Stroke, Vol 25, 1721-1725, Copyright © 1994 by American Heart Association
NA Solomon, HA Glick, CJ Russo, J Lee and KA Schulman
BACKGROUND AND PURPOSE: In clinical trials stroke is reported as a major
morbid outcome, but the impact of stroke on patients is not directly
assessed. This study examines patient preferences for different outcomes of
stroke, including death. METHODS: We presented patients with written case
scenarios of stroke outcomes. The scenarios represented four categories of
stroke severity (mild, moderate, severe, and fatal), and for nonfatal
strokes the scenarios described motor, language, and cognitive deficits.
Patients reported values for each of the 10 stroke scenarios using a
rank-and-scale method over a 100-point range, with 100 representing perfect
health and 0 corresponding to the worst possible health state. RESULTS: One
hundred seventeen of 209 consecutive patients at risk for stroke
participated in this study. Severe strokes were uniformly rated as having
low preference weights (mean +/- SD [median]: 3 +/- 4 [1] for disabling
hemiplegia, 8 +/- 9 [5] for confusion, and 15 +/- 14 [10] for global
aphasia), and severe motor impairment (a disabling hemiplegia) was rated as
significantly worse than death. Even mild deficits resulted in substantial
loss to patients (54 +/- 21 [55] for dysarthria and 53 +/- 21 [50] for mild
anomia). CONCLUSIONS: Strokes may result in a wide variety of post- stroke
consequences for patients. Severe strokes may be viewed by patients as
tantamount to or worse than death. Even mild strokes may cause significant
declines in patient preferences for health states. These data are useful in
interpreting studies that report stroke and death, in designing new studies
that measure stroke in at-risk populations, and in helping patients reach
treatment decisions about therapies designed to prevent strokes.
ARTICLES
Patient preferences for stroke outcomes
Robert Wood Johnson Clinical Scholars Program, Stanford University School of Medicine, Palo Alto, Calif.
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