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Older age is a strong predictor for poor outcome in intracerebral haemorrhage: the INTERACT2 study
Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland.
The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, NSW, Australia.
The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, NSW, Australia.
The Shanghai Institute of Hypertension, Rui Jin Hospital, Shanghai Jiaotong University, Shanghai, China.
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2015 (English)In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 44, no 3, 422-427 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND PURPOSE:: Global ageing contributes greatly to the burden of stroke. We investigated the influence of age on the baseline profile and on outcomes in acute intracerebral haemorrhage (ICH) among participants of the INTERACT2 study.

METHODS:: INTERACT2 was an international, randomised controlled trial in 2839 patients with spontaneous ICH within 6 h of onset and elevated systolic blood pressure (SBP; 150-220 mmHg) who were allocated to receive intensive (target SBP <140 mmHg within 1 h) or guideline-recommended (target SBP <180 mmHg) blood pressure lowering treatment. Stroke severity was assessed with the National Institutes of Health Stroke Scale. Poor outcome was defined as death or major disability ('dependency', modified Rankin Scale scores 3-6) at 90 days. Health-related quality of life (HRQoL) was assessed with the European Quality of Life-5 Dimensions (EQ-5D) questionnaire. Associations between age and outcomes were analysed in multivariable logistic regression models.

RESULTS:: Stroke severity increased in categories of older age (P-trend 0.002). Stroke patients over 75 years old were four times more likely to die or be disabled at 90 days than those <52 years when other confounders were accounted for (odds ratio 4.36, 95% confidence interval 3.12-6.08). Older age was also associated with decreasing HRQoL, across mobility, self-care, usual activities and depression (all P-trend <0.001), and pain or discomfort (P-trend 0.022).

CONCLUSION:: In the INTERACT2 cohort, older people had more severe ICH and worse outcomes (death, major disability and HRQoL). These data will help guide clinicians manage older people with haemorrhagic stroke. Clinical Trial Registration: (NCT00716079).

Place, publisher, year, edition, pages
Oxford University Press, 2015. Vol. 44, no 3, 422-427 p.
National Category
Family Medicine
URN: urn:nbn:se:liu:diva-115371DOI: 10.1093/ageing/afu198ISI: 000355623100014PubMedID: 25497513OAI: diva2:795065
Available from: 2015-03-13 Created: 2015-03-13 Last updated: 2015-09-11
In thesis
1. Cardiovascular risk factors in elderly: With special emphasis on atrial fibrillation, hypertension and diabetes
Open this publication in new window or tab >>Cardiovascular risk factors in elderly: With special emphasis on atrial fibrillation, hypertension and diabetes
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]


The part of the population that belongs to the oldest-old (ages 80 years or older) increases rapidly, worldwide. Cardiovascular disease (CVD) is the leading cause of death and disease burden globally. Multimorbidity is common in old age and stroke, diabetes mellitus (DM) and atrial fibrillation (AF) are strongly associated with age. Cardiovascular risk factors are well studied and documented in younger and middle ages, but not as well in old and frail individuals. Therefore, preventive treatment choices are mostly based on evidence for younger patients. The aim of this thesis was to explore age and other aspects of cardiovascular risk factors; AF, hypertension and DM, in relation to comorbidity, cardiovascular outcome and mortality.


This thesis was based on four different studies:

  • The ELSA85 study of 85 years old in Linköping, Sweden
  • The international, multicentre, randomised controlled INTERACT2 trial of spontaneous intracranial haemorrhage (ICH), mean age 64 years.
  • The prospective SHADES study of nursing home residents, mean age 85 years.
  • The prospective, national SWE-diadep study of dispensed antidiabetics, antidepressantsand prevalent myocardial infarction (MI) in 45-84 years old.

Data was obtained from questionnaires (ELSA85, INTERACT2), medical records and medical examination (ELSA85, INTERACT2, SHADES), and national registers (SWE-Diadep).


The ELSA85 study showed that 16% (n=53) had an ECG showing AF. There was an increased hazard ratio (HR) for all-cause mortality in participants with AF at baseline, at 90 years of age (HR 1.59, 95% [Confidence Interval] CI 1.04-2.44) adjusted for sex. This increase in HR did not persist when adjusted for congestive heart failure (CHF). In the INTERACT2 study, increasing age was associated with increasing frequency of death or dependency (odds ratio [OR] 4.36, 95% [CI] 3.12-6.08 for >75 years vs <52 years, p value for trend <0.001). The SHADES study showed that participants with Systolic blood pressure (SBP) <120 mmHg had an increased HR for mortality (1.56, 95% CI, 1.08–2.27; p=0.019) but there were no differences between SBP groups 140–159 mmHg and ≥160 mmHg compared with the reference group SBP 120–139 mmHg. SBP decreased during the prospective study period. In the SWE-diadep study, individuals with antidiabetics and antidepressants combined had a greater HR for MI compared to the reference of no antidiabetics or antidepressants, mostly so in women aged 45-64 years (HR 7.4, 95% CI: 6.3-8.6).


Risk factors for CVDs in elderly differ from cardiovascular risk factors in middle aged individuals an

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2015. 78 p.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1466
National Category
Public Health, Global Health, Social Medicine and Epidemiology Other Health Sciences Family Medicine
urn:nbn:se:liu:diva-121286 (URN)10.3384/diss.diva-121286 (DOI)978-91-7519-030-3 (print) (ISBN)
Public defence
2015-10-09, Belladonna, ingång 78, Campus US, Linköping, 13:00 (Swedish)
Available from: 2015-09-11 Created: 2015-09-11 Last updated: 2015-09-18Bibliographically approved

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Rådholm, Karin
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Division of Community MedicineFaculty of Medicine and Health SciencesLocal Health Care Services in West Östergötland
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