Abstract T MP103: Long-Term Outcomes of Elderly Patients with Intracerebral Hemorrhage and Atrial Fibrillation

Abstract

Background: There has been limited investigation into the long-term outcomes of elderly patients with intracerebral hemorrhage (ICH) and atrial fibrillation (AF). Although ICH is associated with high short-term mortality, the long-term mortality of those patients with AF who survive a first ICH is unknown, as is the true incidence of recurrent ICH, ischemic stroke and major bleeding. The aims of this study were to examine the long-term outcomes of a cohort of patients with ICH and AF and to identify factors associated with long-term survival. Methods: We used the Ontario Stroke Registry (OSR) to identify a population-based cohort of patients ≥ 65 years of age with ICH and AF who were admitted to one of Ontario’s 150 acute care hospitals between 2002 and 2011. Linkage to health administrative databases was performed to assess mortality at 30 days, 1 year and 2 years as well as rates of recurrent ICH, ischemic stroke and major hemorrhage at 1 year. Prescription drug utilization in the year following hospital discharge was assessed through linkage to the Ontario Drug Benefits (ODB) database. Multivariable logistic regression was used to identify factors associated with long-term survival in these patients. Results: Of the 1,236 elderly patients diagnosed with ICH, 329 (26.6%) had AF. Of those patients discharged alive, 21.1% were prescribed warfarin in the year following discharge. Mortality was 42.6% at 30 days, 58.7% at 1 year and 66.9% at 2 years. The all-cause readmission rate at 1 year was 12.1%, 5.0% for ischemic stroke, 3.5% for recurrent ICH and 7.5% for major bleeding. Multivariable analysis showed that being prescribed an antihypertensive agent (HR 0.151, p<0.0001), a statin (HR 0.463, p=0.0102) or warfarin (HR 0.136, p=0.0056) after ICH was associated with a decreased risk of death at 1 year. Conclusions: In patients with ICH and AF, the incidence of recurrent ICH is lower than the incidence of ischemic stroke or major bleeding at 1 year. Although ICH is associated with high short-term mortality, the 2 year mortality rate for those patients who survive the first 30 days remains stable. Although ICH is often considered a relative contraindication for anticoagulation, this study demonstrates a reduction in long-term mortality in ICH patients treated with warfarin.