4.6 Article

Long term (13 years) prognosis after primary intracerebral haemorrhage: a prospective population based study of long term mortality, prognostic factors and causes of death

Journal

JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY
Volume 84, Issue 10, Pages 1150-1155

Publisher

BMJ PUBLISHING GROUP
DOI: 10.1136/jnnp-2013-305200

Keywords

STROKE; EPIDEMIOLOGY; CLINICAL NEUROLOGY; CEREBROVASCULAR DISEASE

Funding

  1. Swedish Research Council [K2010-61X-20378-04-3]
  2. Swedish Stroke Association
  3. Freemasons Lodge of Instruction EOS in Lund
  4. King Gustaf V and Queen Victoria's foundations
  5. Rut and Erik Hardebo Donation Fund, Region Skane
  6. Lund University

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Introduction Many studies have focused on short term mortality after primary intracerebral haemorrhage (ICH) whereas long term prognosis and causes of death have been less studied. We therefore examined these issues in a population based cohort of 1 year ICH survivors. Methods ICH patients in a defined Swedish population (1.14 million inhabitants) were prospectively registered during 1996. Patients surviving 1year after ICH onset were followed-up regarding survival status and cause of death until December 2009 using data from the National Census Office and the National Cause of Death Register. Patient prognosis was also compared with the general population using official Swedish mortality data. Clinical and radiological prognostic factors were evaluated. Results Of 323 patients with ICH, 172 (53%) survived after 1year, 127 (39%) after 5years and 57 (18%) after 13years. Mortality of the 172, 1 year survivors (mean age 67.7years at ICH) persistently exceeded expected mortality; 13years post ictus survival was only 34% compared with 61% in the general population. Of 115 deaths among the 172, 1 year survivors, 36% were from cerebrovascular disease and 19% from ischaemic heart disease. Independent risk factors for death among 1 year survivors were age (HR 1.08 per year; 95% CI 1.06 to 1.10; p<0.001), diabetes mellitus at baseline (HR 2.10; 95% CI 1.18 to 3.74; p=0.012) and anticoagulant therapy (HR 1.99; 95% CI 1.12 to 3.53; p=0.018) at ICH onset. Conclusions One year survivors after ICH had a substantial and persisting excess mortality compared with the general population. Major causes of death were stroke and ischaemic heart disease.

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