A History of Falls is Associated with a Significant Increase in Acute Mortality in Women after Stroke

Emma J. Foster, Raphae S. Barlas, Adrian D. Wood, Joao H. Bettencourt-Silva, Allan B. Clark, Anthony Kneale Metcalf, Kristian M Bowles, John F Potter, Phyo K. Myint

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Abstract

Background and Purpose: Fall and fracture risk increases after stroke. Little is known about the prognostic significance of previous falls and fractures after stroke. This study aimed to examine whether having a history of either is associated with mortality after stroke.

Methods: Using the prospectively collected stroke register data, between 2003­2015, we analysed the above relationship. Eight sex ­specific Models were analysed, incrementally adjusting for: age, type of stroke, Oxfordshire Community Stroke Project classification, previous comorbidities, frailty depicted by pre­stroke modified Rankin score (mRS) and acute illness parameters. Logistic regression was used for in ­hospital and 30­ day mortality; and Cox Proportional Hazard Models were employed for longer­ term outcomes of mortality.

Results: A total of 10,477 patients with stroke (86.1% ischaemic) were included in the analysis. The mean age (SD) was 77.7±11.9 years; 52.2% were women. 8.6% of men (N=430) and 20.2% of women (N=1105) had a history of falls; 3.8% (N=189) of men and 12.9% of women (N=706) had a history of both falls and fractures. Of the outcomes examined, a history of falls alone was associated with increased in­ hospital and 30­ day mortality in women; OR 1.33 (95%CI:1.03­1.71) and OR 1.34 (95%CI:1.03­1.73) respectively, in the fully adjusted Models. Cox Proportional Hazard Models for longer term outcomes and combined history of falls and fractures showed no significant results.

Conclusions: Falls history is an important factor for acute stroke mortality in women. A previous history of falls may therefore be an important factor to consider in short term stroke prognosis, particularly in women.
Original languageEnglish
Pages (from-to)411-421
Number of pages11
JournalJournal of Clinical Neurology
Volume13
Issue number4
Early online date27 Sep 2017
DOIs
Publication statusPublished - Oct 2017

Keywords

  • stroke
  • falls
  • fractures
  • mortality
  • prognosis

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    Foster, E. J., Barlas, R. S., Wood, A. D., Bettencourt-Silva, J. H., Clark, A. B., Metcalf, A. K., Bowles, K. M., Potter, J. F., & Myint, P. K. (2017). A History of Falls is Associated with a Significant Increase in Acute Mortality in Women after Stroke. Journal of Clinical Neurology, 13(4), 411-421. https://doi.org/10.3988/jcn.2017.13.4.411