Saving The Lost Years After Stroke
Quality of life and lifespan both suffer for victims of stroke highlighting the need for better stroke prevention.
By Jennifer J. Brown, PhD
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WEDNESDAY, October 9, 2013 —People who survive a stroke or mini-stroke lose years from their life. They also have a lower quality of life, according to a study published today in the journal Neurology. The study points to a need for better stroke recovery methods — and a need to do a better job at preventing stroke.
“In the immediate phase, I couldn’t speak and had weakness on my left side, which was frustrating and, more than the physical challenges, isolating and scary,” said Donna K. Arnett, PhD, about surviving a stroke. She was only 27 and working as a nurse when her stroke hit.
After recovering, Dr. Arnett went on to become a professor and served as the president of the American Heart Association. Arnett is now a professor and chair of epidemiology at the University of Alabama at Birmingham.
“In the acute period, the stroke did impact my QOL (quality of life),” said Arnett. “My major concerns during the acute phase were truly basic needs of communication and movement.”
Strokes result from:
- a blood clot blocking the normal blood flow to the brain
- bleeding in the brain after blood vessel bursts.
Damage done in the brain while it is starved of oxygen lead to varying levels of disability.
In the United States, more than 795,000 people each year have a stroke. According to the Center for Disease Control and Prevention (CDC), as many as 130,000 people die from stroke yearly. Stroke is now the fourth leading cause of death.
Measuring Lost Quality of Life After Stroke
We now know that lost quality of life is a common experience for stroke survivors, from the research of Ramon Luengo-Fernandez, DPhil, and others at the University of Oxford in the UK. The investigators found that the people who survived a stroke on average lost two quality years out of five.
For 440 mini-stroke patients and 748 stroke patients in the research study, both quality of life and life expectancy went down. The biggest losses were for the patients who had the most severe stroke.
Patients completed quality of life surveys at one month, six months and longer times over a five year follow-up period. The surveys showed researchers a gradient of life expectancy which they called quality-adjusted life years:
Life Expectancy in Quality Adjusted Life Years
- After minor stroke: 3 years out of 5
- After moderate stroke: 1.7 years out of 5
- After severe stroke: 0.7 years out of 5
Lead investigator Dr. Luengo-Fernandez said that suffering subsequent strokes — or being disabled before the stroke — also significantly reduced people’s 5-year quality-adjusted life expectancy.
Even after a mini-stroke, life is altered. Luengo-Fernandez explained that for survivors of mini-stroke, “The combined impact of medication, anxiety about suffering subsequent events, and for those in employment, the impact on their working life will impact quality of life.”
Social factors influence quality of life after stroke. “We found that at 5 years post-stroke, and after taking into account other patient characteristics, stroke survivors who were married had significantly higher quality of life levels than those who were either widowed, single, or separated/divorced,” said Luengo-Fernandez. Education levels also had a positive impact on quality of life at 5 years.
For Arnett, the recovery from her stroke was gradual. “By one month, I had recovered most of the physical complications and speech disturbances,” she said. “My QOL (quality of life) was much improved, but I was still relearning some things that 'disappeared' from my memory after the stroke — simple things that I had to relearn. And I was dealing with the sadness of what had happened to me.”
How to Improve Quality of Life after Stroke
“By six months I was fully recovered,” said Arnett. “I still had a sense of vulnerability, but also, great hope. I had gone through a life-threatening event and had fully recovered. In many cases, stroke is treatable and preventable.”
One of the main problems after a mini-stroke, also called a transient ischemic attack (TIA) is the increased risk of subsequent stroke, according to Luengo-Fernandez. “Strokes following TIA significantly, and considerably, reduced quality of life,” he said. “Therefore, any intervention that prevents, or reduces, this risk will not only improve subsequent quality of life, but will also improve patients' life expectancy.”
Taking stroke prevention steps is a good start to recovery. Many people will suffer a second stroke. For example, artist Peter V. Cornelis in New York experienced not one, but six strokes. At first paralyzed and unable to speak, he recovered by using his artwork as therapy.
For stroke prevention, Luengo-Fernandez explained that cost-effective treatments of cholesterol-lowering drugs and treatments for reducing high blood pressure already exist. These significantly reduce the risk of suffering not only stroke, but also other cardiovascular events.
After stroke, survivors must be vigilant about keeping cholesterol, blood sugar, and blood pressure in check.
Luengo-Fernandez added, “Reducing risk factors for stroke, e.g. obesity, physical inactivity and diabetes, will also reduce the risk of suffering a stroke.” And not smoking is important in stroke prevention.
To regain quality of life, stroke survivors will need help with recovery. “In our study we found that stroke significantly reduces patients' ability to walk, perform usual activities and take care of themselves (e.g., bathing, feeding and dressing)” said Luengo-Fernandez. “Therefore, interventions such as physiotherapy and speech and language therapy will help patients recover some of their independence, and thus improve their quality of life.”
Luengo-Fernandez added that early targeted treatment is important. Fast and effective diagnosis to guide treatment such as thrombolysis can prevent even more damage to the brain. This will be effective in reducing the impact of stroke on ambulation, speech, and swallowing, therefore helping patients to continue performing their usual activities.
If You See a Stroke Act F.A.S.T.
For a stroke victim, the timing of emergency care is everything. Arnett said, “That is why it is so important to call 911 and get to the hospital as quickly as possible. The sooner treatments are administered, the more the brain has the ability to recover.”
Immediately after the stroke, actingF.A.S.T.to get emergency responders on the scene may save a person’s life. F.A.S.T.
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