DOI: 10.5061/dryad.t76hdr7zj
title: The Incidence of Intracerebral Haemorrhage in Complex Chronic Patients

description: 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 antiaggregants 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% 0.97-0.89] 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.
description: 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 Department of
 Information and New Technologies carried out an automated extraction of
 the CMBD of hospital discharges and SIRE. All the data were included in an
 <i>ad hoc</i> repository, which was delivered to the main
 researcher in a completely anonymous format, supervised and assessed
 according to the General Data Protection Regulation of Spain/Europe of 1st
 February 2017. The Catalan Health Plan extensively implemented a case
 finding system classifying high risk chronic patients into two different
 categories based on defined criteria and primary care physician judgment:
 i) Complex chronic patients (CCP, approximately 5% of the population);
 and, ii) Patients with less than 12 months expected life survival (ACD,
 approximately 1% of the population). The medical records including the CCP
 condition were incorporated into the computerised medical record of the
 Catalan Health Institute in January 2013. This database is managed by
 primary care professionals, who administer and update it in a specific
 format called “Shared individual intervention plan” (PIIC, Catalan acronym
 for <i>Pla d'Intervenció Individualitzat Compartit</i>).
 Currently, 82% of individuals registered as CCPs have an updated
 report.