J Clin Neurol.  2017 Oct;13(4):411-421. 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 EJ
• Barlas RS
• Wood AD
• Bettencourt-Silva JH
• Clark AB
• Metcalf AK
• Bowles KM
• Potter JF
• Myint PK

• KMID: 2392138
• DOI: http://doi.org/10.3988/jcn.2017.13.4.411

Abstract

BACKGROUND AND PURPOSE
The risks of falls and fractures increase after stroke. Little is known about the prognostic significance of previous falls and fractures after stroke. This study examined whether having a history of either event is associated with poststroke mortality.
METHODS
We analyzed stroke register data collected prospectively between 2003 and 2015. Eight sex-specific models were analyzed, to which the following variables were incrementally added to examine their potential confounding effects: age, type of stroke, Oxfordshire Community Stroke Project classification, previous comorbidities, frailty as indicated by the prestroke modified Rankin Scale score, and acute illness parameters. Logistic regression was applied to investigate in-hospital and 30-day mortality, and Cox proportional-hazards models were applied to investigate longer-term outcomes of mortality.
RESULTS
In total, 10,477 patients with stroke (86.1% ischemic) were included in the analysis. They were aged 77.7±11.9 years (mean±SD), and 52.2% were women. A history of falls was present in 8.6% of the men (n=430) and 20.2% of the women (n=1,105), while 3.8% (n=189) of the men and 12.9% of the 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 mortality [odds ratio (OR)=1.33, 95% confidence interval (CI)=1.03-1.71] and 30-day mortality (OR=1.34, 95% CI=1.03-1.73) in women in the fully adjusted models. The Cox proportional-hazards models for longer-term outcomes and the history of falls and fractures combined showed no significant results.
CONCLUSIONS
The history of falls is an important factor for acute stroke mortality in women. A previous history of falls may therefore be an important factor to consider in the short-term stroke prognosis, particularly in women.

Keyword

stroke; falls; fractures; mortality; prognosis

MeSH Terms

Accidental Falls*
Classification
Comorbidity
Female
Hospital Mortality
Humans
Logistic Models
Male
Mortality*
Prognosis
Prospective Studies
Stroke*

Figure

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  Fig. 1 A: Kaplan-Meier curve showing the probability of survival across the whole follow-up period in men with a history of falls compared to those with no history of falls. B: Kaplan-Meier curve showing the probability of survival across the whole follow-up period in men with a history of fractures compared to those with no history of fractures.

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  Fig. 2 A: Kaplan-Meier curve showing the probability of survival across the whole follow-up period in women with a history of falls compared to those with no history of falls. B: Kaplan-Meier curve showing the probability of survival across the whole follow-up period in women with a history of fractures compared to those with no history of fractures.

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