Abstract
BACKGROUND: Early identification of factors influencing long-term health-related quality of life (HRQoL) after stroke is essential for individualising poststroke support. While different patient characteristics have been shown to be associated with HRQoL, few studies have investigated how these associations evolve over time. The interaction between baseline characteristics at time of stroke and the elapsed time since stroke may reveal divergent recovery trajectories that remain obscured when conditions are assessed without consideration of temporal trends. METHODS: This cross-sectional single-centre cohort study analysed data from 47 patients with minor ischaemic stroke, drawn from a local aftercare programme. HRQoL was assessed using the EQ-5D-5L index value once within a period of up to 3 years after stroke. Patient characteristics at hospital admission (ie, National Institutes of Health Stroke Scale, modified Rankin Scale, age, sex and recanalisation therapy) were tested for associations with HRQoL using Spearman's rank correlation and Wilcoxon rank-sum tests. Variables significantly associated with HRQoL were entered into multivariate linear regression (MLR), adjusted for time since stroke. Interaction terms were tested to evaluate whether the effect of baseline characteristics varied by time since stroke. RESULTS: Only age at time of stroke showed a significant association with EQ-5D-5L index values. The final MLR model included quadratic age terms and their interaction with time since stroke, explaining 29% of the variance in HRQoL (p<0.001). Based on this model, younger age is associated with increasing HRQoL from stroke onward, whereas older age is associated with decreasing HRQoL. CONCLUSIONS: This study indicates that age and time since stroke jointly influence long-term HRQoL after minor stroke. Our findings guide the hypothesis that older individuals may predominantly face progressive HRQoL deterioration after stroke, while younger patients show marked recovery potential. Tailoring aftercare strategies to age-specific recovery profiles could improve the long-term support and outcomes after stroke. TRIAL REGISTRATION NUMBER: DRKS00031333.