Health related quality of life and satisfaction with care of stroke patients in Budapest: A substudy of the EuroHOPE project

PLoS One. 2020 Oct 22;15(10):e0241059. doi: 10.1371/journal.pone.0241059. eCollection 2020.

Abstract

Background: Disadvantaged socioeconomic status is associated with higher stroke incidence and mortality, and higher readmission rate. We aimed to assess the effect of socioeconomic factors on case fatality, health related quality of life (HRQoL), and satisfaction with care of stroke survivors in the framework of the European Health Care Outcomes, Performance and Efficiency (EuroHOPE) study in Hungary, one of the leading countries regarding stroke mortality.

Methods: We evaluated 200 consecutive patients admitted for first-ever ischemic stroke in a single center and performed a follow-up at 3 months after stroke. We recorded pre- and post-stroke socioeconomic factors, and assessed case fatality, HRQoL and patient satisfaction with the care received. Stroke severity at onset was scored by the National Institutes of Health Stroke scale (NIHSS), disability at discharge from acute care was evaluated by the modified Rankin Score (mRS). To evaluate HRQoL and patient satisfaction with care we used the EQ-5D-5L, 15D and EORTC IN PATSAT 32 questionnaires.

Results: At 3 months after stroke the odds of death was significantly increased by stroke severity (NIHSS, OR = 1.209, 95%CI: 1.125-1.299, p<0.001) and age (OR = 1.045, 95%CI: 1.003-1.089, p = 0.038). In a multiple linear regression model, independent predictors of HRQoL were age, disability at discharge, satisfaction with care, type of social dwelling after stroke, length of acute hospital stay and rehospitalization. Satisfaction with care was influenced negatively by stroke severity (Coef. = -1.111, 95%C.I.: -2.159- -0.062, p = 0.040), and positively by having had thrombolysis (Coef. = 25.635, 95%C.I.: 5.212-46.058, p = 0.016) and better HRQoL (Coef. = 22.858, 95%C.I.: 6.007-39.708, p = 0.009).

Conclusion: In addition to age, disability, and satisfaction with care, length of hospital stay and type of social dwelling after stroke also predicted HRQoL. Long-term outcome after stroke could be improved by reducing time spent in hospital, i.e. by developing home care rehabilitation facilities thus reducing the need for readmission to inpatient care.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Disease Management
  • Female
  • Hospitalization
  • Humans
  • Hungary / epidemiology
  • Length of Stay
  • Male
  • Middle Aged
  • Patient Discharge
  • Patient Satisfaction*
  • Quality of Life*
  • Retrospective Studies
  • Severity of Illness Index
  • Stroke / epidemiology*
  • Stroke / therapy

Grant support

The work was supported by the EuroHOPE Research Grant [241721], financed by the European Union, belonging into the seventh Framework Program (FP7) of the European Commission (to IS, DB, JL, EB, UH and IV). It was also supported by grants from the National Brain Research Program (KITA-NAP-13-1-2013-0001, to DB), the Higher Education Institutional Excellence Program and the New National Excellence Program (UNKP-17-3, to DB) of the Ministry of Human Resources of the Government of Hungary. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.