Direct Assessment of Health Utilities Using the Standard Gamble Among Patients With Primary Intracerebral Hemorrhage

No understanding.  Perceived future quality of life is completely unknown because we have nothing that will get patients 100% recovered.  So depression is likely.

Direct Assessment of Health Utilities Using the Standard Gamble Among Patients With Primary Intracerebral Hemorrhage

Kristen B. Slaughter

,

Ellie G. Meyer

,

Arvind B. Bambhroliya

,

Jennifer R. Meeks

,

Wamda Ahmed

,

Ritvij Bowry

,

Reza Behrouz

,

Osman Mir

,

Charles Begley

,

Jon E. Tyson

,

Charles Miller

,

Steven Warach

,

James C. Grotta

,

Louise D. McCullough

,

Sean I. Savitz

,

Farhaan S. Vahidy

Originally published13 Sep 2019https://doi.org/10.1161/CIRCOUTCOMES.119.005606Circulation: Cardiovascular Quality and Outcomes. 2019;12:e005606

Abstract

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.

Footnotes

The Data Supplement is available at https://www.ahajournals.org/doi/suppl/10.1161/CIRCOUTCOMES.119.005606.

Farhaan S. Vahidy, PhD, MBBS, MPH, McGovern Medical School, UTHealth, MSB 2.101A, 6431 Fannin St, Houston, TX 77030. Email farhaan.vahidy@uth.tmc.edu