Depression and other determinants of values placed on current health stateby stroke patients Evidence from the VA Acute Stroke (VASt) study

Background and Purpose-This prospective study examined the determinants of the utility (value) placed on health status among a sample of patients with acute ischemic and intracerebral hemorrhagic stroke. Methods-Data were from the VA Acute Stroke (VASO study, a nationwide prospe ctive cohort of 1073 acute stroke patients admitted at any of 9 Department of Veterans Affairs Medical Center sites between April 1, 1995, and March 3 1, 1997. The primary outcome was the patient's health status utility as mea sured by the time-tradeoff method. Data were obtained by telephone intervie ws at 1, 6, and 12 months and by medical record review. General linear mixe d modeling was used to assess the effects of social, psychological, and phy sical factors on patients' valuations of their current health state. The an alysis was confined to the 327 patients who were able to provide self-repor ts at greater than or equal to 2 time points. Results-Patients' valuations of their health state status over the initial 12 months after stroke were very stable over time, with only a slight impro vement at 6 months, followed by a slight decline at 12 months. In adjusted analyses, living alone, being institutionalized, decreased physical functio n, and depression were independently associated with lower levels of patien t health status utility over time. Conclusions-Stroke patient health status utilities are relatively stable du ring the initial year after stroke. In addition to physical function, psych ological health and social environment are important determinants of patien t health status utility. These factors need to be considered when-conductin g stroke decision analyses if more accurate conclusions are to be drawn reg arding preferred patterns of care.