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  • Factors Influencing Long-term Health-Related Quality of Life among Patients After Aneurysmal and Nonaneurysmal Subarachnoid Hemorrhage

    Final Number:

    Arthur P McIntosh NP, PhD; Ajith J. Thomas MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2012 Annual Meeting

    Introduction: Anecdotal evidence and contradictory research suggest that patients with NASAH experience some of the same health-related quality of life (HRQoL) issues as patients with ASAH. HRQoL was measured in many studies by tools that are not good indicators of multidimensional domains of health-related quality of life. Patients in these studies have been classified as having “good outcomes” or having a “benign hemorrhage,” without having returned to their pre-hemorrhage level of functioning. The goal of this study was to detect the strength of association and differences in HRQoL between patients who experienced a NASAH versus an ASAH. Factors influencing NASAH patients’ experiences of HRQoL issues were determined and compared to and adjusted to those of ASAH patients.

    Methods: This quantitative survey design study compared health-related quality of life (HRQoL) 1 to 3 years post-hemorrhage in patients who have experienced a NASAH to those who have experienced an ASAH.

    Results: There were no significant differences between 28 of the 36 demographic and clinical characteristics examined in this study. The nonaneurysmal group had more physical symptom complaints while the aneurysmal group had more emotional symptoms. Both groups had low levels of PTSD, and these levels did not differ significantly between groups. However, PTSD and social support were shown by regression analysis to impact HRQOL for both groups.

    Conclusions: We recommend that clinicians assess for PTSD in all subarachnoid hemorrhage patients and institute treatment early, which decrease the negative effects on HRQOL. This may include offering psychological services or social work early in the hospital course to all SAH patients. Further research are needed to assist in interventions that improve vocational reintegration after SAH. NASAH patients should no longer be referred to as having suffered a “benign hemorrhage.” They have had a life changing hemorrhage that may forever change their lives and impact their HRQOL

    Patient Care: This research provides physicians, midlevel practitioners,nurses and other clinicians with data that can potentially help improve several aspects of quality of life for SAH patients. This includes providing information about the affects of a SAH on HRQOL. Communication of information during all phases of hospitalization and follow-up was found to be crucial to our participants and their families. Our participants reported wanting more information about their diagnosis/plan of care during all phases of acute inpatient hospitalization, during rehabilitation, and upon discharge. Hutter & Gilsbach recommended back in 1995 that both ASAH and NASAH patients receive psychological counseling. Clinicians and nurses can refer patients to an inpatient social work team or to a psychiatry consultation. Much of the angst may be reduced by teaching patients about the natural course of subarachnoid hemorrhages. Patients with NASAH particularly need to hear information that they are at no more risk for a second subarachnoid hemorrhage than any other population. Much fear could be reduced in this population if healthcare workers could share the information from the Greebe and Rinkel (2007) study of perimesencephalic NASAH subjects showing that patients with perimesencephalic hemorrhage have no long-term excess mortality compared with the general population.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1)To describe the physical, psychological, social, and vocational impact of nonaneurysmal and aneurysmal subarachnoid hemorrhage. 2)To understand differences in HRQOL between patients with NASAH and ASAH. 3)To describe management strategies used by patients with nonaneurysmal and aneurysmal subarachnoid hemorrhage that helped improve their HRQoL.

    References: Hutter, B.O., & Gilsbach, J. M. (1995). Quality of life and cognitive deficits after subarachnoid hemorrhage. British Journal of Neurosurgery, 9(4), 465–475. Greebe, P. R., & Rinkel, G. J .E. (2007). Life expectancy after perimesencephalic subarchnoid hemorrhage. Stroke, 38, 1222-1124. doi: 10.1161/01.STR.0000260093.49693.7a

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