TY - JOUR
T1 - Direct Assessment of Health Utilities Using the Standard Gamble among Patients with Primary Intracerebral Hemorrhage
AU - Slaughter, Kristen B.
AU - Meyer, Ellie G.
AU - Bambhroliya, Arvind B.
AU - Meeks, Jennifer R.
AU - Ahmed, Wamda
AU - Bowry, Ritvij
AU - Behrouz, Reza
AU - Mir, Osman
AU - Begley, Charles
AU - Tyson, Jon E.
AU - Miller, Charles
AU - Warach, Steven
AU - Grotta, James C.
AU - McCullough, Louise D.
AU - Savitz, Sean I.
AU - Vahidy, Farhaan S.
N1 - Funding Information:
We acknowledge the support provided by the Biostatistics/ Epidemiology/ Research Design component of the Center for Clinical and Translational Sciences for this project.
Funding Information:
EnRICH is funded by Texas State Legislature via the Lone Star Stroke Consortium. The study is approved by institutional review boards of all participating sites. Patients are currently being enrolled with anticipated completion of follow-up and data quality by December 2019. Study updates are regularly provided via the Lone Star Stroke website (http:// lonestarstroke.com). On study completion, deidentified data availability for further analyses will be determined by the Institutional Review Board and the Executive Committee of the Lone Star Stroke.
Funding Information:
This work is funded by the Texas State Legislature via the Lone Star Stroke Research Consortium. Neither the Texas State Legislature nor the Lone Star Stroke Research Consortium influenced study design, data collection and analysis, data interpretation or writing of this manuscript. The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official views of the State of Texas.
Publisher Copyright:
© 2019 American Heart Association, Inc.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2019/9/1
Y1 - 2019/9/1
N2 - Background: Standard gamble (SG) directly measures patients' valuation of their health state. We compare in-hospital and day-90 SG utilities (SGU) among intracerebral hemorrhage patients and report a 3-way association between SGU, EuroQoL-5 dimension, and modified Rankin Scale at day 90. Methods and Results: Patients with intracerebral hemorrhage underwent in-hospital and day-90 assessments for the modified Rankin Scale, EuroQoL-5 dimension, and SG. SG provides patients a choice between their current health state and a hypothetical treatment with varying chances of either perfect health or a painless death. Higher SGU (scale, 0-1) indicates lower risk tolerance and thus higher valuation of the current health state. Logistic regression was used to estimate the likelihood of low SGU (≤0.6), and Wilcoxon paired signed-rank test compared in-hospital and day-90 SGU. In-hospital and day-90 SG was obtained from 381 and 280 patients, respectively, including 236 paired observations. Median (interquartile range) in-hospital and day-90 SGUs were 0.85 (0.40-0.98) and 0.98 (0.75-1.00; P<0.001). In-hospital SGUs were lower with advancing age (P=0.007), higher National Institutes of Health Stroke Scale, and intracerebral hemorrhage scores (P<0.001). Proxy-based assessments resulted in lower SGUs; median difference (95% CI),-0.2 (-0.33 to-0.07). After adjustment, higher National Institutes of Health Stroke Scale and proxy assessments were independently associated with lower SGU, along with an effect modification of age by race. Day-90 SGU and modified Rankin Scale were significantly correlated; however, SGUs were higher than the EuroQoL-5 dimension utilities at higher modified Rankin Scale levels. Conclusions: Divergence between directly (SGU) and indirectly (EuroQoL-5 dimension) assessed utilities at high levels of functional disability warrant careful prognostication of intracerebral hemorrhage outcomes and should be considered in designing early end-of-life care discussions with families and patients.
AB - Background: Standard gamble (SG) directly measures patients' valuation of their health state. We compare in-hospital and day-90 SG utilities (SGU) among intracerebral hemorrhage patients and report a 3-way association between SGU, EuroQoL-5 dimension, and modified Rankin Scale at day 90. Methods and Results: Patients with intracerebral hemorrhage underwent in-hospital and day-90 assessments for the modified Rankin Scale, EuroQoL-5 dimension, and SG. SG provides patients a choice between their current health state and a hypothetical treatment with varying chances of either perfect health or a painless death. Higher SGU (scale, 0-1) indicates lower risk tolerance and thus higher valuation of the current health state. Logistic regression was used to estimate the likelihood of low SGU (≤0.6), and Wilcoxon paired signed-rank test compared in-hospital and day-90 SGU. In-hospital and day-90 SG was obtained from 381 and 280 patients, respectively, including 236 paired observations. Median (interquartile range) in-hospital and day-90 SGUs were 0.85 (0.40-0.98) and 0.98 (0.75-1.00; P<0.001). In-hospital SGUs were lower with advancing age (P=0.007), higher National Institutes of Health Stroke Scale, and intracerebral hemorrhage scores (P<0.001). Proxy-based assessments resulted in lower SGUs; median difference (95% CI),-0.2 (-0.33 to-0.07). After adjustment, higher National Institutes of Health Stroke Scale and proxy assessments were independently associated with lower SGU, along with an effect modification of age by race. Day-90 SGU and modified Rankin Scale were significantly correlated; however, SGUs were higher than the EuroQoL-5 dimension utilities at higher modified Rankin Scale levels. Conclusions: Divergence between directly (SGU) and indirectly (EuroQoL-5 dimension) assessed utilities at high levels of functional disability warrant careful prognostication of intracerebral hemorrhage outcomes and should be considered in designing early end-of-life care discussions with families and patients.
KW - critical care outcomes
KW - intracranial hemorrhages
KW - patient outcome assessment
KW - quality of life
KW - stroke
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U2 - 10.1161/CIRCOUTCOMES.119.005606
DO - 10.1161/CIRCOUTCOMES.119.005606
M3 - Article
C2 - 31514521
AN - SCOPUS:85072149584
SN - 1941-7713
VL - 12
JO - Circulation: Cardiovascular Quality and Outcomes
JF - Circulation: Cardiovascular Quality and Outcomes
IS - 9
M1 - e005606
ER -