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Stroke is the second leading cause of death and dependency in Europe and costs the European Union more than €30bn, yet significant gaps in the patient pathway remain and the cost-effectiveness of comprehensive stroke care to meet these needs is unknown. The European Brain Council Value of Treatment Initiative combined patient representatives, stroke experts, neurological societies and literature review to identify unmet needs in the patient pathway according to Rotterdam methodology. The cost-effectiveness of comprehensive stroke services was determined by a Markov model, using UK cost data as an exemplar and efficacy data for prevention of death and dependency from published systematic reviews and trials, expressing effectiveness as quality-adjusted life-years (QALYs). Model outcomes included total costs, total QALYs, incremental costs, incremental QALYs and the incremental cost-effectiveness ratio (ICER). Key unmet needs in the stroke patient pathway included inadequate treatment of atrial fibrillation (AF), access to neurorehabilitation and implementation of comprehensive stroke services. In the Markov model, full implementation of comprehensive stroke services was associated with a 9.8% absolute reduction in risk of death of dependency, at an intervention cost of £9566 versus £6640 for standard care, and long-term care costs of £35 169 per 5.1251 QALYS vs. £32 347.40 per 4.5853 QALYs, resulting in an ICER of £5227.89. Results were robust in one-way and probabilistic sensitivity analyses. Implementation of comprehensive stroke services is a cost-effective approach to meet unmet needs in the stroke patient pathway, to improve acute stroke care and support better treatment of AF and access to neurorehabilitation.

Conflict of interest statementAK reports grants from European Union 7th Framework Program during the conduct of the study. ADM has nothing to disclose. CM has nothing to disclose. AW has nothing to disclose. ES has nothing to disclose. ME reports grants from European Union 7th Framework Program during the conduct of the study. THC has nothing to disclose. MEn reports grants from European Union 7th Framework Program during the conduct of the study, grants from Bayer and fees paid to the Charité from Bayer, Boehringer Ingelheim, BMS/Pfizer, Daiichi Sankyo, Amgen, GlaxoSmithKlineGSK, Sanofi, Covidien, Novartis, all outside the submitted work. JBF reports grants from European Union 7th Framework Program during the conduct of the study and personal fees from Bioclinica, BMS, Biogen, Artemida, Cerevast, Guerbet, EISAI and Nicolab outside the submitted work. JF has nothing to disclose. IG reports grants from European Union 7th Framework Program during the conduct of the study. JP has nothing to disclose. VT reports grants from European Union 7th Framework Program and personal fees and non-financial support from Boehringer Ingelheim, Pfizer/BMS, Bayer, Sygnis, Amgen and Allergan outside the submitted work. RL reports no personal fees, but institutional support for consultancy and speaker fees from Bayer, Boehringer-Ingelheim, Genentech, Ischemaview, Medtronic and Occlutech outside the submitted work. KWM reports grants from European Union 7th Framework Program during the conduct of the study, personal fees and non-financial support from Boehringer Ingelheim outside the submitted work, personal fees from Boehringer Ingelheim, Bayer, Daiichi Sankyo and ReNeuron outside the submitted work. NN has nothing to disclose. SP reports grants from European Union 7th Framework Program during the conduct of the study. CZS reports grants from Novo Nordisk Foundation and personal fees from Bayer outside the submitted work. CG reports grants from European Union 7th Framework Program during the conduct of the study, personal fees from AMGEN, Bayer Vital, BMS, Boehringer Ingelheim, Sanofi Aventis, Abbott, and Prediction Biosciences outside the submitted work. GT reports grants from European Union 7th Framework Program during the conduct of the study, personal fees from Acandis, Boehringer Ingelheim, BMS/Pfizer, Stryker, Daiichi Sankyo, grants and personal fees from Bayer, grants from Corona Foundation, German Innovation Fonds and Else Kroener Fresenius Foundation outside the submitted work. BC reports grants from European Union 7th Framework Program during the conduct of the study and personal fees from Bayer Vital and Abbott, all outside the submitted work. ; International audience ; Stroke has a deleterious impact on quality of life. However, it is less well known if stroke lesions in different brain regions are associated with reduced quality of life (QoL). We therefore investigated this association by multivariate lesion-symptom mapping. We analyzed magnetic resonance imaging and clinical data from the WAKE-UP trial. European Quality of Life 5 Dimensions (EQ-5D) 3 level questionnaires were completed 90 days after stroke. Lesion symptom mapping was performed using a multivariate machine learning algorithm (support vector regression) based on stroke lesions 22-36 h after stroke. Brain regions with significant associations were explored in reference to white matter tracts. Of 503 randomized patients, 329 were included in the analysis (mean age 65.4 years, SD 11.5; median NIHSS = 6, IQR 4-9; median EQ-5D score 90 days after stroke 1, IQR 0-4, median lesion volume 3.3 ml, IQR 1.1-16.9 ml). After controlling for lesion volume, significant associations between lesions and EQ-5D score were detected for the right putamen, and internal capsules of both hemispheres. Multivariate lesion inference analysis revealed an association between injuries of the cortico-spinal tracts with worse self-reported quality of life 90 days after stroke in comparably small stroke lesions, extending previous reports of the association of striato-capsular lesions with worse functional outcome. Our findings are of value to identify patients at risk of impaired QoL after stroke.

Conflict of interest statementAK reports grants from European Union 7th Framework Program during the conduct of the study. ADM has nothing to disclose. CM has nothing to disclose. AW has nothing to disclose. ES has nothing to disclose. ME reports grants from European Union 7th Framework Program during the conduct of the study. THC has nothing to disclose. MEn reports grants from European Union 7th Framework Program during the conduct of the study, grants from Bayer and fees paid to the Charité from Bayer, Boehringer Ingelheim, BMS/Pfizer, Daiichi Sankyo, Amgen, GlaxoSmithKlineGSK, Sanofi, Covidien, Novartis, all outside the submitted work. JBF reports grants from European Union 7th Framework Program during the conduct of the study and personal fees from Bioclinica, BMS, Biogen, Artemida, Cerevast, Guerbet, EISAI and Nicolab outside the submitted work. JF has nothing to disclose. IG reports grants from European Union 7th Framework Program during the conduct of the study. JP has nothing to disclose. VT reports grants from European Union 7th Framework Program and personal fees and non-financial support from Boehringer Ingelheim, Pfizer/BMS, Bayer, Sygnis, Amgen and Allergan outside the submitted work. RL reports no personal fees, but institutional support for consultancy and speaker fees from Bayer, Boehringer-Ingelheim, Genentech, Ischemaview, Medtronic and Occlutech outside the submitted work. KWM reports grants from European Union 7th Framework Program during the conduct of the study, personal fees and non-financial support from Boehringer Ingelheim outside the submitted work, personal fees from Boehringer Ingelheim, Bayer, Daiichi Sankyo and ReNeuron outside the submitted work. NN has nothing to disclose. SP reports grants from European Union 7th Framework Program during the conduct of the study. CZS reports grants from Novo Nordisk Foundation and personal fees from Bayer outside the submitted work. CG reports grants from European Union 7th Framework Program during the conduct of the study, personal fees from AMGEN, Bayer Vital, BMS, Boehringer Ingelheim, Sanofi Aventis, Abbott, and Prediction Biosciences outside the submitted work. GT reports grants from European Union 7th Framework Program during the conduct of the study, personal fees from Acandis, Boehringer Ingelheim, BMS/Pfizer, Stryker, Daiichi Sankyo, grants and personal fees from Bayer, grants from Corona Foundation, German Innovation Fonds and Else Kroener Fresenius Foundation outside the submitted work. BC reports grants from European Union 7th Framework Program during the conduct of the study and personal fees from Bayer Vital and Abbott, all outside the submitted work. ; International audience ; Stroke has a deleterious impact on quality of life. However, it is less well known if stroke lesions in different brain regions are associated with reduced quality of life (QoL). We therefore investigated this association by multivariate lesion-symptom mapping. We analyzed magnetic resonance imaging and clinical data from the WAKE-UP trial. European Quality of Life 5 Dimensions (EQ-5D) 3 level questionnaires were completed 90 days after stroke. Lesion symptom mapping was performed using a multivariate machine learning algorithm (support vector regression) based on stroke lesions 22-36 h after stroke. Brain regions with significant associations were explored in reference to white matter tracts. Of 503 randomized patients, 329 were included in the analysis (mean age 65.4 years, SD 11.5; median NIHSS = 6, IQR 4-9; median EQ-5D score 90 days after stroke 1, IQR 0-4, median lesion volume 3.3 ml, IQR 1.1-16.9 ml). After controlling for lesion volume, significant associations between lesions and EQ-5D score were detected for the right putamen, and internal capsules of both hemispheres. Multivariate lesion inference analysis revealed an association between injuries of the cortico-spinal tracts with worse self-reported quality of life 90 days after stroke in comparably small stroke lesions, extending previous reports of the association of striato-capsular lesions with worse functional outcome. Our findings are of value to identify patients at risk of impaired QoL after stroke.

Conflict of interest statementAK reports grants from European Union 7th Framework Program during the conduct of the study. ADM has nothing to disclose. CM has nothing to disclose. AW has nothing to disclose. ES has nothing to disclose. ME reports grants from European Union 7th Framework Program during the conduct of the study. THC has nothing to disclose. MEn reports grants from European Union 7th Framework Program during the conduct of the study, grants from Bayer and fees paid to the Charité from Bayer, Boehringer Ingelheim, BMS/Pfizer, Daiichi Sankyo, Amgen, GlaxoSmithKlineGSK, Sanofi, Covidien, Novartis, all outside the submitted work. JBF reports grants from European Union 7th Framework Program during the conduct of the study and personal fees from Bioclinica, BMS, Biogen, Artemida, Cerevast, Guerbet, EISAI and Nicolab outside the submitted work. JF has nothing to disclose. IG reports grants from European Union 7th Framework Program during the conduct of the study. JP has nothing to disclose. VT reports grants from European Union 7th Framework Program and personal fees and non-financial support from Boehringer Ingelheim, Pfizer/BMS, Bayer, Sygnis, Amgen and Allergan outside the submitted work. RL reports no personal fees, but institutional support for consultancy and speaker fees from Bayer, Boehringer-Ingelheim, Genentech, Ischemaview, Medtronic and Occlutech outside the submitted work. KWM reports grants from European Union 7th Framework Program during the conduct of the study, personal fees and non-financial support from Boehringer Ingelheim outside the submitted work, personal fees from Boehringer Ingelheim, Bayer, Daiichi Sankyo and ReNeuron outside the submitted work. NN has nothing to disclose. SP reports grants from European Union 7th Framework Program during the conduct of the study. CZS reports grants from Novo Nordisk Foundation and personal fees from Bayer outside the submitted work. CG reports grants from European Union 7th Framework Program during the conduct of the study, personal fees from ...

Conflict of interest statementAK reports grants from European Union 7th Framework Program during the conduct of the study. ADM has nothing to disclose. CM has nothing to disclose. AW has nothing to disclose. ES has nothing to disclose. ME reports grants from European Union 7th Framework Program during the conduct of the study. THC has nothing to disclose. MEn reports grants from European Union 7th Framework Program during the conduct of the study, grants from Bayer and fees paid to the Charité from Bayer, Boehringer Ingelheim, BMS/Pfizer, Daiichi Sankyo, Amgen, GlaxoSmithKlineGSK, Sanofi, Covidien, Novartis, all outside the submitted work. JBF reports grants from European Union 7th Framework Program during the conduct of the study and personal fees from Bioclinica, BMS, Biogen, Artemida, Cerevast, Guerbet, EISAI and Nicolab outside the submitted work. JF has nothing to disclose. IG reports grants from European Union 7th Framework Program during the conduct of the study. JP has nothing to disclose. VT reports grants from European Union 7th Framework Program and personal fees and non-financial support from Boehringer Ingelheim, Pfizer/BMS, Bayer, Sygnis, Amgen and Allergan outside the submitted work. RL reports no personal fees, but institutional support for consultancy and speaker fees from Bayer, Boehringer-Ingelheim, Genentech, Ischemaview, Medtronic and Occlutech outside the submitted work. KWM reports grants from European Union 7th Framework Program during the conduct of the study, personal fees and non-financial support from Boehringer Ingelheim outside the submitted work, personal fees from Boehringer Ingelheim, Bayer, Daiichi Sankyo and ReNeuron outside the submitted work. NN has nothing to disclose. SP reports grants from European Union 7th Framework Program during the conduct of the study. CZS reports grants from Novo Nordisk Foundation and personal fees from Bayer outside the submitted work. CG reports grants from European Union 7th Framework Program during the conduct of the study, personal fees from AMGEN, Bayer Vital, BMS, Boehringer Ingelheim, Sanofi Aventis, Abbott, and Prediction Biosciences outside the submitted work. GT reports grants from European Union 7th Framework Program during the conduct of the study, personal fees from Acandis, Boehringer Ingelheim, BMS/Pfizer, Stryker, Daiichi Sankyo, grants and personal fees from Bayer, grants from Corona Foundation, German Innovation Fonds and Else Kroener Fresenius Foundation outside the submitted work. BC reports grants from European Union 7th Framework Program during the conduct of the study and personal fees from Bayer Vital and Abbott, all outside the submitted work. ; International audience ; Stroke has a deleterious impact on quality of life. However, it is less well known if stroke lesions in different brain regions are associated with reduced quality of life (QoL). We therefore investigated this association by multivariate lesion-symptom mapping. We analyzed magnetic resonance imaging and clinical data from the WAKE-UP trial. European Quality of Life 5 Dimensions (EQ-5D) 3 level questionnaires were completed 90 days after stroke. Lesion symptom mapping was performed using a multivariate machine learning algorithm (support vector regression) based on stroke lesions 22-36 h after stroke. Brain regions with significant associations were explored in reference to white matter tracts. Of 503 randomized patients, 329 were included in the analysis (mean age 65.4 years, SD 11.5; median NIHSS = 6, IQR 4-9; median EQ-5D score 90 days after stroke 1, IQR 0-4, median lesion volume 3.3 ml, IQR 1.1-16.9 ml). After controlling for lesion volume, significant associations between lesions and EQ-5D score were detected for the right putamen, and internal capsules of both hemispheres. Multivariate lesion inference analysis revealed an association between injuries of the cortico-spinal tracts with worse self-reported quality of life 90 days after stroke in comparably small stroke lesions, extending previous reports of the association of striato-capsular lesions with worse functional outcome. Our findings are of value to identify patients at risk of impaired QoL after stroke.

Conflict of interest statementAK reports grants from European Union 7th Framework Program during the conduct of the study. ADM has nothing to disclose. CM has nothing to disclose. AW has nothing to disclose. ES has nothing to disclose. ME reports grants from European Union 7th Framework Program during the conduct of the study. THC has nothing to disclose. MEn reports grants from European Union 7th Framework Program during the conduct of the study, grants from Bayer and fees paid to the Charité from Bayer, Boehringer Ingelheim, BMS/Pfizer, Daiichi Sankyo, Amgen, GlaxoSmithKlineGSK, Sanofi, Covidien, Novartis, all outside the submitted work. JBF reports grants from European Union 7th Framework Program during the conduct of the study and personal fees from Bioclinica, BMS, Biogen, Artemida, Cerevast, Guerbet, EISAI and Nicolab outside the submitted work. JF has nothing to disclose. IG reports grants from European Union 7th Framework Program during the conduct of the study. JP has nothing to disclose. VT reports grants from European Union 7th Framework Program and personal fees and non-financial support from Boehringer Ingelheim, Pfizer/BMS, Bayer, Sygnis, Amgen and Allergan outside the submitted work. RL reports no personal fees, but institutional support for consultancy and speaker fees from Bayer, Boehringer-Ingelheim, Genentech, Ischemaview, Medtronic and Occlutech outside the submitted work. KWM reports grants from European Union 7th Framework Program during the conduct of the study, personal fees and non-financial support from Boehringer Ingelheim outside the submitted work, personal fees from Boehringer Ingelheim, Bayer, Daiichi Sankyo and ReNeuron outside the submitted work. NN has nothing to disclose. SP reports grants from European Union 7th Framework Program during the conduct of the study. CZS reports grants from Novo Nordisk Foundation and personal fees from Bayer outside the submitted work. CG reports grants from European Union 7th Framework Program during the conduct of the study, personal fees from AMGEN, Bayer Vital, BMS, Boehringer Ingelheim, Sanofi Aventis, Abbott, and Prediction Biosciences outside the submitted work. GT reports grants from European Union 7th Framework Program during the conduct of the study, personal fees from Acandis, Boehringer Ingelheim, BMS/Pfizer, Stryker, Daiichi Sankyo, grants and personal fees from Bayer, grants from Corona Foundation, German Innovation Fonds and Else Kroener Fresenius Foundation outside the submitted work. BC reports grants from European Union 7th Framework Program during the conduct of the study and personal fees from Bayer Vital and Abbott, all outside the submitted work. ; International audience ; Stroke has a deleterious impact on quality of life. However, it is less well known if stroke lesions in different brain regions are associated with reduced quality of life (QoL). We therefore investigated this association by multivariate lesion-symptom mapping. We analyzed magnetic resonance imaging and clinical data from the WAKE-UP trial. European Quality of Life 5 Dimensions (EQ-5D) 3 level questionnaires were completed 90 days after stroke. Lesion symptom mapping was performed using a multivariate machine learning algorithm (support vector regression) based on stroke lesions 22-36 h after stroke. Brain regions with significant associations were explored in reference to white matter tracts. Of 503 randomized patients, 329 were included in the analysis (mean age 65.4 years, SD 11.5; median NIHSS = 6, IQR 4-9; median EQ-5D score 90 days after stroke 1, IQR 0-4, median lesion volume 3.3 ml, IQR 1.1-16.9 ml). After controlling for lesion volume, significant associations between lesions and EQ-5D score were detected for the right putamen, and internal capsules of both hemispheres. Multivariate lesion inference analysis revealed an association between injuries of the cortico-spinal tracts with worse self-reported quality of life 90 days after stroke in comparably small stroke lesions, extending previous reports of the association of striato-capsular lesions with worse functional outcome. Our findings are of value to identify patients at risk of impaired QoL after stroke.

Conflict of interest statementAK reports grants from European Union 7th Framework Program during the conduct of the study. ADM has nothing to disclose. CM has nothing to disclose. AW has nothing to disclose. ES has nothing to disclose. ME reports grants from European Union 7th Framework Program during the conduct of the study. THC has nothing to disclose. MEn reports grants from European Union 7th Framework Program during the conduct of the study, grants from Bayer and fees paid to the Charité from Bayer, Boehringer Ingelheim, BMS/Pfizer, Daiichi Sankyo, Amgen, GlaxoSmithKlineGSK, Sanofi, Covidien, Novartis, all outside the submitted work. JBF reports grants from European Union 7th Framework Program during the conduct of the study and personal fees from Bioclinica, BMS, Biogen, Artemida, Cerevast, Guerbet, EISAI and Nicolab outside the submitted work. JF has nothing to disclose. IG reports grants from European Union 7th Framework Program during the conduct of the study. JP has nothing to disclose. VT reports grants from European Union 7th Framework Program and personal fees and non-financial support from Boehringer Ingelheim, Pfizer/BMS, Bayer, Sygnis, Amgen and Allergan outside the submitted work. RL reports no personal fees, but institutional support for consultancy and speaker fees from Bayer, Boehringer-Ingelheim, Genentech, Ischemaview, Medtronic and Occlutech outside the submitted work. KWM reports grants from European Union 7th Framework Program during the conduct of the study, personal fees and non-financial support from Boehringer Ingelheim outside the submitted work, personal fees from Boehringer Ingelheim, Bayer, Daiichi Sankyo and ReNeuron outside the submitted work. NN has nothing to disclose. SP reports grants from European Union 7th Framework Program during the conduct of the study. CZS reports grants from Novo Nordisk Foundation and personal fees from Bayer outside the submitted work. CG reports grants from European Union 7th Framework Program during the conduct of the study, personal fees from ...

Altres ajuts: The Stroke Genetics Network (SiGN) study was funded by a cooperative agreement grant from the US National Institute of Neurological Disorders and Stroke (NINDS), NIH (U01 NS069208 and R01 NS100178). SAHLSIS was supported by the Swedish Heart and Lung Foundation (HLF-20160316), the Swedish Research Council (K2014-64X-14605-12-5), the Swedish Stroke Association, the Swedish state (under the "Avtal om Läkarutbildning och Medicinsk Forskning, ALF") (ALFGBG-720081). Australian Stroke Genetics Collaboration study was supported by the National Health and Medical Research Council, Australia. Stroke Pharmacogenomics and Genetics group was supported by Invictus plus network, Generation project, and Miguel Servet programme from Instituto de Salud Carlos III, GODs project and Epigenesis project from Marató de TV3 Foundation and Agaur from Generalitat de Catalunya Government. Arne Lindgren was supported by the Swedish Heart and Lung Foundation, Region Skåne, Skåne University Hospital, the Freemasons Lodge of Instruction EOS in Lund, Lund University, the Foundation of Färs & Frosta-one of Spar-banken Skåne's ownership Foundations, and the Swedish Stroke Association. Martin Söderholm was supported by grants from the Swedish Stroke Association, the Foundation of Färs & Frosta-one of Sparbanken Skåne's ownership Foundations, and the Swedish government (under the "Avtal om Läkarutbildning och Medicinsk Forskning, ALF"). Annie Pedersen was supported by grants from the Swedish government (under the "Avtal om Läkarutbildning och Medi-cinsk Forskning, ALF") and the Gothenburg Foundation for Neurological Research. Natalia Rost was in part supported by NIH-NINDS (R01NS086905 and R01NS082285). Daniel Strbian was supported by the Finnish Subsidiary Governmental Fund (VTR). The authors thank NINDS for funding the genotyping of patients included in the SiGN study (U01 NS069208 and R01 NS100178) and Sólveig Grétarsdóttir for genotyping a subsample of the SAHLSIS cohort. ; ObjectiveTo discover common genetic variants ...