P665Incidence and predictors of intracerebral haemorrhage recurrence in patients with and without atrial fibrillation: a cohort study

Abstract

Abstract Background Intracerebral haemorrhage is a devastating vascular event. Clinical predictors of recurrence facilitating individualised post-bleeding patient management are sparsely described. Concomitant atrial fibrillation is common in patients with intracerebral haemorrhage due to widespread use of oral anticoagulation in this specific population. Objective We aimed to describe incidence of intracerebral haemorrhage recurrence and explore the prognostic value of 25 clinical predictors for recurrence in patients with and without atrial fibrillation, including various comorbidities, civil status, lifestyle, medication, and measures of bleeding severity reflected by the Scandinavian Stroke Scale score. Methods Cohort study of patients with incident intracerebral haemorrhage diagnosed from 2003–2016 identified using nationwide Danish administrative registries. Results reported as cumulative incidence of intracerebral recurrence accounting for competing risk of death. Univariate and multivariate predictors of recurrence were estimated using Cox regression analyses (hazard ratios [HRs], 95% confidence intervals [CI]). Results We identified 9,255 patients with incident intracerebral haemorrhage (median age 73 years, 46.6% females, 16% with atrial fibrillation). Five-year risks of intracerebral haemorrhage recurrence were approximately 10% in the study population, although slightly higher for patients without atrial fibrillation (Figure). Predictors of recurrence were broadly similar for patients with and without atrial fibrillation. Age in categories <60 years (reference), age 60–70 years (HR 1.30, 95% CI 1.03–1.65), age 70–80 years (HR 1.60, 95% CI 1.27–2.01), age >80 years (HR 1.20, 95% CI 0.91–1.57), nursing home residency (HR 1.48, 95% CI 1.03–2.15), and Scandinavian Stroke Scale score (“mild” versus “moderate” (HR 1.40, 95% CI 1.13–1.72) and “severe” (HR 1.94, 95% CI 1.59–2.37) were the strongest predictors of intracerebral haemorrhage recurrence. Conclusions Intracerebral haemorrhage recurrence risk after five years was approximately 10%. Robust clinical predictors of recurrence were few and broadly similar for patients with and without atrial fibrillation, with age and measures of bleeding severity being the most important. Acknowledgement/Funding The study was supported by “The BMS/Pfizer ERISTA Program 2016”. The sponsor had no role in the preparation of the manuscript