Abstract Details

Title Causes of Death in a Longitudinal Analysis of Spontaneous Intracerebral Hemorrhage Survivors

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S9 - Cerebrovascular Disease: Intracerebral Hemorrhage (4:18 PM-4:30 PM)

Poster/Presentation
Number 005

Objective To determine the causes of death in first-time ICH survivors.

Background With improvements in acute care, more patients are surviving a first-time spontaneous intracerebral hemorrhage (ICH). In the growing survivor population, little is known about effective secondary stroke prevention strategies or long-term causes of illness and death.

Design/Methods We performed a longitudinal study of prospectively collected claims data from hospitals in California (2005-2011), New York (2005-2014) and Florida (2005-2014). State residents admitted with a non-traumatic ICH (ICD-9-CM code 431) who survived to discharge were included. Subjects were followed for any readmission resulting in death. Cause of death was defined as the primary diagnosis assigned at discharge. Kaplan-Meier survival analysis was used to estimate the risk of in-hospital death during follow-up. Cox proportional hazards and multinomial logistic regression identified factors associated with risk and cause for death. History of atrial fibrillation (AF) was evaluated as a covariate.

Results Of 64,063 ICH survivors (mean age 68 [SD 15]), 11,361 (18%) died during follow-up (median follow-up 4 years, IQR 2.3-6.3). The one-year risk of death was 9.5% (95% CI 9.2-9.7) and the median time to death was 10 months (IQR 2-31). Subjects who died were older (73 vs. 67, p <0.001) and more likely to have history of AF (21% vs. 14%, p<0.001). The leading causes of death were infection (28%), recurrent intracranial hemorrhage (12%), respiratory failure (8%), and cardiac disease (8%). Death in subjects with AF was more likely to be caused by ischemic stroke (OR 2.18, 95% CI 1.69-2.81, p<0.001) or cardiac causes (OR 1.62, 95% CI 1.28-2.03, p=0.002).

Conclusions

Infection is the leading cause for death in ICH survivors, followed by recurrent intracranial hemorrhage and respiratory failure. Survivors with AF experience an elevated risk for death by ischemic stroke. These findings may represent interventional targets in efforts to extend improved outcomes in ICH survivors.

Authors/Disclosures
Lindsey R. Kuohn, MD PRESENTER	Dr. Kuohn has nothing to disclose.
Audrey Leasure	Ms. Leasure has nothing to disclose.
	No disclosure on file
Kevin N. Vanent	Mr. Vanent has nothing to disclose.
Santosh B. Murthy, MD (Weill Cornell Medicine)	Dr. Murthy has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Stroke and Neurological disorders. The institution of Dr. Murthy has received research support from National Institutes of Health/NINDS.
Hooman Kamel, MD (Weill Cornell Medical College)	Dr. Kamel has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for JAMA Neurology. Dr. Kamel has received personal compensation in the range of $50,000-$99,999 for serving as a Endpoint adjudication committee with Boehringer-Ingelheim.
Charles Matouk	Charles Matouk has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Silk Road Medical. Charles Matouk has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Microvention. Charles Matouk has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Navigantis.
Lauren H. Sansing, MD	Dr. Sansing has nothing to disclose.
Guido J. Falcone, MD (Yale School of Medicine)	The institution of Dr. Falcone has received research support from NIH. The institution of Dr. Falcone has received research support from AHA.
Kevin N. Sheth, MD, FAAN (Yale UniversityDivision of Neuro and Critical Care)	Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ceribell. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Zoll. Dr. Sheth has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for NControl. Dr. Sheth has received stock or an ownership interest from Astrocyte. Dr. Sheth has received stock or an ownership interest from Alva. The institution of Dr. Sheth has received research support from Biogen. The institution of Dr. Sheth has received research support from Novartis. The institution of Dr. Sheth has received research support from Bard. The institution of Dr. Sheth has received research support from Hyperfine. Dr. Sheth has received intellectual property interests from a discovery or technology relating to health care.

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