Shannon M Fernando1,2, Danial Qureshi3,4,5,6, Robert Talarico4,5, Peter Tanuseputro3,7,4,5,6, Dar Dowlatshahi3,8,5, Manish M Sood3,9,4,5, Eric E Smith10,11, Michael D Hill10,11, Victoria A McCredie12,13,14, Damon C Scales12,14,15, Shane W English1,3,5, Bram Rochwerg14,16,17, Kwadwo Kyeremanteng1,7,5,18. 1. Division of Critical Care, Department of Medicine (S.M.F., S.W.E., K.K.), University of Ottawa, ON, Canada. 2. Department of Emergency Medicine (S.M.F.), University of Ottawa, ON, Canada. 3. School of Epidemiology and Public Health (D.Q., P.T., D.D., M.M.S., S.W.E.), University of Ottawa, ON, Canada. 4. ICES, Toronto, ON, Canada (D.Q., R.T., P.T., M.M.S., P.T.). 5. Clinical Epidemiology Program, Ottawa Hospital Research Institute, ON, Canada (D.Q., R.T., P.T., D.D., M.M.S., S.W.E., K.K.). 6. Bruyère Research Institute, Ottawa, ON, Canada (D.Q., P.T.). 7. Division of Palliative Care, Department of Medicine (P.T., K.K.), University of Ottawa, ON, Canada. 8. Division of Neurology, Department of Medicine (D.D.), University of Ottawa, ON, Canada. 9. Division of Nephrology, Department of Medicine (M.M.S.), University of Ottawa, ON, Canada. 10. Calgary Stroke Program, Hotchkiss Brain Institute (E.E.S., M.D.H.), Cumming School of Medicine, University of Calgary, AB, Canada. 11. Department of Clinical Neurosciences (E.E.S., M.D.H.), Cumming School of Medicine, University of Calgary, AB, Canada. 12. Interdepartmental Division of Critical Care Medicine, University of Toronto, ON, Canada (V.A.M., D.C.S.). 13. Krembil Research Institute, Toronto Western Hospital, University Health Network, ON, Canada (V.A.M.). 14. Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada (V.A.M., D.C.S.). 15. Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada (D.C.S.). 16. Department of Medicine, Division of Critical Care (B.R.), McMaster University, Hamilton, ON, Canada. 17. Department of Health Research Methods, Evidence, and Impact (B.R.), McMaster University, Hamilton, ON, Canada. 18. Institut du Savoir Montfort, Ottawa, ON, Canada (K.K.).
Abstract
BACKGROUND AND PURPOSE: Spontaneous intracerebral hemorrhage (ICH) is a devastating form of stroke associated with significant morbidity and mortality. Recent epidemiological data on incidence, mortality, and association with oral anticoagulation are needed. METHODS: Retrospective cohort study of adult patients (≥18 years) with ICH in the entire population of Ontario, Canada (April 1, 2009-March 30, 2019). We captured outcome data using linked health administrative databases. The primary outcome was mortality during hospitalization, as well as at 1 year following ICH. RESULTS: We included 20 738 patients with ICH. Mean (SD) age was 71.3 (15.1) years, and 52.6% of patients were male. Overall incidence of ICH throughout the study period was 19.1/100 000 person-years and did not markedly change over the study period. In-hospital and 1-year mortality were high (32.4% and 45.4%, respectively). Mortality at 2 years was 49.5%. Only 14.5% of patients were discharged home independently. Over the study period, both in-hospital and 1-year mortality reduced by 10.4% (37.5% to 27.1%, P<0.001) and 7.6% (50.0% to 42.4%, P<0.001), respectively. Use of oral anticoagulation was associated with both in-hospital mortality (adjusted odds ratio 1.37 [95% CI, 1.26-1.49]) and 1-year mortality (hazard ratio, 1.18 [95% CI, 1.12-1.25]) following ICH. CONCLUSIONS: Both short- and long-term mortality have decreased in the past decade. Most survivors from ICH are likely to be discharged to long-term care. Oral anticoagulation is associated with both short- and long-term mortality following ICH. These findings highlight the devastating nature of ICH, but also identify significant improvement in outcomes over time.
BACKGROUND AND PURPOSE: Spontaneous intracerebral hemorrhage (ICH) is a devastating form of stroke associated with significant morbidity and mortality. Recent epidemiological data on incidence, mortality, and association with oral anticoagulation are needed. METHODS: Retrospective cohort study of adult patients (≥18 years) with ICH in the entire population of Ontario, Canada (April 1, 2009-March 30, 2019). We captured outcome data using linked health administrative databases. The primary outcome was mortality during hospitalization, as well as at 1 year following ICH. RESULTS: We included 20 738 patients with ICH. Mean (SD) age was 71.3 (15.1) years, and 52.6% of patients were male. Overall incidence of ICH throughout the study period was 19.1/100 000 person-years and did not markedly change over the study period. In-hospital and 1-year mortality were high (32.4% and 45.4%, respectively). Mortality at 2 years was 49.5%. Only 14.5% of patients were discharged home independently. Over the study period, both in-hospital and 1-year mortality reduced by 10.4% (37.5% to 27.1%, P<0.001) and 7.6% (50.0% to 42.4%, P<0.001), respectively. Use of oral anticoagulation was associated with both in-hospital mortality (adjusted odds ratio 1.37 [95% CI, 1.26-1.49]) and 1-year mortality (hazard ratio, 1.18 [95% CI, 1.12-1.25]) following ICH. CONCLUSIONS: Both short- and long-term mortality have decreased in the past decade. Most survivors from ICH are likely to be discharged to long-term care. Oral anticoagulation is associated with both short- and long-term mortality following ICH. These findings highlight the devastating nature of ICH, but also identify significant improvement in outcomes over time.
Authors: Kazuma Nakagawa; Randi Chen; Steven M Greenberg; G Webster Ross; Bradley J Willcox; Timothy A Donlon; Richard C Allsopp; D Craig Willcox; Brian J Morris; Kamal H Masaki Journal: J Hypertens Date: 2022-08-03 Impact factor: 4.776
Authors: Jens Witsch; David J Roh; Radhika Avadhani; Alexander E Merkler; Hooman Kamel; Issam Awad; Daniel F Hanley; Wendy C Ziai; Santosh B Murthy Journal: JAMA Netw Open Date: 2021-12-01