Off-Hour admission and outcomes in patients with acute intracerebral hemorrhage in the INTERACT2 trial

INTERACT2 Investigators , Shoichiro Sato, Hisatomi Arima, Emma Heeley, Yoichiro Hirakawa, Candice Delcourt, Richard I. Lindley, Thompson Robinson, Yining Huang, Lewis Morgenstern, Christian Stapf, Jiguang Wang, John Chalmers, Craig S. Anderson

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8 Citations (Scopus)


Background: Conflicting data exist of an association between off-hour (weekend, holiday, or night-time) hospital admission and adverse outcome in intracerebral hemorrhage (ICH). We determined the association between off-hour admissions and poor clinical outcome, and of any differential effect of early intensive blood pressure (BP) lowering treatment between off- and on-hour admissions, among participants of the Intensive BP Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2). Methods: Subsidiary analysis of INTERACT2, a multinational, multicenter, clinical trial of patients with spontaneous ICH with elevated systolic BP, randomly assigned to intensive (target systolic BP <140 mm Hg) or guideline-based (<180 mm Hg) BP management. Primary outcome was death or major disability (modified Rankin scale of 3-6) at 90 days. Off-hour admission was defined as night-time (4:30 p.m. to 8:30 a.m.) on weekdays, weekends (Saturday and Sunday), and public holidays in each participating country. Results: Of 2,794 patients with information on the primary outcome, 1,770 (63%) were admitted to study centers during off-hours. Off-hour admission was not associated with risk of poor outcome at 90 days (53% off-hour vs. 55% on-hour; p = 0.49), even after adjustment for comorbid risk factors (odds ratio 0.92; 95% CI 0.76-1.12). Consistency exists in the effects of intensive BP lowering between off- and on-hour admission (p = 0.85 for homogeneity). Conclusions: Off-hour admission was not associated with increased risks of death or major disability among trial protocol participants with acute ICH. Intensive BP lowering can provide similar treatment effect irrespective of admission hours.

Original languageEnglish
Pages (from-to)114-120
Number of pages7
JournalCerebrovascular Diseases
Issue number3-4
Publication statusPublished - Sept 2015
Externally publishedYes


  • Acute stroke care
  • Blood pressure
  • Clinical trials
  • Hypertension
  • Intracerebral hemorrhage


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