Abstract Number: Esoc2026a1791 Impact of Care Bundle Implementation on Hematoma Expansion and 30-Day Mortality After Intracerebral Hemorrhage: Evidence From a Prospective Italian Registry (2018–2024)

Abstract Background and aims Bundles of care have demonstrated benefits in improving outcomes in intracerebral hemorrhage (ICH). This study examined the adoption of a care bundle approach, in a natural context without structerd implementation strategies, and evaluates whether achievement of therapeutic targets is associated with hematoma expansion (HE) and 30-day mortality. Methods Using data from a prospective population-based stroke registry (2018-2024), we analyzed blood pressure, blood glucose, body temperature, anticoagulation reversal and neurosurgical referrals, in patients with ICH. HE was defined as an increase in hematoma volume ≥ 33% from baseline on serial neuroimagings. Data collected were stratified into three periods: 2018-2019, 2020-2022, 2023-2024, reflecting the evolution of the “bundle of care” approach. Results We included 518 patients with ICH (55.4% male, median age 76 years, interquartile range 69-85). After 24 hours from ICH, the proportion of patients with blood pressure control (systolic blood pressure 140 mg/dl) improved from 36.3% in 2018-2019, to 47.6% in 2023-2024 (P = 0.136); the proportion of patients with blood glucose control (108 mg/dl) and normal body temperature (37.0*C) significantly improved as well. HE decreased from 23.5% of ICH cases in 2018-2019, to 12.2% in 2023-2024 (P = 0.006); the proportion of patients who maintained stable hematoma volume increased from 39.6% in 2018-2019, to 62.2% in 2023-2024. These changes had an impact on 30-day survival, which changed from 65.2%, to 63.5%, to 76.8% (P = 0.088). Conclusions These findings suggest that incremental improvements in adherence to care bundle components, even without formal implementation strategies, may translate into better ICH outcomes in routine clinical practice. Conflict of interest Raffaele Ornello reports grants from Novartis, Pfizer, and Allergan and compensation from Teva Pharmaceutical Industries, Eli Lilly and Company, Novartis, and H. Lundbeck A S for other services; AbbVie and Eli Lilly for data and safety monitoring services; Teva Pharmaceutical Industries for consultant services; and reports and travel support from Teva Pharmaceutical Industries. Simona Sacco Sacco reports consultancy or speaker fees from Novartis, Novo Nordisk, Boehringer Ingelheim, Teva, Allergan, Pfizer, Abbott, Lundbeck, AstraZeneca, and Eli Lilly. Dr Turc reports consulting for AI-Stroke, Neurologica, and lectures for Guerbet France; she is Presidente of ESO and Editor in Chief of Cephalagia. The other authors have nothing to disclose.