Background and Purpose -Although much is known about the long-term outcome of stroke patients in terms of mortality and disability, there has been little research on the patient-centered outcome of health-related quality of life (HRQoL). There are limited natural history data on HRQoL beyond 2 years after stroke and no data on those factors present at stroke onset that predict HRQoL beyond 2 years after stroke. For these reasons, we aimed to examine these aspects of HRQoL in an unselected population of stroke patients. Methods -All cases of first-ever stroke from a prospective community-based stroke incidence study (excluding subarachnoid hemorrhage) were assessed 5 years after stroke. HRQoL was measured with the assessment of quality of life instrument. ANOVA was used to determine baseline predictors of HRQoL. Results -In total, 978 cases were recruited, 45%were male, and the mean age (±SD) was 75.5±13.8 years. Five years after stroke, 441 (45.1%) were alive and 356 were assessed (80.7%). Those assessed were more often born in Australia and older in age (both P < 0.05). Seventy-one survivors (20%) had a very low HRQoL (score ≤0.1). The independent baseline predictors of low HRQoL at 5 years after stroke were increasing age, lower socioeconomic status, and markers of stroke severity. Conclusion -At 5 years after stroke, we found that a substantial proportion of survivors were suffering from poor HRQoL. As our popu lation ages, the number of strokes and, thus, stroke survivors with poor HRQoL i s likely to increase. Therefore, strategies to improve HRQoL should be vigorousl y pursued. Background and Purpose -Although much is known about the long-term outcome of stroke patients in terms of mortality and disability, there has been little research on the patient-centered outcome of health-related quality of life (HRQoL). There are limited natural history data on HRQoL beyond 2 years after stroke and no data on those factors present at stroke onset that predict HRQoL beyond 2 years after stroke. For these reasons, we aimed to examine these aspects of HRQoL in an unselected population of stroke patients. Methods - All cases of first-ever stroke from a prospective community-based stroke incidence study (excluding subarachnoid hemorrhage) were assessed 5 years after stroke. ANOVA was used to determine baseline predictors of HRQoL. Five years after stroke, 441 (45.1%) were alive and 356 were assessed (8) Results-In total, 978 cases were recruited, 45% were male and the mean age (± SD) was 75.5 ± 13.8 years 0.7%). Seventy-one survivors (20%) had a very low HRQoL (score ≤0.1). The independent baseline predictors of low HRQoL at 5 years after stroke were increasing age, lower socioeconomic status, and markers of stroke severity. Conclusion-At 5 years after stroke, we found that a large proportion of survivors were suffering from poor HRQoL. As our popu lation ages, the number of strokes and, thus, stroke survivors with poor HRQoL is likely to increase.