PATIENT PREFERENCES FOR STROKE OUTCOMES

Background and Purpose In clinical trials stroke is reported as a majo r morbid outcome, but the impact of stroke on patients is not directly assessed. This study examines patient preferences for different outco mes of stroke, including death. Methods We presented patients with wri tten case scenarios of stroke outcomes. The scenarios represented four categories of stroke severity (mild, moderate, severe, and fatal), an d for nonfatal strokes the scenarios described motor, language, and co gnitive deficits. Patients reported values for each of the 10 stroke s cenarios using a rank-and-scale method over a 100-point range, with 10 0 representing perfect health and 0 corresponding to the worst possibl e health state. Results One hundred seventeen of 209 consecutive patie nts at risk for stroke participated in this study. Severe strokes were uniformly rated as having low preference weights (mean+/-SD [median]: 3+/-4 [1] for disabling hemiplegia, 8+/-9 [5] for confusion, and 15+/ -14 [10] for global aphasia), and severe motor impairment (a disabling hemiplegia) was rated as significantly worse than death. Even mild de ficits resulted in substantial loss to patients (54+/-21 [55] for dysa rthria and 53+/-21 [50] for mild anomia). Conclusions Strokes may resu lt in a wide variety of poststroke consequences for patients. Severe s trokes may be viewed by patients as tantamount to or worse than death. Even mild strokes may cause significant declines in patient preferenc es for health states. These data are useful in interpreting studies th at report stroke and death, in designing new studies that measure stro ke in at-risk populations, and in helping patients reach treatment dec isions about therapies designed to prevent strokes.