Clinical research studyIncidence of intracranial hemorrhage in patients with atrial fibrillation who are prone to fall
Section snippets
Methods
The primary endpoint was hospitalization for an intracranial hemorrhage after the index hospital admission. The study was approved by the Washington University human subjects’ committee.
Cohort descriptions
Subjects at high risk for falls were older and had more comorbidities than other patients. In addition, they were significantly less likely to receive warfarin or aspirin therapy (Table 1).
Trial-like patients (n = 3236) were younger (mean age, 73 years) and healthier (mean number of bleeding risk factors, 0.6). Most of them were prescribed antithrombotic therapy (53.7% warfarin; 23.1% aspirin).
Data integrity and validation
We validated the fall-risk designation by examining ICD-9 codes for falling and for nonpathologic
Discussion
Despite their low use of warfarin (33.5%), patients at high risk for falls suffered 2.8 intracranial hemorrhages per 100 patient-years, more than twice the 1.1 intracranial hemorrhage rate of other participants and more than 5 times the 0.5 rate of trial-like participants. The increased risk of intracranial hemorrhage in patients at high risk for falls was due to their increased incidence of traumatic intracranial hemorrhage, which was increased four-fold compared to other patients, even after
Acknowledgment
The authors appreciate the assistance of the Iowa Foundation for Medical Care, the other Quality Improvement Organizations, and the Centers for Medicare & Medicaid Services (CMS) in providing data that made this research possible.
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Grant Support: Supported by the American Heart Association (0270099N). Disclaimer: The conclusions presented are solely those of the authors and do not represent those of the Quality Improvement Organizations, American Heart Association, or CMS. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of commercial products imply endorsement of them by the U. S. Government. The authors assume full responsibility for the accuracy and completeness of the ideas presented.