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Published on: October 15, 2021
Complex chronic patients as an emergent group with high risk of intracerebral haemorrhage: an observational cohort
Blanca Lorman-Carbó1, Josep Lluís Clua-Espuny2, Eulàlia Muria-Subirats3
1Department of Primary Care, Catalonian Health Institute, EAP Tortosa-est, UUDD Terres de l'Ebre; University Rovira Virgili, Tortosa, Spain.
Insights
Complex chronic patients (CCP) have a significantly higher incidence of intracerebral hemorrhage (ICH). A HAS-BLED score of 3 or higher, hypercholesterolemia, and cardiovascular disease are key independent risk factors for ICH in this population.
Area of Science:
- Gerontology and Public Health
- Neurology and Epidemiology
- Clinical Medicine
Background:
- Global demographic aging increases the number of older adults with complex health needs.
- Intracerebral hemorrhage (ICH) poses severe risks, particularly for individuals with multiple chronic conditions.
- Quantifying ICH incidence in complex chronic patients (CCP) is crucial for targeted interventions.
Purpose of the Study:
- To determine the incidence of intracerebral hemorrhage (ICH) in a cohort of complex chronic patients (CCP).
- To identify independent risk factors associated with ICH occurrence in CCPs.
- To evaluate the utility of bleeding risk scores in predicting ICH in this high-risk group.
Main Methods:
- A multicentre, retrospective, community-based cohort study involving 3594 CCPs from 2013-2017.
- ICH cases identified via ICD-10 codes in the e-SAP database; demographic, clinical, and pharmacological data collected.
- Logistic regression analysis used to identify independent risk factors, excluding HAS-BLED score components to prevent overlap.
Main Results:
- The incidence density of ICH was 151 per 10,000 person-years (4.4% of participants).
- Independent risk factors identified: HAS-BLED score ≥3 (OR 3.54), hypercholesterolemia (OR 1.62), and cardiovascular disease (OR 1.48).
- A HAS-BLED score ≥3 demonstrated high sensitivity (0.93) and negative predictive value (0.98) for ICH risk.
Conclusions:
- ICH incidence in CCPs is substantially higher (5-60 times) than in the general elderly population.
- Utilizing bleeding risk scores like HAS-BLED can enhance preventive strategies for high-risk CCPs.
- Early identification and management of risk factors are vital for reducing ICH burden in aging populations.
Background:
Demographic aging is a generalised event and the proportion of older adults is increasing rapidly worldwide with chronic pathologies, disability, and complexity of health needs. The intracerebral haemorrhage (ICH) has devastating consequences in high risk people. This study aims to quantify the incidence of ICH in complex chronic patients (CCP).
Methods:
This is a multicentre, retrospective and community-based cohort study of 3594 CCPs followed up from 01/01/2013 to 31/12/2017 in primary care without a history of previous ICH episode. The cases were identified from clinical records encoded with ICD-10 (10th version of the International Classification of Diseases) in the e-SAP database of the Catalan Health Institute. The main variable was the ICH episode during the study period. Demographic, clinical, functional, cognitive and pharmacological variables were included. Descriptive and logistic regression analyses were carried out to identify the variables associated with suffering an ICH. The independent risk factors were obtained from logistic regression models, ruling out the variables included in the HAS-BLED score, to avoid duplication effects. Results are presented as odds ratio (OR) and 95% confidence interval (CI). The analysis with the resulting model was also stratified by sex.
Results:
161 (4.4%) participants suffered an ICH episode. Mean age 87 ± 9 years; 55.9% women. The ICH incidence density was 151/10000 person-years [95%CI 127-174], without differences by sex. Related to subjects without ICH, presented a higher prevalence of arterial hypertension (83.2% vs. 74.9%; p = 0.02), hypercholesterolemia (55.3% vs. 47.4%, p = 0.05), cardiovascular disease (36.6% vs. 28.9%; p = 0.03), and use of antiplatelet drugs (64.0% vs. 52.9%; p = 0.006). 93.2% had a HAS-BLED score ≥ 3. The independent risk factors for ICH were identified: HAS-BLED ≥3 [OR 3.54; 95%CI 1.88-6.68], hypercholesterolemia [OR 1.62; 95%CI 1.11-2.35], and cardiovascular disease [OR 1.48 IC95% 1.05-2.09]. The HAS_BLED ≥3 score showed a high sensitivity [0.93 CI95% 0.89-0.97] and negative predictive value [0.98 (CI95% 0.83-1.12)].
Conclusions:
In the CCP subgroup the incidence density of ICH was 5-60 times higher than that observed in elder and general population. The use of bleeding risk score as the HAS-BLED scale could improve the preventive approach of those with higher risk of ICH.
Trial Registration:
This study was retrospectively registered in ClinicalTrials.gov ( NCT03247049 ) on August 11/2017.
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