Abstract
Background: International research indicates that patients with spontaneous intracerebral haemorrhage (ICH) have worse clinical outcomes than those with ischaemic stroke.
Aims: This study analyses a national cohort to compare the baseline characteristics, in-hospital interventions, complications and outcomes of patients admitted with ICH and ischaemic stroke in New Zealand.
Methods: We conducted a post-hoc analysis of a prospective, nationwide cohort study. Adult patients with a confirmed diagnosis of spontaneous ICH or ischaemic stroke were recruited from 28 hospitals between 1 May and 31 October 2018. The primary outcome was modified Rankin Scale (mRS) at 3 months, dichotomised into favourable (mRS 0-2) and unfavourable (mRS 3-6). Secondary outcomes included dichotomised mRS at 12 months, mortality at 3 and 12 months, and living situation at 3 months. Results were adjusted for age, pre-stroke independence, living alone, stroke severity, sex, ethnicity and presenting hospital.
Results: The study included 291 patients with ICH and 1937 patients with ischaemic stroke. Baseline characteristics were largely similar, but patients with ICH scored higher on clinical measures of stroke severity. At 3 months after stroke, patients with ICH had lower odds of a favourable functional outcome than those with ischaemic stroke (adjusted odds ratio (aOR) = 0.36, 95% confidence interval (CI) 0.24-0.53, P < 0.001), higher mortality (aOR = 2.41, 95% CI 1.68-3.46, P < 0.001), and were over twice as likely to be living in residential care (aOR = 2.55, 95% CI 1.39-4.71, P = 0.003). Patients with ICH also had more in-hospital complications, lower rates of admission to an acute stroke unit and higher rates of early palliative care initiation.
Conclusion: This New Zealand-based study confirms that patients with ICH have poorer outcomes than those with ischaemic stroke. Further research is needed into effective therapies for ICH and to assess adherence to best practice ICH management across New Zealand.