Key result
Despite a 53.4% mortality rate at 12 months, 85.6% of poor-grade aneurysmal subarachnoid hemorrhage survivors achieved a favorable outcome with a mean EQ-5D-3L index value of 0.86.
Why the study?
Poor-grade aneurysmal subarachnoid hemorrhage causes high mortality and disability, but quality-of-life data among survivors are scarce due to underrepresentation in prior studies.
Observational (n=237)
Yes
Despite high initial mortality, approximately 80% of poor-grade aneurysmal subarachnoid hemorrhage survivors achieve a favorable outcome and reasonably good quality of life at 6 and 12 months.
May support prognostic counseling in poor-grade aSAH; leaves open optimal management strategies pending prospective trials.
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.
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Goldberg et al. (2023) conducted an observational in Poor-grade aneurysmal subarachnoid hemorrhage (n=237). Poor-grade aneurysmal subarachnoid hemorrhage was evaluated on Favorable outcome (mRS 0-3) and mean EQ-5D-3L index value at 12 months among survivors. Despite a 53.4% mortality rate at 12 months, 85.6% of poor-grade aneurysmal subarachnoid hemorrhage survivors achieved a favorable outcome with a mean EQ-5D-3L index value of 0.86.
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