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August 06, 2013; 81 (6) Article

Mortality after hemorrhagic stroke

Data from general practice (The Health Improvement Network)

Antonio González-Pérez, David Gaist, Mari-Ann Wallander, Gillian McFeat, Luis A. García-Rodríguez
First published July 10, 2013, DOI: https://doi.org/10.1212/WNL.0b013e31829e6eff
Antonio González-Pérez
From the Spanish Centre for Pharmacoepidemiologic Research (CEIFE) (A.G.-P., L.A.G.-R.), Madrid; Andalusian Bioinformatics Research Center (CAEBi) (A.G.-P.), Seville, Spain; Neurology Department (D.G.), Odense University Hospital and Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark; Department of Public Health and Caring Science (M.-A.W.), Uppsala University, Sweden; AB Bayer Pharma (M.-A.W.), Solna, Sweden; and Research Evaluation Unit (G.M.), Oxford PharmaGenesis Ltd., Oxford, UK.
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David Gaist
From the Spanish Centre for Pharmacoepidemiologic Research (CEIFE) (A.G.-P., L.A.G.-R.), Madrid; Andalusian Bioinformatics Research Center (CAEBi) (A.G.-P.), Seville, Spain; Neurology Department (D.G.), Odense University Hospital and Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark; Department of Public Health and Caring Science (M.-A.W.), Uppsala University, Sweden; AB Bayer Pharma (M.-A.W.), Solna, Sweden; and Research Evaluation Unit (G.M.), Oxford PharmaGenesis Ltd., Oxford, UK.
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Mari-Ann Wallander
From the Spanish Centre for Pharmacoepidemiologic Research (CEIFE) (A.G.-P., L.A.G.-R.), Madrid; Andalusian Bioinformatics Research Center (CAEBi) (A.G.-P.), Seville, Spain; Neurology Department (D.G.), Odense University Hospital and Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark; Department of Public Health and Caring Science (M.-A.W.), Uppsala University, Sweden; AB Bayer Pharma (M.-A.W.), Solna, Sweden; and Research Evaluation Unit (G.M.), Oxford PharmaGenesis Ltd., Oxford, UK.
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Gillian McFeat
From the Spanish Centre for Pharmacoepidemiologic Research (CEIFE) (A.G.-P., L.A.G.-R.), Madrid; Andalusian Bioinformatics Research Center (CAEBi) (A.G.-P.), Seville, Spain; Neurology Department (D.G.), Odense University Hospital and Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark; Department of Public Health and Caring Science (M.-A.W.), Uppsala University, Sweden; AB Bayer Pharma (M.-A.W.), Solna, Sweden; and Research Evaluation Unit (G.M.), Oxford PharmaGenesis Ltd., Oxford, UK.
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Luis A. García-Rodríguez
From the Spanish Centre for Pharmacoepidemiologic Research (CEIFE) (A.G.-P., L.A.G.-R.), Madrid; Andalusian Bioinformatics Research Center (CAEBi) (A.G.-P.), Seville, Spain; Neurology Department (D.G.), Odense University Hospital and Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark; Department of Public Health and Caring Science (M.-A.W.), Uppsala University, Sweden; AB Bayer Pharma (M.-A.W.), Solna, Sweden; and Research Evaluation Unit (G.M.), Oxford PharmaGenesis Ltd., Oxford, UK.
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Citation
Mortality after hemorrhagic stroke
Data from general practice (The Health Improvement Network)
Antonio González-Pérez, David Gaist, Mari-Ann Wallander, Gillian McFeat, Luis A. García-Rodríguez
Neurology Aug 2013, 81 (6) 559-565; DOI: 10.1212/WNL.0b013e31829e6eff

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Abstract

Objective: To investigate short-term case fatality and long-term mortality after intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH) using data from The Health Improvement Network database.

Methods: Thirty-day case fatality was stratified by age, sex, and calendar year after ICH and SAH using logistic regression. Cox proportional hazards regression analyses were used to estimate the risk of death during the first year of follow-up and survivors at 1 year.

Results: Case fatality after ICH was 42.0%, compared with 28.7% after SAH. It increased with age (ICH: 29.7% for 20–49 years, 54.6% for 80–89 years; SAH: 20.3% for 20–49 years, 56.7% for 80–89 years; both p-trend < 0.001), and decreased over the period 2000–2001 to 2006–2008 (ICH: from 53.1% to 35.8%, p-trend < 0.001; SAH: from 33.3% to 24.7%, p-trend = 0.02). Risk of death was significantly higher among stroke patients during the first year of follow-up compared with controls (ICH: hazard ratio [HR] 2.60, 95% confidence interval [CI] 2.09–3.24, p < 0.01; SAH: HR 2.87, 95% CI 2.07–3.97, p < 0.01) and remained elevated among survivors at 1 year (ICH: HR 2.02, 95% CI 1.75–2.32, p < 0.01; SAH: HR 1.32, 95% CI 1.02–1.69, p = 0.03).

Conclusions: More than one-third of individuals die in the first month after hemorrhagic stroke, and patients younger than 50 years are more likely to die after ICH than SAH. Short-term case fatality has decreased over time. Patients who survive hemorrhagic stroke have a continuing elevated risk of death compared with matched individuals from the general population.

GLOSSARY

CI=
confidence interval;
HR=
hazard ratio;
ICH=
intracerebral hemorrhage;
PCP=
primary care physician;
SAH=
subarachnoid hemorrhage;
THIN=
The Health Improvement Network

Footnotes

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • See page 566

  • Supplemental data at www.neurology.org

  • Received September 28, 2012.
  • Accepted in final form March 8, 2013.
  • © 2013 American Academy of Neurology
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