Oral Presentation Australian and New Zealand Stroke Organisation Conference 2026

Determinants of impaired health-related quality of life in functionally recovered acute ischaemic stroke patients: secondary analysis of the OPTIMISTmain trial (139396)

Chenming Gu 1 , Menglu Ouyang 1 , Xia Wang 1 , Leibo Liu 1 , Victor Urrutia 2 , Craig Anderson 1 , Debbie Summers 3 , Brenda Johnson 2
  1. The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
  2. The Johns Hopkins Hospital Comprehensive Stroke Center, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, USA
  3. Saint Luke’s Hospital of Kansas City, Marion Bloch Neuroscience Institute, Kansas City, USA

Background/Aims

Favourable functional recovery after acute ischaemic stroke (AIS) does not translate into preserved health-related quality of life (HRQoL). We aimed to evaluate the prevalence and determinants of HRQoL impairment in this population..

Methods

In this secondary analysis of the Optimal Post rTpa-Iv Monitoring in Ischaemic Stroke Trial (OPTIMISTmain), an international, stepped-wedge, cluster-randomised trial comparing a low-intensity to a standard monitoring protocol, we analysed thrombolysed, mild-to-moderate AIS patients achieving a 90-day modified Rankin Scale (mRS) score of 0-1. The primary outcome, HRQoL impairment, was defined as an EQ-5D visual analogue scale (VAS) <70 or utility score <0.739 (the 25th percentile of the entire trial population). Secondary outcomes included continuous VAS, utility score, and individual EQ-5D domains (any problems vs. no problems). Multivariable logistic regression models were applied to identify determinants.

Results

Among 2,774 AIS patients achieving mRS 0-1, 267 (9.63%) experienced HRQoL impairment (median age 67 years; 41.6% female). White ethnicity (vs. Asian; odds ratio [OR]: 5.13, 95% confidence interval [CI]: 2.69-9.79), higher admission National Institutes of Health Stroke Scale (OR: 1.11, 95% CI: 1.05-1.18), and sleep impairment during hospitalisation (OR: 1.96, 95% CI: 1.34-2.88) were independently associated with HRQoL impairment. Consistent determinants were observed across VAS, utility score, and multiple HRQoL domains. Specifically, female sex (OR: 1.50, 95% CI: 1.05-2.13) and SAEs (OR: 2.27, 95% CI: 1.20-4.30) were associated with anxiety/depression.

Conclusion

Despite favourable functional recovery, HRQoL impairment still persists among AIS patients. Targeting modifiable factors, particularly sleep impairment and complications, may support individualised management and improve patient-perceived outcomes.