Adjusted Morbidity Groups and Intracerebral Haemorrhage: A Retrospective Primary Care Cohort Study

Overview

Journal Int J Environ Res Public Health

Publisher MDPI

Specialties Environmental Health
Public Health

Date 2021 Dec 24

PMID 34948927

Authors

Blanca Lorman-Carbo

Josep Lluis Clua-Espuny

Eulalia Muria-Subirats

Juan Ballesta-Ors

Maria Antonia Gonzalez-Henares

Meritxell Palleja-Millan

Francisco M Martin-Lujan

Affiliations

Soon will be listed here.

Abstract

Background: Intracerebral haemorrhage rates are increasing among highly complex, elderly patients. The main objective of this study was to identify modifiable risk factors of intracerebral haemorrhage.

Methods: Multicentre, retrospective, community-based cohort study was conducted, including patients in the Adjusted Morbidity Group 4 with no history of intracerebral haemorrhage. Cases were obtained from electronic clinical records of the Catalan Institute of Health and were followed up for five years. The primary outcome was the occurrence of intracerebral haemorrhage during the study period. Demographic, clinical and pharmacological variables were included. Logistic regression analyses were carried out to detect prognostic variables for intracerebral haemorrhage.

Results: 4686 subjects were included; 170 (3.6%) suffered an intracerebral haemorrhage (85.8/10,000 person-year [95% CI 85.4 to 86.2]). The HAS-BLED score for intracerebral haemorrhage risk detection obtained the best AUC (0.7) when used in the highest complexity level (cut-off point ≥3). Associated independent risk factors were age ≥80 years, high complexity and use of antiplatelet agents.

Conclusions: The Adjusted Morbidity Group 4 is associated with a high risk of intracerebral haemorrhage, particularly for highly complex patients and the use of antiplatelet agents. The risk of bleeding in these patients must be closely monitored.

References

Weinstock M, Uhlmann E, Zwicker J . Intracranial hemorrhage in cancer patients treated with anticoagulation. Thromb Res. 2016; 140 Suppl 1:S60-5. DOI: 10.1016/S0049-3848(16)30100-1. View

Pisters R, Lane D, Nieuwlaat R, de Vos C, Crijns H, Lip G . A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest. 2010; 138(5):1093-100. DOI: 10.1378/chest.10-0134. View

Gurbel P, Tantry U, Weisman S . A narrative review of the cardiovascular risks associated with concomitant aspirin and NSAID use. J Thromb Thrombolysis. 2018; 47(1):16-30. DOI: 10.1007/s11239-018-1764-5. View

Shin J, Park M, Lee S, Choi S, Kim M, Choi N . Risk of intracranial haemorrhage in antidepressant users with concurrent use of non-steroidal anti-inflammatory drugs: nationwide propensity score matched study. BMJ. 2015; 351:h3517. PMC: 4501372. DOI: 10.1136/bmj.h3517. View

Fang M, Go A, Chang Y, Borowsky L, Pomernacki N, Udaltsova N . A new risk scheme to predict warfarin-associated hemorrhage: The ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) Study. J Am Coll Cardiol. 2011; 58(4):395-401. PMC: 3175766. DOI: 10.1016/j.jacc.2011.03.031. View

Ogren J, Irewall A, Soderstrom L, Mooe T . Serious hemorrhages after ischemic stroke or TIA - Incidence, mortality, and predictors. PLoS One. 2018; 13(4):e0195324. PMC: 5886551. DOI: 10.1371/journal.pone.0195324. View

McNeil J, Wolfe R, Woods R, Tonkin A, Donnan G, Nelson M . Effect of Aspirin on Cardiovascular Events and Bleeding in the Healthy Elderly. N Engl J Med. 2018; 379(16):1509-1518. PMC: 6289056. DOI: 10.1056/NEJMoa1805819. View

Gonzalez GONZALEZ A, Miquel Gomez A, Rodriguez Morales D, Hernandez Pascual M, Sanchez Perruca L, Mediavilla Herrera I . [Concordance and usefulness of a stratification system for clinical decision making]. Aten Primaria. 2016; 49(4):240-247. PMC: 6875952. DOI: 10.1016/j.aprim.2016.04.009. View

Piepoli M, Hoes A, Agewall S, Albus C, Brotons C, Catapano A . 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by.... Eur Heart J. 2016; 37(29):2315-2381. PMC: 4986030. DOI: 10.1093/eurheartj/ehw106. View

10.

Gonzalez-Henares M, Clua-Espuny J, Lorman-Carbo B, Fernandez-Saez J, Queralt-Tomas L, Muria-Subirats E . Risk of Long-Term Mortality for Complex Chronic Patients with Intracerebral Hemorrhage: A Population-Based e-Cohort Observational Study. Adv Ther. 2019; 37(2):833-846. DOI: 10.1007/s12325-019-01206-y. View

11.

January C, Samuel Wann L, Calkins H, Chen L, Cigarroa J, Cleveland Jr J . 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the.... J Am Coll Cardiol. 2019; 74(1):104-132. DOI: 10.1016/j.jacc.2019.01.011. View

12.

Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B . 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur J Cardiothorac Surg. 2016; 50(5):e1-e88. DOI: 10.1093/ejcts/ezw313. View

13.

Krishnamurthi R, Ikeda T, Feigin V . Global, Regional and Country-Specific Burden of Ischaemic Stroke, Intracerebral Haemorrhage and Subarachnoid Haemorrhage: A Systematic Analysis of the Global Burden of Disease Study 2017. Neuroepidemiology. 2020; 54(2):171-179. DOI: 10.1159/000506396. View

14.

Bowman L, Mafham M, Wallendszus K, Stevens W, Buck G, Barton J . Effects of Aspirin for Primary Prevention in Persons with Diabetes Mellitus. N Engl J Med. 2018; 379(16):1529-1539. DOI: 10.1056/NEJMoa1804988. View

15.

ODonnell M, Xavier D, Liu L, Zhang H, Chin S, Rao-Melacini P . Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet. 2010; 376(9735):112-23. DOI: 10.1016/S0140-6736(10)60834-3. View

16.

Meschia J, Bushnell C, Boden-Albala B, Braun L, Bravata D, Chaturvedi S . Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014; 45(12):3754-832. PMC: 5020564. DOI: 10.1161/STR.0000000000000046. View

17.

Islam M, Poly T, Walther B, Yang H, Lin M, Li Y . Risk of Hemorrhagic Stroke in Patients Exposed to Nonsteroidal Anti-Inflammatory Drugs: A Meta-Analysis of Observational Studies. Neuroepidemiology. 2018; 51(3-4):166-176. DOI: 10.1159/000490741. View

18.

Stein M, Misselwitz B, Hamann G, Scharbrodt W, Schummer D, Oertel M . Intracerebral hemorrhage in the very old: future demographic trends of an aging population. Stroke. 2012; 43(4):1126-8. DOI: 10.1161/STROKEAHA.111.644716. View

19.

Duenas-Espin I, Vela E, Pauws S, Bescos C, Cano I, Cleries M . Proposals for enhanced health risk assessment and stratification in an integrated care scenario. BMJ Open. 2016; 6(4):e010301. PMC: 4838738. DOI: 10.1136/bmjopen-2015-010301. View

20.

Halvorsen S, Andreotti F, Ten Berg J, Cattaneo M, Coccheri S, Marchioli R . Aspirin therapy in primary cardiovascular disease prevention: a position paper of the European Society of Cardiology working group on thrombosis. J Am Coll Cardiol. 2014; 64(3):319-27. DOI: 10.1016/j.jacc.2014.03.049. View