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Cerebrovascular disease
Research paper
Associations with health-related quality of life after intracerebral haemorrhage: pooled analysis of INTERACT studies
  1. Candice Delcourt1,2,
  2. Danni Zheng1,
  3. Xiaoying Chen1,
  4. Maree Hackett1,3,
  5. Hisatomi Arima1,4,
  6. Jun Hata5,
  7. Emma Heeley6,
  8. Rustam Al-Shahi Salman7,
  9. Mark Woodward1,8,
  10. Yining Huang9,
  11. Thompson Robinson10,
  12. Pablo M Lavados11,
  13. Richard I Lindley1,12,
  14. Christian Stapf13,
  15. Leo Davies1,2,
  16. John Chalmers1,2,
  17. Craig S Anderson1,2,14,
  18. Shoichiro Sato1,15
  19. for the INTERACT Investigators
  1. 1The George Institute for Global Health, The University of Sydney, Sydney, New South Wales, Australia
  2. 2Neurology Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
  3. 3The University of Central Lancashire, Lancashire, UK
  4. 4Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
  5. 5Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
  6. 6Centre for Health Record Linkage, NSW Ministry of Health, Sydney, New South Wales, Australia
  7. 7Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
  8. 8Nuffield Department of Population Health, The George Institute for Global Health, Oxford University, Oxford, UK
  9. 9Department of Neurology, Peking University First Hospital, Beijing, China
  10. 10Department of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Diseases, University of Leicester, Leicester, UK
  11. 11Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Universidad de Chile, Santiago, Chile
  12. 12Westmead Hospital Clinical School, Westmead, New South Wales, Australia
  13. 13Department of Neuroscience, CRCHUM, University of Montreal, Montreal, Quebec, Canada
  14. 14The George Institute for Global Health China at Peking University Health Sciences Center, Beijing, China
  15. 15Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
  1. Correspondence to Professor Craig S Anderson The George Institute for Global Health, PO Box M201, Missenden Road, Camperdown, NSW 2050, Australia; canderson{at}georgeinstitute.org.au

Abstract

Background and purpose Limited data exist on health-related quality of life (HRQoL) after intracerebral haemorrhage (ICH). We aimed to determine baseline factors associated with HRQoL among participants of the pilot and main phases of the Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trials (INTERACT 1 and 2).

Methods The INTERACT studies were randomised controlled trials of early intensive blood pressure (BP) lowering in patients with ICH (<6 hours) and elevated systolic BP (150–220 mm Hg). HRQoL was determined using the European Quality of Life Scale (EQ-5D) at 90 days, completed by patients or proxy responders. Binary logistic regression analyses were performed to identify factors associated with poor overall HRQoL.

Results 2756 patients were included. Demographic, clinical and radiological factors associated with lower EQ-5D utility score were age, randomisation outside of China, antithrombotic use, high baseline National Institutes of Health Stroke Scale (NIHSS) score, larger ICH, presence of intraventricular extension and use of proxy responders. High (≥14) NIHSS score, larger ICH and proxy responders were associated with low scores in all five dimensions of the EQ-5D. The NIHSS score had a strong association with poor HRQoL (p<0.001). Female gender and antithrombotic use were associated with decreased scores in dimensions of pain/discomfort and usual activity, respectively.

Conclusions Poor HRQoL was associated with age, comorbidities, proxy source of assessment, clinical severity and ICH characteristics. The strongest association was with initial clinical severity defined by high NIHSS score.

Trial registration numbers NCT00226096 and NCT00716079; Post-results.

https://doi.org/10.1136/jnnp-2016-314414

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    Footnotes

    • Twitter Follow Rustam Al-Shahi Salman at @BleedingStroke

    • Collaborators INTERACT Investigators (see online only reference ‘Supplemental data 2_INTERACT Investigators.pdf’).

    • Contributors CD, DZ, CSA and SS contributed to the concept and rationale for the study. DZ and SS contributed to statistical analyses. CD, DZ, and Sato were responsible for the first draft of the manuscript. CD, DZ, XC, CSA and SS contributed to the interpretation of the results. All authors participated in the drafting and took responsibility for the content and integrity of this article.

    • Funding The National Health and Medical Research Council of Australia provided funding for this research.

    • Competing interests CSA received speaker fees from Takeda China and Advisory Committee reimbursement from Medtronic and Astra Zeneca. The other authors report no conflicts of interest.

    • Ethics approval Relevant ethics committee in countries involved.

    • Provenance and peer review Not commissioned; externally peer reviewed.