programme in August and November 2011. Served on Novo Nordisk advisory boards in 2011 and 2012.
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
Given speaker fee by Pfizer for presenting at conference in Liverpool, November 2012.
Editorial Boards:
1.
Diabetic Medicine, Associate Editor, 2008-2011.
Patents:
1.
NONE
Publishing Royalties:
1.
Gray AM, Clarke PM, Wolstenholme JL, Wordsworth S. Applied Methods of Cost-effectiveness Analysis in Health Care. Handbooks in Health Economic Evaluation. Oxford: Oxford University Press, 2010.
Employment, Commercial Entity:
1.
University of Oxford, tenured position, professor.
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Linda Bull, RGN
From the Health Economics Research Centre (R.L.-F., A.M.G.), Nuffield Department of Population Health, University of Oxford; and the Stroke Prevention Research Unit (L.B., S.W., F.C., P.M.R), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Sarah Welch, RGN
From the Health Economics Research Centre (R.L.-F., A.M.G.), Nuffield Department of Population Health, University of Oxford; and the Stroke Prevention Research Unit (L.B., S.W., F.C., P.M.R), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Fiona Cuthbertson, MCSP
From the Health Economics Research Centre (R.L.-F., A.M.G.), Nuffield Department of Population Health, University of Oxford; and the Stroke Prevention Research Unit (L.B., S.W., F.C., P.M.R), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Peter M. Rothwell, FMedSci
From the Health Economics Research Centre (R.L.-F., A.M.G.), Nuffield Department of Population Health, University of Oxford; and the Stroke Prevention Research Unit (L.B., S.W., F.C., P.M.R), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK.
Disclosure
Scientific Advisory Boards:
1.
Bayer - Executive Committee of ARRIVE Trial - 2006 onwards Servier - Executive Committee of PERFORM trial - 2005 -2010 Pfizer - IDMC if Rocket-AF Trial - 2006 - 2009 Biotronic - Executive Committee of device trial - 2005 - 2011
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
I don't keep a record. Certainly had travel expenses paid by Sanofi-Aventis, Servier, Astra-Zeneca and Bayer in past. However, nothing relevant to this manuscript.
Editorial Boards:
1.
Editorial Board - Lancet Neurology, Stroke, Cerebrovascular Diseases Assistant editor - International Journal of Stroke
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
For the Oxford Vascular Study
From the Health Economics Research Centre (R.L.-F., A.M.G.), Nuffield Department of Population Health, University of Oxford; and the Stroke Prevention Research Unit (L.B., S.W., F.C., P.M.R), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK.

Notes

Correspondence to Prof. Rothwell: [email protected]
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

Author Contributions

R.L.-F.: study concept and design, data management, draft and revision of the manuscript, statistical analysis, interpretation of data. A.M.G.: revision of the manuscript, interpretation of data, statistical analysis. L.B., S.W., F.C.: data acquisition, revision of the manuscript. P.M.R.: study concept and design, revision of the manuscript, interpretation of data, study supervision.

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