Profiles of patients' self-reported health after acute stroke

D Leander Rimmele, Theresa Schrage, Lisa Lebherz, Levente Kriston, Christian Gerloff, Martin Härter, Götz Thomalla, D Leander Rimmele, Theresa Schrage, Lisa Lebherz, Levente Kriston, Christian Gerloff, Martin Härter, Götz Thomalla

Abstract

Background: We aimed to identify groups of patients with similar health status after stroke, assessed by patient reported outcome measures (PROMs), to improve initial risk stratification.

Methods: In a prospective study, inpatients were recruited during acute stroke treatment. Demographics, history, and cardio-vascular risk factors were assessed at baseline. Self-reported functional status, physical and mental health as well as anxiety and depressive symptoms were assessed 3 and 12 months after stroke and used to identify latent classes. The association of patient characteristics with latent class membership was investigated with multinomial logistic regression.

Results: Of the 650 patients included with a mean age of 75 years and 48% female, 70% had ischemic, 6% hemorrhagic strokes, and 24% transient ischemic attacks. Median NIHSS on admission was 2 (IQR:0,5). Values of PROMs remained comparable at 3 and 12 months. A three-class model was developed, differentiating between patients with mildly (75%), moderately (17%), and severely (8%) impaired self-reported health status. Adjusted for univariately significant baseline characteristics, initial NIHSS distinguished mild- from moderate-, and moderate- from severe-class-membership (p < 0.001). Length of inpatient stay (p < 0.001;OR = 1.1), diabetes (p = 0.021;OR = 1.91), and atrial fibrillation (p = 0.004;OR = 2.20) predicted allocation to the moderately vs. mildly affected class.

Conclusions: Grading stroke patients by a standard set of PROMs up to 1 year after stroke allows to distinguish the diverse impact of baseline characteristics on differently affected groups. In addition to initial stroke severity, longer inpatient stay, presence of diabetes and atrial fibrillation correlate with greater impairment of self-reported health in the less affected groups.

Trial registration: http://www.ClinicalTrials.gov ; Unique identifier: NCT03795948 .

Keywords: ICHOM, PROMIS; Patient-reported outcome measures; Stroke; Value-based health care.

Conflict of interest statement

DLR, TS, LL, LK, and MH have nothing to report. CG reports personal fees from Amgen, Bayer Vital, Bristol-Myers Squibb, Boehringer Ingelheim, Sanofi Aventis, Abbott, and Prediction Biosciences outside the submitted work. GT reports receiving consulting fees from Acandis, grant support, and lecture fees from Bayer, lecture fees from Boehringer Ingelheim, Bristol-Myers Squibb/Pfizer, and Daiichi Sankyo, and consulting fees and lecture fees from Stryker outside the submitted work.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Class Evolution Tree of the four empirically most strongly supported models from the latent profile analysis. The bold numbers indicate absolute and relative frequency. The depicted variables are patient-reported outcomes. Abbreviations: PH = physical health; MH = mental health; Dep = depressive symptoms; Anx = anxiety; Funct = functional status; mod. = moderate
Fig. 2
Fig. 2
Patient-reported outcomes after 3 and 12 months clustered in three classes of mild (1), moderate (2), and severe (3) impairment. Physical health (PH) and mental health (MH) were assessed by PROMIS-10, anxiety (Anx) and depressive symptoms (DP) by the PHQ-4, dependencies in functional status (Funct) concerning dressing, toileting and walking by the ICHOM-SSS after 3 and 12 months of diagnosis. Outcomes were clustered by Latent Profile Analysis in three classes (1 = blue, 2 = red, 3 = green). The different values of the items were related to the Z-Score for comparability. Abbreviations: PH = physical health; MH = mental health; Anx = anxiety; DP = depressive symptoms; PROMIS-10 = Patient-reported Outcomes Measurement Information System Short Form-10; PHQ-4 = Patient Health Questionnaire-4; ICHOM-SSS=International Consortium for Health Outcome Measurement Standard Set for Stroke

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