Quality of life after intracerebral hemorrhage: results of the Factor Seven for Acute Hemorrhagic Stroke (FAST) trial.
OBJECTIVE
Neurological impairment and physical disability are frequent and important complications of stroke with serious consequences for health-related quality of life (HRQOL). Little data exist, however, on the risk factors for poor HRQOL after intracerebral hemorrhage, the deadliest and most disabling form of stroke.


METHODS
Factor Seven for Acute Hemorrhagic Stroke (FAST) was an international, randomized, double-blind, placebo-controlled trial conducted between May 2005 and February 2007 at 122 sites in 22 countries. All patients were followed for 3 months after stroke onset and HRQOL was assessed using the EuroQoL. Multivariate stepwise logistic regression was used to identify predictors of poor HRQOL based on demographic and clinical baseline characteristics and in-hospital complications.


RESULTS
Six hundred fifty-seven patients survived until 3 months after stroke onset, and 621 (95%) completed the EuroQoL. Two percent had a utility score <0 (HRQOL worse than death), 15% a utility score <0.2, 32% a utility score <0.5, and 87% a score <0.87 (average score in the general population). At the other end of the scale, 13% had a utility score of 1 (perfect HRQOL). Independent predictors of poor HRQOL were advanced age (OR, 1.80; P<0.0001), higher baseline National Institutes of Health Stroke Scale score (OR, 1.11; P<0.0001), higher systolic blood pressure (OR, 1.05; P=0.0039), higher baseline intracerebral hemorrhage volume (OR, 1.11; P=0.015), deep (versus lobar) hematoma location (OR, 3.05; P=0.003), and increase in neurological deficit in first 72 hours after ICH onset (Delta Glasgow Coma Scale >or=2 or Delta National Institutes of Health Stroke Scale >or=4; OR, 2.04; P=0.006). The model explained a large amount of the variation in the utility score (C-statistic 0.77).


CONCLUSIONS
The vast majority of survivors after intracerebral hemorrhage have very poor HRQOL. Critical care interventions designed to control blood pressure or prevent neuroworsening may improve HRQOL in intracerebral hemorrhage survivors.
Christensen
Michael C
MC
Global Development, Novo Nordisk A/S, Bagsvaerd, Denmark. mcrc@novonordisk.com
Mayer
Stephan
S
Ferran
Jean-Marc
JM
D000208:Acute Disease; D000368:Aged; D000704:Analysis of Variance; D001794:Blood Pressure / Q000187:drug effects; D002543:Cerebral Hemorrhage / Q000150:complications / Q000523:psychology*; D003422:Critical Care; D004311:Double-Blind Method; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D020521:Stroke / Q000209:etiology / Q000523:psychology*; D011795:Surveys and Questionnaires