Health related Quality of Life and Prediction of Life Expectancy using Charlson Comorbidity Index in Post Stroke patients

Cerebrovascular accident (CVA) or brain attack orSTROKE as we commonly refer to is the sudden death ofneurons in a localized area of brain due to inadequate bloodsupply. The mortality rate due to stroke in India is 22 timesthat of malaria and 1.4 times that of tuberculosis. It’s a majorpublic health challenge not only for neuropharmacologybut the society in general.1 Patients suffering from strokeare usually recipients of a long list of medicines where thetherapy continues for a long time, usually lifelong.Comorbidities are major determinants in the treatmentof stroke which is common in patients with hypertension,high blood cholesterol, Diabetes Mellitus, heart disease.Heavy smoking and alcohol consumption are other causesfor Stroke.2 According to India stroke factsheet updated in2012, the estimated age-adjusted prevalence rate for strokeranges between 84/100,000 and 262/100,000 in rural andbetween 334/100,000 and 424/100,000 in urban areas.3 Recentreports have shown a substantial increase of stroke inyounger population.4 50% of stroke is preventable by controlof modifiable risk factors and lifestyle changes (aerobicexercise to counteract inactivity, weight loss in obesity,glucose control in diabetics, smoking cessation, anddiet).5American Stroke Association (ASA) and the AmericanHeart Association (AHA) have recently published updatedguidelines for secondary prevention of stroke.6,7The management of stroke should be individualized. Asproper drug utilization is a concern for various diseases, thesame is also important for stroke management. The drugutilization in stroke care is of very much concern in developingcountries, as healthcare infrastructure is inadequate,government has insufficient control on the system of drugsupply and also due to free availability of drugs on prescriptionoften illegally. The drug treatment strategy is involvedwith proper selection of drugs like thrombolytics, anticoagulants,antihypertensives (angiotensin converting enzyme inhibitors,angiotensin II receptor blockers, diuretics), bloodlipid lowering agents (statins), antiplatelet drugs (aspirinand clopidogrel), and neuro protectors.8A patient’s psychological functioning and psycho-socialsituation may be severely disrupted by the disease. The degreeof disturbance is usually determined by the severity ofthe stroke and degree of cognitive deficits. Hence, studyingQOL in patients is also one of the aims of the study.9Post-stroke cognitive impairment is very common, particularlyafter recurrent stroke, which affects up to one-thirdof stroke survivors.10,11 These comorbid motor and cognitiveimpairments can significantly increase the risk of longterm functional disability as well as increase the healthcarecosts.12 Most of the patients recover in first 3-6 months afterthe acute neurological event, with almost 70% of theirrecovery in first 3 months after a stroke. After 6 months, therecovery can be considered to be almost nil. However, for thehemiplegics, physiotherapy can be a healthy source for gainingthe stairway to becoming physically fit.13 Thus, alongwith medications functional recovery also depends upon institutionof early rehabilitation, which aims to enhance skilllearning which promotes plasticity