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(Stroke. 2004;35:2340.)
© 2004 American Heart Association, Inc.

Original Contributions

Quality of Life After Stroke

The North East Melbourne Stroke Incidence Study (NEMESIS)

Jonathan W. Sturm, PhD; Geoffrey A. Donnan, MD; Helen M. Dewey, PhD; Richard A. L. Macdonell, MD; Amanda K. Gilligan, MBBS; Velandai Srikanth, PhD Amanda G. Thrift, PhD

From the National Stroke Research Institute (J.W.S., G.A.D., H.M.D., R.A.L.M., A.K.G., A.G.T.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne; the Department of Neurology (J.W.S), Gosford Hospital, Central Coast Area Health, Gosford, and the Department of Medicine, University of Newcastle, New South Wales; the Department of Neurology (G.A.D., H.M.D., R.A.L.M., A.K.G., A.G.T.), Austin Health, West Heidelberg; the Department of Medicine (G.A.D., H.M.D., R.A.L.M., A.G.T.), University of Melbourne, Melbourne; the Menzies Research Institute (V.S.), Hobart; and the Department of Epidemiology and Preventive Medicine (A.G.T.), Monash Medical School, Alfred Hospital, Melbourne, Australia.

Correspondence to Dr Jonathan Sturm, Department of Neurology, Gosford Hospital, PO Box 361, NSW 2250, Australia. E-mail jwsturm{at}doh.health.nsw.gov.au

Background and Purpose— Health-related quality of life (HRQoL) data are scarce from unselected populations. The aims were to assess HRQoL at 2 years poststroke, to identify determinants of HRQoL in stroke survivors, and to identify predictors at stroke onset of subsequent HRQoL.

Methods— All first-ever cases of stroke in a population of 306 631 over a 1-year period were assessed. Stroke severity, comorbidity, and demographic information were recorded. Two-year poststroke HRQoL was assessed using the Assessment of Quality of Life (AQoL) instrument (deceased patients score=0). Handicap, disability, physical impairment, depression, anxiety, living arrangements, and recurrent stroke at 2 years were documented. If necessary, proxy assessments were obtained, except for mood. Linear regression analyses were performed to identify factors independently associated with HRQoL.

Results— Of 266 incident cases alive at 2 years, 225 (85%) were assessed. The mean AQoL utility score for all survivors was 0.47 (95% CI, 0.42 to 0.52). Almost 25% of survivors had a score of 0.1. The independent determinants of HRQoL in survivors were handicap, physical impairment, anxiety and depression, disability, institutionalization, dementia, and age. The factors present at stroke onset that independently predicted HRQoL at 2 years poststroke were age, female sex, initial NIHSS score, neglect, and low socioeconomic status.

Conclusions— A substantial proportion of stroke survivors have very poor HRQoL. Interventions targeting handicap and mood have the potential to improve HRQoL independently of physical impairment and disability.

Key Words: cerebrovascular disorders • epidemiology • outcome • quality of life • stroke

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