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

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Stroke
Mortality
Proportional Hazards Models
Comorbidity
Logistic Models
History

Keywords

  • stroke
  • falls
  • fractures
  • mortality
  • prognosis

Cite this

Foster, E. J., Barlas, R. S., Wood, A. D., Bettencourt-Silva, J. H., Clark, A. B., Metcalf, A. K., ... 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

A History of Falls is Associated with a Significant Increase in Acute Mortality in Women after Stroke. / Foster, Emma J.; Barlas, Raphae S.; Wood, Adrian D.; Bettencourt-Silva, Joao H.; Clark, Allan B.; Metcalf, Anthony Kneale; Bowles, Kristian M; Potter, John F; Myint, Phyo K.

In: Journal of Clinical Neurology, Vol. 13, No. 4, 10.2017, p. 411-421.

Research output: Contribution to journalArticle

Foster, EJ, Barlas, RS, Wood, AD, Bettencourt-Silva, JH, Clark, AB, Metcalf, AK, Bowles, KM, Potter, JF & Myint, PK 2017, 'A History of Falls is Associated with a Significant Increase in Acute Mortality in Women after Stroke', Journal of Clinical Neurology, vol. 13, no. 4, pp. 411-421. https://doi.org/10.3988/jcn.2017.13.4.411
Foster, Emma J. ; Barlas, Raphae S. ; Wood, Adrian D. ; Bettencourt-Silva, Joao H. ; Clark, Allan B. ; Metcalf, Anthony Kneale ; Bowles, Kristian M ; Potter, John F ; Myint, Phyo K. / A History of Falls is Associated with a Significant Increase in Acute Mortality in Women after Stroke. In: Journal of Clinical Neurology. 2017 ; Vol. 13, No. 4. pp. 411-421.
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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.",
keywords = "stroke, falls, fractures, mortality, prognosis",
author = "Foster, {Emma J.} and Barlas, {Raphae S.} and Wood, {Adrian D.} and Bettencourt-Silva, {Joao H.} and Clark, {Allan B.} and Metcalf, {Anthony Kneale} and Bowles, {Kristian M} and Potter, {John F} and Myint, {Phyo K.}",
note = "Acknowledgement We gratefully acknowledge the data team of the Stroke Services, Norfolk and Norwich University Stroke Research Group.",
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T1 - A History of Falls is Associated with a Significant Increase in Acute Mortality in Women after Stroke

AU - Foster, Emma J.

AU - Barlas, Raphae S.

AU - Wood, Adrian D.

AU - Bettencourt-Silva, Joao H.

AU - Clark, Allan B.

AU - Metcalf, Anthony Kneale

AU - Bowles, Kristian M

AU - Potter, John F

AU - Myint, Phyo K.

N1 - Acknowledgement We gratefully acknowledge the data team of the Stroke Services, Norfolk and Norwich University Stroke Research Group.

PY - 2017/10

Y1 - 2017/10

N2 - 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.

AB - 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.

KW - stroke

KW - falls

KW - fractures

KW - mortality

KW - prognosis

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DO - 10.3988/jcn.2017.13.4.411

M3 - Article

VL - 13

SP - 411

EP - 421

JO - Journal of Clinical Neurology

JF - Journal of Clinical Neurology

SN - 1738-6586

IS - 4

ER -