Mortality after hemorrhagic stroke: Data from general practice (The Health Improvement Network)

• Published in: Neurology Vol. 81; no. 6; pp. 559 - 565
• Main Authors: González-Pérez, Antonio, Gaist, David, Wallander, Mari-Ann, McFeat, Gillian, García-Rodríguez, Luis A
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD by AAN Enterprises, Inc 06-08-2013; Lippincott Williams & Wilkins
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Case-Control Studies; Cerebral Hemorrhage - mortality; Cohort Studies; Databases, Factual - trends; Female; Follow-Up Studies; General Practice - trends; Health Status; Humans; Longitudinal Studies; Male; Medical sciences; Middle Aged; Neurology; Risk Factors; Stroke - mortality; Vascular diseases and vascular malformations of the nervous system; Young Adult; Vascular disease; Stroke; Improvement; Nervous system diseases; Mortality; Central nervous system disease; Cardiovascular disease; General practice; Hemorrhage; Cerebrovascular disease; Cerebral disorder
• ISSN: 0028-3878; 1526-632X; 1526-632X
• DOI: 10.1212/WNL.0b013e31829e6eff

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 (ICH29.7% for 20–49 years, 54.6% for 80–89 years; SAH20.3% 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 (ICHfrom 53.1% to 35.8%, p-trend < 0.001; SAHfrom 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 (ICHhazard ratio [HR] 2.60, 95% confidence interval [CI] 2.09–3.24, p < 0.01; SAHHR 2.87, 95% CI 2.07–3.97, p < 0.01) and remained elevated among survivors at 1 year (ICHHR 2.02, 95% CI 1.75–2.32, p < 0.01; SAHHR 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.