Devastating Loss of Life Expectancy and Quality-Adjusted Life Years after Stroke in Brazil: A Focus on Hemorrhagic Subtypes

OBJECTIVES: This study aims to evaluate the loss of life expectancy and quality-adjusted life-years (QALYs) in patients suffering from various stroke types in Brazil, focusing on intraparenchymal hemorrhage (IPH) subtypes, including medication-related causes involving direct oral anticoagulants (DOACs) or warfarin.

METHODS: We developed a Markov model to simulate life expectancy and QALYs post-stroke. Data from 8,231 patients in the population-based Joinville Stroke Registry (Joinvasc) were used to determine model parameters, including annual death and stroke recurrence risk of different stroke types. Post-stroke utility values for disabled or non-disabled patients after stroke were sourced from a previously published Joinvasc study. Death risk and utility values per age group in the general population were obtained from the Brazilian Institute of Geography and Statistics nationwide data and previously published Brazilian EQ-5D norms respectively.

RESULTS: At an average age of 66 years, stroke patients were estimated to have a life expectancy of 10.2 years and 7.1 QALYs. This contrasted with the general population’s 19.5 years of life and 14.9 QALYs, translating to 9.4 years of life lost (YLL) and 7.1 QALYs lost. We estimated 9.2 YLL and 7.7 QALYs lost for ischemic strokes, 13.0 YLL and 10.7 QALYs lost for IPH and 12.5 YLL and 9.9 QALYs lost for subarachnoid hemorrhages. Among IPH subtypes, the most severe outcomes were associated with warfarin (15.6 YLL and 12.5 QALYs lost), followed by DOACs (14.4 YLL and 11.9 QALYs lost), non-lobar IPH (13.9 YLL and 11.4 QALYs lost) and lobar IPH (11.2 YLL and 9.4 QALYs lost).

CONCLUSIONS: While all stroke types were associated with significant YLL and QALYs lost, the outcomes were notably worse in cases of subarachnoid hemorrhages and IPH, particularly those related to anticoagulants. This insight underscores the necessity for preventive measures and optimized post-stroke care, particularly in the management of IPH, to mitigate these losses.