Incidence, Predictors, and Prognostic Impact of Bleeding After Hospital Discharge Following Acute Coronary Syndrome: A Cohort Study Within the Clinical Practice Research Datalink

Ismail, Nafiu; Jordan, Kelvin P; Kadam, Umesh T; Edwards, John J; Mamas, Mamas A

Abstract

Introduction: The secondary management of acute coronary syndrome (ACS) with antithrombotic medication achieves the desired goal of reducing adverse ischaemic events, albeit at the expense of increased bleeding complications. However, little is known about the extent of these bleeding events following hospital discharge. Objective: To determine the incidence, predictors and prognostic impact of bleeding overall and site-specific bleeds on all-cause mortality following hospital discharge post-ACS. Methods: We used a primary care database (CPRD), with linkage to secondary care data (HES) to determine the incidence, timing, and types of bleeding events within 12 months of hospital discharge post-ACS. We assessed independent associations between post-discharge bleeding and baseline patient characteristics using a competing risk model. The association of bleeding with all-cause mortality was also assessed using a Cox model. Results: Among 27,660 patients surviving to hospital discharge, 3,620 (13%) experienced bleeding complications at a median time of 123 days (IQR: 45, 223) post-hospital discharge. The incidence of bleeding within 12 months of hospital discharge was 162/1000 persons years. Bruising (26%) was the most common type of first bleeding event, followed by gastrointestinal bleed (19%). Significant predictors of post-discharge bleeding included prior history of bleeding complication, oral anticoagulant prescription, history of PVD, COPD, and advanced age >80 years. Predictors for post-discharge bleeding varied depending on the anatomic site of the bleeding event. Bleeding increased the risk of all-cause mortality following hospital discharge for ACS (HR 1.70, 95% CI: 1.50, 1.92), and risk of mortality was greatest among patients that experienced intracranial bleeding events (HR 7.52, 95% CI: 4.41, 12.81). Conclusions: Bleeding complications post-hospital discharge are common within the primary care setting, and carry a greater risk of mortality. Patients who experience these bleeding events have distinct baseline characteristics. These characteristics can inform risk-benefit considerations in deciding on favourable combination and duration of secondary antithrombotic therapy.

Citation

Ismail, N., Jordan, K. P., Kadam, U. T., Edwards, J. J., & Mamas, M. A. (2019, November). Incidence, Predictors, and Prognostic Impact of Bleeding After Hospital Discharge Following Acute Coronary Syndrome: A Cohort Study Within the Clinical Practice Research Datalink. Presented at American Heart Association's 2019 Scientific Sessions, Philadelphia, Pennsylvania, USA

• Presentation Conference Type: Lecture
• Conference Name: American Heart Association's 2019 Scientific Sessions
• Conference Location: Philadelphia, Pennsylvania, USA
• Start Date: Nov 16, 2019
• End Date: Nov 18, 2019
• Acceptance Date: Nov 19, 2019
• Publication Date: Nov 11, 2019
• Series Title: American Heart Association Scientific Sessions 2019
• DOI: https://doi.org/10.1161/circ.140.suppl_1.16491
• Publisher URL: https://www.ahajournals.org/doi/10.1161/circ.140.suppl_1.16491