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Withdrawal of active treatment after intracerebral haemorrhage in the INTERACT2 study

in the second Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT2), a minority of patients received withdrawal of active treatment (WAT). We wished to determine the characteristics of these patients, and the relation of this decision-making to subsequent management and... Full description

Journal Title: Age and ageing 2017, Vol.46 (2), p.329-332
Main Author: Muñoz Venturelli, Paula
Other Authors: Wang, Xia , Zahuranec, Darin B , Lavados, Pablo M , Stapf, Christian , Lindley, Richard , Delcourt, Candice , Chalmers, John , Anderson, Craig S , Robinson, Thompson G
Format: Electronic Article Electronic Article
Language: English
Subjects:
Publisher: England: Oxford University Press
ID: ISSN: 0002-0729
Link: https://www.ncbi.nlm.nih.gov/pubmed/27831492
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title: Withdrawal of active treatment after intracerebral haemorrhage in the INTERACT2 study
format: Article
creator:
  • Muñoz Venturelli, Paula
  • Wang, Xia
  • Zahuranec, Darin B
  • Lavados, Pablo M
  • Stapf, Christian
  • Lindley, Richard
  • Delcourt, Candice
  • Chalmers, John
  • Anderson, Craig S
  • Robinson, Thompson G
subjects:
  • Acute Disease
  • Aged
  • Aged, 80 and over
  • Analysis
  • Blood Pressure
  • Care and treatment
  • Cerebral Hemorrhage - diagnosis
  • Cerebral Hemorrhage - mortality
  • Cerebral Hemorrhage - physiopathology
  • Cerebral Hemorrhage - therapy
  • Chi-Square Distribution
  • Clinical Decision-Making
  • Decision Support Techniques
  • Disability Evaluation
  • Female
  • Hospital Mortality
  • Humans
  • Intracerebral haemorrhage
  • Intracerebral hemorrhage
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Odds Ratio
  • older people
  • outcome
  • Patient Selection
  • Predictive Value of Tests
  • prognosis
  • Risk Factors
  • Short Report
  • Time Factors
  • Treatment Outcome
  • withdrawal of care
  • withdrawal of treatment
  • Withholding Treatment
ispartof: Age and ageing, 2017, Vol.46 (2), p.329-332
description: in the second Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT2), a minority of patients received withdrawal of active treatment (WAT). We wished to determine the characteristics of these patients, and the relation of this decision-making to subsequent management and final outcome. the INTERACT2 cohort of acute intracerebral haemorrhage (ICH) patients had a decision of WAT within 7 days after hospital admission recorded. Multivariable logistic regression was used to identify the determinants of WAT and poor outcome at 90 days, defined by modified Rankin scale (mRS) scores 3-6. of 2,779 participants with available data, WAT occurred in 121 (4%) and this was significantly associated with increasing age, greater neurological severity, larger haematoma volume, intraventricular extension and randomisation to intensive BP lowering. Compared to other patients, those with WAT had greater mortality (81/121 [67%] versus 205/2624 [8%]; P < 0.001) and survivors were more likely to be severely disabled (mRS score 4-5, 19/39 [49%] versus 695/2419 [29%]; P = 0.006). WAT was undertaken in patients with recognised predictors of poor prognosis, who subsequently were more likely to die or be left with severe disability. Improved understanding of specific factors determining WAT in ICH patients might improve care delivery and outcomes. the INTERACT2 study is registered with ClinicalTrials.gov (NCT00716079).
language: eng
source:
identifier: ISSN: 0002-0729
fulltext: no_fulltext
issn:
  • 0002-0729
  • 1468-2834
url: Link


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titleWithdrawal of active treatment after intracerebral haemorrhage in the INTERACT2 study
creatorMuñoz Venturelli, Paula ; Wang, Xia ; Zahuranec, Darin B ; Lavados, Pablo M ; Stapf, Christian ; Lindley, Richard ; Delcourt, Candice ; Chalmers, John ; Anderson, Craig S ; Robinson, Thompson G
creatorcontribMuñoz Venturelli, Paula ; Wang, Xia ; Zahuranec, Darin B ; Lavados, Pablo M ; Stapf, Christian ; Lindley, Richard ; Delcourt, Candice ; Chalmers, John ; Anderson, Craig S ; Robinson, Thompson G ; INTERACT2 Investigators ; for the INTERACT2 Investigators
descriptionin the second Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT2), a minority of patients received withdrawal of active treatment (WAT). We wished to determine the characteristics of these patients, and the relation of this decision-making to subsequent management and final outcome. the INTERACT2 cohort of acute intracerebral haemorrhage (ICH) patients had a decision of WAT within 7 days after hospital admission recorded. Multivariable logistic regression was used to identify the determinants of WAT and poor outcome at 90 days, defined by modified Rankin scale (mRS) scores 3-6. of 2,779 participants with available data, WAT occurred in 121 (4%) and this was significantly associated with increasing age, greater neurological severity, larger haematoma volume, intraventricular extension and randomisation to intensive BP lowering. Compared to other patients, those with WAT had greater mortality (81/121 [67%] versus 205/2624 [8%]; P < 0.001) and survivors were more likely to be severely disabled (mRS score 4-5, 19/39 [49%] versus 695/2419 [29%]; P = 0.006). WAT was undertaken in patients with recognised predictors of poor prognosis, who subsequently were more likely to die or be left with severe disability. Improved understanding of specific factors determining WAT in ICH patients might improve care delivery and outcomes. the INTERACT2 study is registered with ClinicalTrials.gov (NCT00716079).
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subjectAcute Disease ; Aged ; Aged, 80 and over ; Analysis ; Blood Pressure ; Care and treatment ; Cerebral Hemorrhage - diagnosis ; Cerebral Hemorrhage - mortality ; Cerebral Hemorrhage - physiopathology ; Cerebral Hemorrhage - therapy ; Chi-Square Distribution ; Clinical Decision-Making ; Decision Support Techniques ; Disability Evaluation ; Female ; Hospital Mortality ; Humans ; Intracerebral haemorrhage ; Intracerebral hemorrhage ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; older people ; outcome ; Patient Selection ; Predictive Value of Tests ; prognosis ; Risk Factors ; Short Report ; Time Factors ; Treatment Outcome ; withdrawal of care ; withdrawal of treatment ; Withholding Treatment
ispartofAge and ageing, 2017, Vol.46 (2), p.329-332
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0The Author 2016. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com
1The Author 2016. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com 2016
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1Wang, Xia
2Zahuranec, Darin B
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7Chalmers, John
8Anderson, Craig S
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descriptionin the second Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT2), a minority of patients received withdrawal of active treatment (WAT). We wished to determine the characteristics of these patients, and the relation of this decision-making to subsequent management and final outcome. the INTERACT2 cohort of acute intracerebral haemorrhage (ICH) patients had a decision of WAT within 7 days after hospital admission recorded. Multivariable logistic regression was used to identify the determinants of WAT and poor outcome at 90 days, defined by modified Rankin scale (mRS) scores 3-6. of 2,779 participants with available data, WAT occurred in 121 (4%) and this was significantly associated with increasing age, greater neurological severity, larger haematoma volume, intraventricular extension and randomisation to intensive BP lowering. Compared to other patients, those with WAT had greater mortality (81/121 [67%] versus 205/2624 [8%]; P < 0.001) and survivors were more likely to be severely disabled (mRS score 4-5, 19/39 [49%] versus 695/2419 [29%]; P = 0.006). WAT was undertaken in patients with recognised predictors of poor prognosis, who subsequently were more likely to die or be left with severe disability. Improved understanding of specific factors determining WAT in ICH patients might improve care delivery and outcomes. the INTERACT2 study is registered with ClinicalTrials.gov (NCT00716079).
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1Aged
2Aged, 80 and over
3Analysis
4Blood Pressure
5Care and treatment
6Cerebral Hemorrhage - diagnosis
7Cerebral Hemorrhage - mortality
8Cerebral Hemorrhage - physiopathology
9Cerebral Hemorrhage - therapy
10Chi-Square Distribution
11Clinical Decision-Making
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23Odds Ratio
24older people
25outcome
26Patient Selection
27Predictive Value of Tests
28prognosis
29Risk Factors
30Short Report
31Time Factors
32Treatment Outcome
33withdrawal of care
34withdrawal of treatment
35Withholding Treatment
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titleWithdrawal of active treatment after intracerebral haemorrhage in the INTERACT2 study
authorMuñoz Venturelli, Paula ; Wang, Xia ; Zahuranec, Darin B ; Lavados, Pablo M ; Stapf, Christian ; Lindley, Richard ; Delcourt, Candice ; Chalmers, John ; Anderson, Craig S ; Robinson, Thompson G
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2Aged, 80 and over
3Analysis
4Blood Pressure
5Care and treatment
6Cerebral Hemorrhage - diagnosis
7Cerebral Hemorrhage - mortality
8Cerebral Hemorrhage - physiopathology
9Cerebral Hemorrhage - therapy
10Chi-Square Distribution
11Clinical Decision-Making
12Decision Support Techniques
13Disability Evaluation
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20Male
21Middle Aged
22Multivariate Analysis
23Odds Ratio
24older people
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27Predictive Value of Tests
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30Short Report
31Time Factors
32Treatment Outcome
33withdrawal of care
34withdrawal of treatment
35Withholding Treatment
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pages329-332
issn0002-0729
eissn1468-2834
abstractin the second Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT2), a minority of patients received withdrawal of active treatment (WAT). We wished to determine the characteristics of these patients, and the relation of this decision-making to subsequent management and final outcome. the INTERACT2 cohort of acute intracerebral haemorrhage (ICH) patients had a decision of WAT within 7 days after hospital admission recorded. Multivariable logistic regression was used to identify the determinants of WAT and poor outcome at 90 days, defined by modified Rankin scale (mRS) scores 3-6. of 2,779 participants with available data, WAT occurred in 121 (4%) and this was significantly associated with increasing age, greater neurological severity, larger haematoma volume, intraventricular extension and randomisation to intensive BP lowering. Compared to other patients, those with WAT had greater mortality (81/121 [67%] versus 205/2624 [8%]; P < 0.001) and survivors were more likely to be severely disabled (mRS score 4-5, 19/39 [49%] versus 695/2419 [29%]; P = 0.006). WAT was undertaken in patients with recognised predictors of poor prognosis, who subsequently were more likely to die or be left with severe disability. Improved understanding of specific factors determining WAT in ICH patients might improve care delivery and outcomes. the INTERACT2 study is registered with ClinicalTrials.gov (NCT00716079).
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pmid27831492
doi10.1093/ageing/afw187
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