Targeting health-related quality of life issues not found with functional outcome measures a year after aneurysm subarachnoid hemorrhage in a Swedish national cohort

Q: What are the key findings of this study?

Patients with a favorable functional outcome one year after aneurysmal subarachnoid hemorrhage reported significantly more problems with usual activities compared to a matched general population (27.0% vs 12.5%; OR 2.58).

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Aneurysmal subarachnoid hemorrhage (aSAH) (n=634). Intervention: Aneurysmal subarachnoid hemorrhage with favorable functional outcome vs. Sex- and age-matched general population. Primary outcome: Any problems with usual activities (EQ-5D-3L) (OR 2.58, p=<0.001).

Q: What does this research mean for the field?

Aneurysmal subarachnoid hemorrhage survivors with favorable functional outcomes report significantly more difficulties with usual activities one year post-ictus compared to an age- and sex-matched general population. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To identify health-related quality of life impairments in aneurysmal subarachnoid hemorrhage survivors who achieved favorable functional outcomes compared with an age- and sex-matched general population.

Helena Aineskog; Bryndís Baldvinsdóttir; Ola Nilsson; Asgeir Store Jakola; Erik Kronvall; Elisabeth Ronne Engström; Paula Klurfan; Peter Alpkvist; Mikael Svensson; Jan Hillman; Peter Lindvall

doi:10.1007/s00701-026-07059-z

October 16, 2026Acta NeurochirurgicaOpen Access

Targeting health-related quality of life issues not found with functional outcome measures a year after aneurysm subarachnoid hemorrhage in a Swedish national cohort

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Key result

Subarachnoid hemorrhage survivors with good functional recovery report ~2.6-fold higher odds of daily activity problems.

OR 2.58
P<0.001
n=634

Why the study?

Outcome after aneurysmal subarachnoid hemorrhage often includes lifetime issues even for independent survivors, and health-related quality of life issues in patients with favorable functional outcome compared to the general population were not well characterized.

Does survivorship of aneurysmal subarachnoid hemorrhage with a favorable functional outcome impact health-related quality of life compared to an age- and sex-matched general population?

Key Points

To identify health-related quality of life impairments in aneurysmal subarachnoid hemorrhage survivors who achieved favorable functional outcomes compared with an age- and sex-matched general population.
Analyzed 634 patients from a Swedish national prospective study (2014–2018), evaluating 471 patients with favorable functional outcomes (Glasgow Outcome Scale Extended score 5–8) at a median follow-up of 445 days.
Assessed quality of life using the EQ-5D-3L survey and compared responses to age- and sex-matched reference cohorts derived from 32,597 Stockholm County residents.
Calculated odds ratios across five domains (mobility, self-care, usual activities, pain/discomfort, anxiety/depression) with significance predefined at α = 0.001.
Patients with favorable outcomes reported significantly more moderate problems (24.0% vs 10.9%; OR 2.58, p < .001) and any problems (27.0% vs 12.5%; OR 2.58, p < .001) with usual activities compared to matched controls.
Survivors reported fewer overall mobility problems (9.6% vs 14.7%; OR 0.62, p = 0.002) but higher rates of extreme anxiety/depression (5.3% vs 2.8%; OR 1.94, p = 0.002) than the general population.
Patients with unfavorable outcomes rated worse across all dimensions, with an average visual analog scale score of 52.2 compared to 74.1 in the favorable outcome cohort.

Study Design

Type

Cross-Sectional (n=634)

Multicenter

Yes

Structured PICO

Does survivorship of aneurysmal subarachnoid hemorrhage with a favorable functional outcome impact health-related quality of life compared to an age- and sex-matched general population?

P

Population

634 adult patients with aneurysmal subarachnoid hemorrhage, including 471 with a favorable functional outcome, assessed for health-related quality of life 1 year post-ictus.

E

Exposure

Survivorship of aneurysmal subarachnoid hemorrhage (aSAH) with favorable functional outcome (Glasgow Outcome Scale Extended [GOSE] 5-8)

C

Comparator

Age- and sex-matched general population from a cross-sectional cohort of 32,597 people living in Stockholm County

O

Outcome

Health-related quality of life (HRQoL) assessed by EQ-5D-3L (Euro-quality of life—5 dimensions—3 levels) domain problems at 1 yearpatient reported

Main Result

Odds Ratio: 2.58

Absolute Event Rate: 27% vs 12.5%

p-value: p=<0.001

Limitations

Exclusion of patients who died early or were not admitted to a neurosurgical facility
Missing data from patients lost to follow-up or who did not answer the questionnaire
Lack of adjustment for key comorbidities and modifiable risk factors like smoking and hypertension
Use of historical general population data (2006) from Stockholm County which may differ sociodemographically from the broader Swedish cohort
Excludes patients who died early or were too unstable for transport to a neurosurgical facility
Loss to follow-up and non-response to the EQ-5D-3L questionnaire might skew the population studied
Lack of adjustment for comorbidities such as hypertension and smoking, which were higher in the aSAH group
Reference general population data from Stockholm County in 2006 may not perfectly match the national aSAH demographic and temporal trends
Cross-sectional design prevents assessment of changes over time

Implication

Even independent aSAH survivors with favorable functional recovery (GOSE 5-8) experience significantly higher rates of problems with usual activities and extreme anxiety/depression at one year compared to a matched general population.

Abstract

Purpose Outcome after aneurysmal subarachnoid hemorrhage (aSAH) is often devastating with life time issues also for independent survivors. We aimed to identify health related quality of life (HRQoL) issues in this favorable functional outcome group compared to a sex and age matched general population. Methods We have analyzed data from 634 Swedish aSAH patients from a national prospective study ranging between 2014 and 2018. One year after ictus, functional outcome was analyzed using Glasgow Outcome Scale Extended (GOSE) and HRQoL assessed by Euro-quality of life—5 dimensions—3 levels (EQ-5D-3L). Favorable GOSE (5–8) were found in 471 patients. Age- and sex-matched populations were created by published data from a cross-sectional cohort of 32,597 people living in Stockholm County in 2006. Odds ratios (ORs) for rating a specific EQ-5D-3L level were calculated for each domain. Significance was set at α = 0.001. Results Patients reported less mobility problems than the matched general population (9.6% vs 14.7%; OR 0.62 p = 0.002). However, with usual activities significantly more difficulties with moderate, ( 24.0% vs 10.9%; OR 2.58, p < .001) and any problems (27.0% vs 12.5%; OR 2.58, p < .001) were reported. More issues with extreme anxiety/depression were also reported ((5.3% vs 2.8%; OR 1.94; p = 0.002). Unfavorable GOSE patients were doing worse than the matched population in all levels and dimensions measured (Online Resource 1, 2, 3 and 4). Conclusion Although patients with favorable functional outcome report good or better mobility compared to their age and sex matched general population, they have significantly more issues with usual activities a year after aSAH more extreme issues with anxiety/depression were also reported To our knowledge, this is the first time EQ-5D-3L data is compared in a national group of aSAH patients with favorable functional outcome to a sex and age matched general population.

Discussion

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Cite This Study

Aineskog et al. (2026) conducted a cross-sectional in Aneurysmal subarachnoid hemorrhage (aSAH) (n=634). Aneurysmal subarachnoid hemorrhage with favorable functional outcome vs. Sex- and age-matched general population was evaluated on Any problems with usual activities (EQ-5D-3L) (OR 2.58, p=<0.001). Patients with a favorable functional outcome one year after aneurysmal subarachnoid hemorrhage reported significantly more problems with usual activities compared to a matched general population (27.0% vs 12.5%; OR 2.58).

synapsesocial.com/papers/6ad34de0727baf805bb60eee https://doi.org/10.1007/s00701-026-07059-z

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Targeting health-related quality of life issues not found with functional outcome measures a year after aneurysm subarachnoid hemorrhage in a Swedish national cohort

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Targeting health-related quality of life issues not found with functional outcome measures a year after aneurysm subarachnoid hemorrhage in a Swedish national cohort

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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