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1Fifth Year Doctor of Pharmacy Student, Sree Krishna College of Pharmacy and Research Centre, Parassala, Thiruvananthapuram, Kerala, India.
2Associate Professor, Department of Pharmacy Practice, Sree Krishna College of Pharmacy and Research Centre, Parassala, Thiruvananthapuram, Kerala, India.
3Professor & HOD, Department of Pharmacy Practice, Sree Krishna College of Pharmacy and Research Centre, Parassala, Thiruvananthapuram, Kerala, India.
4Lecturer, Department of Pharmacy Practice, Sree Krishna College of Pharmacy and Research Centre, Parassala, Thiruvananthapuram, Kerala, India.
5Principal, Sree Krishna College of Pharmacy and Research Centre, Parassala, Thiruvananthapuram, Kerala, India
Ischemic stroke significantly affects patients' quality of life (QoL) and is one of the world's major causes of death and long-term disability. QoL assessment is a crucial part of patient care and rehabilitation since stroke impacts psychological, social, and functional well-being in addition to physical damage. The purpose of this systematic review of the literature is to assess how well patients with ischemic stroke measure their quality of life and to pinpoint the risk factors that are linked to these outcomes. Electronic databases such as PubMed, Google Scholar, and ScienceDirect were used to do a thorough literature search for research published between 2010 and 2025. Hemorrhagic stroke studies, non-English articles, case reports, and studies without QoL evaluation were removed. In contrast, research involving ischemic stroke patients with QoL assessment were included. QoL was evaluated in the physical, psychological, and social dimensions using a variety of standardized instruments, including the SF-36, EQ-5D, Stroke Specific Quality of Life Scale (SS-QOL), Stroke Impact Scale (SIS), Modified Rankin Scale, and Barthel Index. The results show that physical disability, depression, cognitive impairment, dependence on daily tasks, and social isolation are common causes of decreased quality of life in ischaemic stroke survivors. Outcomes are considerably worsened by risk factors like advanced age, hypertension, diabetes mellitus, smoking, alcohol use, atrial fibrillation, and recurrent stroke. Poorer QoL was also linked to severe stroke, lower socioeconomic level, and female gender. In summary, ischaemic stroke significantly impacts many aspects of life, highlighting the necessity of early rehabilitation, psychological support, risk factor management, and tailored patient-centered treatment to enhance recovery results and long-term quality of life.
The most frequent kind of stroke is an ischemic stroke, which happens when a blood vessel in the brain or neck becomes blocked. The obstruction may result from "the formation of a clot within a blood vessel of the brain or neck, called thrombosis; the movement of a clot from another part of the body, such as the heart to the brain, called embolism or a severe narrowing of an artery in or leading to the brain, called stenosis" Stroke can happen at any age, even though the risk rises with age.(1) The illness continues to be a major global source of morbidity and mortality, placing a heavy strain on both individuals and public health systems. Reducing its worldwide burden requires a detailed understanding of its underlying mechanisms, risk factors, and evidence-based management techniques due to its extensive impact across varied populations. The majority of stroke victims are elderly, and age has a significant impact on post-stroke patient outcomes. In high-income nations, age-standardized stroke incidence and mortality are significantly decreasing. However, low-income and middle-income nations account for 70% of strokes as well as 87% of stroke-related fatalities and disability-adjusted life years. (2) A deeper comprehension of the causes of stroke in the elderly may have significant practical ramifications for future health-care policies, preventive measures, and clinical management. Compared to younger people who experience ischaemic stroke, older patients frequently receive less effective treatment and have worse prognosis.(3) A patient's independence is lost and their health-related quality of life (HR-QoL) is negatively impacted by Ischemic Stroke.(4) The aim of the study is to perform a systemic literature review on measuring the quality of life and factors contributing it in ischemic stroke patients.
Pathophysiology of Ischemic Stroke
An abrupt neurological outburst brought on by poor blood vessel perfusion to the brain is known as a stroke. Studying the clinical manifestation of a stroke requires an understanding of the neurovascular anatomy. Two internal carotids in the front and two vertebral arteries in the back (the circle of Willis) control blood flow to the brain. Hemorrhagic stroke is brought on by bleeding or leaking blood vessels, whereas ischaemic stroke is caused by insufficient blood and oxygen flow to the brain. About 85% of stroke patients die as a result of ischaemic occlusions; intracerebral haemorrhage accounts for the remaining deaths. In the brain, ischaemic occlusion causes thrombotic and embolic situations. Vascular narrowing brought on vascular atherosclerosis affects blood flow in thrombosis. Eventually, the accumulation of plaque will narrow the vascular chamber and create clots, which will result in thrombotic stroke. Reduced blood supply to the brain area results in an embolism in an embolic stroke; this causes extreme stress and premature cell death (necrosis). Following necrosis, the plasma membrane is disrupted, organelles enlarge and release cellular contents into extracellular space, and neuronal function is lost. Inflammation, energy failure, loss of homeostasis, acidosis, elevated intracellular calcium levels, excitotoxicity, free radical-mediated toxicity, cytokine-mediated cytotoxicity, complement activation, damage to the blood–brain barrier, glial cell activation, oxidative stress, and leukocyte infiltration are additional significant events that contribute to stroke pathology. (5)
Figure 1: Mechanism of Ischemic Stroke
MATERIALS AND METHODS
This study conducted a systemic literature review (SLR) of published articles on Quality of life and factors contributing it in Ischemic Stroke patients between 2015-2025 according to the statement of Preferred Reporting Items for Systematic Review (PRISMA). the search methods for this study includes Pubmed, Medscape and Science Direct.
Table 1 Eligibility Criteria
|
Inclusion Criteria |
Exclusion Criteria |
|
Studies on Ischemic Stroke patients |
Hemorrhagic stroke studies |
|
Studies assessing quality of life (QoL) |
Studies without QoL assessment |
|
Published in English |
Non- english articles |
|
Specific time period (2010-2025) |
Case reports |
Impact of Ischemic Stroke on Quality Of Life
Hea Lim Choi and his colleagues conducted a study, stroke survivors with disabilities had a greater risk of depression than those without disabilities. When stroke survivors were compared to the matched control group a year after the stroke, the probability of developing depression rose as the severity of their disability increased. (6) A stroke impairs the body's ability to function at its best. The impairment of motor functions—being incapacitated, losing strength, having difficulty carrying out one's own tasks, and needing assistance—was the primary concern of survivors. This fear then leads to a sense of dehumanisation, worthlessness, and powerlessness.(7) Another crucial result following a stroke is quality of life (QOL). Whether or whether they have fully recovered functionally, most stroke survivors cut back on their social and recreational activities once they return home. QOL tools have started to be created and used for stroke prognostic assessment. Physical status, mental and psychological status, social activity status, and functional status are all measured in standard multidimensional health-related QOL survey instruments. Many tools have been created, such as the 36-item short-form survey from the Medical Outcome Study (SF-36), the Sickness Impact Profile, and the Stroke Impact Scale (SIS).(8) In a research by Nipaporn Butsing, patients with no stroke symptoms, small stroke, and moderate stroke showed substantial improvements in mean HRQoL (p < 0.05), whereas those with severe stroke did not (p = 0.156). Over a six-month period, patients with enough monthly income experienced a substantial increase in HRQoL (p<0.05). Patients with severe strokes and low incomes had lower HRQoL. To enhance their HRQoL, supportive programs are necessary. (9) Lenka Sedova and colleagues did a study. Patient gender was found to have a significant impact on patient quality of life. Furthermore, as people aged, their quality of life declined across all SF-36 aspects, with the exception of mental health. According to SF-36, employed respondents rated their quality of life as the highest, while elderly pensioners rated it as the lowest in terms of occupational placement. The data reveals that respondents' higher education has a beneficial impact on quality of life in individual categories. (10)
Risk Factors for Ischemic Stroke
Age, gender, race, and geography are among the risk variables. Smoking, physical inactivity, arterial hypertension, dyslipidaemia, obesity, and diabetes mellitus are the most common risk factors for cerebrovascular events in young individuals (18–55 years old). Men are more likely to experience some risk factors, such as heavy drinking and insufficient sleep, whereas women are more likely to get migraines. Black stroke patients have higher rates of hypertension and diabetes mellitus than white stroke patients, but they also have lower rates of atrial fibrillation, alcoholism, and smoking. Additionally, in individuals with various illnesses, some symptoms can increase the risk of stroke. For instance, in patients with primary aldosteronism, proteinuria is linked to a higher risk of ischaemic stroke. Stroke is more common when there are several risk factors present. Patients with hypertension and other risk factors are at the greater risk for stroke. Through prothrombolic effects and cerebral hypoperfusion, patients with valvular heart disease, infective endocarditis, vasculitis, or peripheral vascular disease considerably enhance the morbidity and mortality of stroke. As a result, the risk factors are numerous and intricate. Atrial fibrillation, diabetes, heavy alcohol consumption, smoking, and hypertension all raise the risk of ischaemic stroke.(11) Individuals who have had an ischaemic stroke are more likely to have another one. The fatality rate from ischaemic stroke has decreased as a result of advancements in stroke management and therapy. Recurrent strokes are still common, though. Approximately 80–85% of ischaemic stroke patients currently survive, although 15–30% have another stroke within the first two years. Recurrent strokes have a greater death rate and significantly worsen neurological disability. The cause of the initial stroke has a significant impact on the likelihood of a subsequent stroke. Large artery atherosclerosis (LAA) and cardioembolic (CE) stroke subtypes are shown to have the highest rates of recurrence. (12)
Tools for Measuring Quality of Life In Stroke Patients
Factors Affecting Quality of Life
Physical domain
A patient's quality of life is mostly determined by their physical condition. It affects the capacity to carry out everyday chores and encompasses elements like independence in daily tasks, dependence on medicine and medical support, sleep and rest impacting energy levels and weariness, pain and discomfort, and work capacity. The QoL in the physical domain is influenced by social support, sleep quality, self-esteem, hardiness, spirituality, and psychological well-being. Studies indicate that stroke raises the incidence of insomnia and obstructive sleep apnoea, both of which have a detrimental effect on recovery after a stroke by shortening sleep duration.
Psychological Domain
A patient's psychological state, which represents their capacity to adjust to different internal and external stresses, has an impact on their quality of life.. Nearly one-third of stroke patients experience post-stroke depression, making it the most prevalent psychiatric consequence. Patients with damage to the left and right dorsolateral prefrontal cortex are more likely to experience depression. While hyperactivity in the right hemisphere is linked to more severe depressive symptoms, hypoactivity in the left hemisphere is linked to worse emotional judgement. Stroke patients' prognosis, damage recovery, and neurorehabilitation results can all be negatively impacted by psychological stress that interferes with rehabilitation compliance.
Social domain
Interpersonal relationships that affect, modify, or enhance behaviour are directly linked to the social domain of quality of life.(19)
Demographic factors
Age: Older age have poorer QoL due to co-morbidities,
Gender: Females often report poor QoL.(20)
CONCLUSION
Compared to the normal population, stroke sufferers have a low quality of life. QoL is frequently linked to movement, and the majority of patients experienced physical limitations following a stroke diagnosis. The patient's quality of life typically impacted by the patient's age, gender, socioeconomic situation, comorbidities, and carer. Therefore, when implementing the patient's rehabilitation program, these considerations must be taken into account. The quality of life (QoL) of stroke patients is the sole subject of this study; the cost of managing stroke patients is not examined in detail. It is thought that the expense of treating stroke victims may have an effect on their quality of life. Therefore, it is advised that this area be investigated in future research.
REFERENCES
Shamini J.*, Soumya R.V., Nithin Manohar R., Mahitha, Prasobh G. R., Abisek, Aswathy K. S., Measurement of Quality of Life and Associated Risk Factors in Patients with Ischemic Stroke: A Systemic Literature Review, Int. J. Med. Pharm. Sci., 2026, 2 (5), 540-545. https://doi.org/10.5281/zenodo.20258566
10.5281/zenodo.20258566