Determinants of Patient-Reported Physical and Mental Health 90 Days After Stroke: A Prospective Brazilian Cohort Study

Qualidade de vida auto relatada 90 dias após o AVC

Résumé

Background: Stroke is a leading cause of long-term disability worldwide, yet patient-reported quality of life (QoL) data after stroke remain scarce in low- and middle-income countries (LMICs), where the burden is disproportionately high.

Objective: To identify independent predictors of poor patient-reported physical and mental health 90 days after stroke in a Brazilian cohort.

Methods: Prospective observational cohort of 504/513  adult stroke patients admitted to Santa Casa de Porto Alegre (2022-2025). PROMIS-10 was administered at 90 days. Multivariate logistic regression identified independent predictors.

Results: Poor physical health was independently predicted by female sex (OR 1.71; 95% CI 1.13–2.59), severe neurological deficit at admission (NIHSS; OR 4.30; 95% CI 1.30–14.20), and greater functional disability at discharge (mRS; OR 1.37; 95% CI 1.21–1.55). Poor mental health was independently predicted by hypertension (OR 1.63; 95% CI 1.03–2.57), severe NIHSS (OR 5.88; 95% CI 1.75–19.76), and higher mRS at discharge (OR 1.15; 95% CI 1.03–1.29). Public health system (SUS) coverage was associated with worse scores in univariate analyses but lost significance after adjustment, suggesting clinical severity mediates the socioeconomic effect on QoL.

Conclusions: Stroke severity and functional status at discharge were the strongest independent determinants of patient-reported QoL at 90 days. Female sex and hypertension identify subgroups at disproportionate risk of poor physical and mental health respectively. These findings support integrating patient-reported outcomes into stroke care quality assessments in resource-constrained settings.