Temporal trends in health-related quality of life after stroke: analysis from the South London Stroke Register 1995-2011

Background Survival after stroke has dramatically increased in the last two decades as the treatment of stroke has improved. However, time-trend analyses of health-related quality of life in stroke patients covering this time period are still not well investigated. Aims The study aims to examine temporal trends in mental and physical health-related quality of life of stroke survivors between the period of 1995 and 2011. Methods First in a lifetime strokes were registered in the South London Stroke Register between 1995 and 2011. Using the Short Form-12 Health Survey, trends in self-reported health-related quality of life at one-year after stroke were assessed over a 17-year period using linear regression, adjusting for socio-demographics, risk factors, and case-mix variables. Analyses stratifying by age, gender, race-ethnicity, and functional impairment were also performed. Results The overall trends of mental and physical health-related quality of life scores at one-year after stroke remained relatively unchanged over the period 1995–2011. However, mental health-related quality of life scores significantly improved between the period of 1995–2007 [β = 0·94 (95% CI; 0·15 to 1·74), P = 0·02], after which scores deteriorated [β = −2·02 (–3·82 to −0·22), P = 0·03]. Physical health-related quality of life scores remained stable until 2007, after which scores declined [β = −1·63 (–3·25 to −0·01), P = 0·05]. Conclusions Despite declining health-related quality of life trends within the general population, stroke survivors' overall health-related quality of life remained unchanged, possibly due to lower expectations of health among stroke survivors. However, in recent years there has been a significant unexplained decline in both physical and mental health-related quality of life, suggesting that despite stroke policy aims to improve health-related quality of life, more needs to be done to target this decline.