Quality of Life After Poor-Grade Aneurysmal Subarachnoid Hemorrhage

Abstract

BACKGROUND:Poor-grade aneurysmal subarachnoid hemorrhage (aSAH) is associated with high mortality and poor disability outcome. Data on quality of life (QoL) among survivors are scarce because patients with poor-grade aSAH are underrepresented in clinical studies reporting on QoL after aSAH.OBJECTIVE:To provide prospective QoL data on survivors of poor-grade aSAH to aid clinical decision making and counseling of relatives.METHODS:The herniation World Federation of Neurosurgical Societies scale study was a prospective observational multicenter study in patients with poor-grade (World Federation of Neurosurgical Societies grades 4 & 5) aSAH. We collected data during a structured telephone interview 6 and 12 months after ictus. QoL was measured using the EuroQoL - 5 Dimensions - 3 Levels (EQ-5D-3L) questionnaire, with 0 representing a health state equivalent to death and 1 to perfect health. Disability outcome for favorable and unfavorable outcomes was measured with the modified Rankin Scale.RESULTS:Two hundred-fifty patients were enrolled, of whom 237 were included in the analysis after 6 months and 223 after 12 months. After 6 months, 118 (49.8%) patients were alive, and after 12 months, 104 (46.6%) patients were alive. Of those, 95 (80.5%) and 89 (85.6%) reached a favorable outcome with mean EQ-5D-3L index values of 0.85 (±0.18) and 0.86 (±0.18). After 6 and 12 months, 23 (19.5%) and 15 (14.4%) of those alive had an unfavorable outcome with mean EQ-5D-3L index values of 0.27 (±0.25) and 0.19 (±0.14).CONCLUSION:Despite high initial mortality, the proportion of poor-grade aSAH survivors with good QoL is reasonably large. Only a minority of survivors reports poor QoL and requires permanent care.

Explainable machine learning in outcome prediction of high-grade aneurysmal subarachnoid hemorrhage

“…This effort will greatly aid physicians in gaining a High-grade aSAH is associated with elevated mortality and unfavorable neurologic outcomes [13]. A recent investigation revealed significant proportion of survivors of high-grade aSAH showed a good quality of life after appropriate clinical decision making [14]. Therefore, there is a critical need for early prediction of long-term functional outcomes and the identification of risk factors.…”

Importance of Medical Management in Patients With Aneurysmal Subarachnoid Hemorrhage

“…1 Recent data, however, suggest that despite high early mortality, patients with high-grade SAH can have outcomes that exceed expectations. 2 The care of the patient with aneurysmal SAH involves multidisciplinary teams who need to quickly make extremely challenging decisions, such as how and when to secure an aneurysm or how and when to alleviate intracranial hypertension. The recently published 2023 Guideline for the Management of Patients With Aneurysmal Subarachnoid Hemorrhage from the American Heart Association/American Stroke Association 1 not only discusses these pressing matters but, importantly, also underscores the crucial role that good medical management has on patient outcomes.…”

“…1 Recent data, however, suggest that despite high early mortality, patients with high-grade SAH can have outcomes that exceed expectations. 2…”

Clinical severity of aneurysmal subarachnoid hemorrhage over time: systematic review

“…The results of the ANOVA indicated that the differences in the number of patients among the different midyear The discrepancy between patients assigned to poor WFNS/HH grades and a growing proportion of favorable outcomes in this group is problematic. It shows that besides improved patient care resulting in better outcomes, also the inherent weakness of these grading systems [19]. Consequently, the unconditional withdrawal of maximal therapy for WFNS and HH grade 5 aSAH patients has become increasingly unacceptable [20][21][22][23].…”