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Cardiovascular Predictors of Long-Term Outcomes After Non-Traumatic Subarachnoid Hemorrhage

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Abstract

Background and Purpose

Cardiac injury is common after subarachnoid hemorrhage (SAH) and is associated with adverse early outcomes, but long-term effects are unknown. The first aim of this study was to compare the long-term rates of death, stroke, and cardiac events in SAH survivors versus a matched population without SAH. The second aim was to quantify the effects of cardiac injury on the outcome rates.

Methods

This was a retrospective cohort study of patients with and without non-traumatic SAH. For aim #1, the predictor variable was SAH and the outcome variables were all-cause and cerebrovascular mortality, stroke, cardiac mortality, acute coronary syndrome (ACS), and heart failure (HF) admission. A multivariable Cox proportional hazards analysis was performed. For aim #2, the predictor variables were cardiac injury (elevated serum cardiac enzymes or a diagnosis code for ACS) and dysfunction (pulmonary edema on X-Ray or a diagnosis code for HF).

Results

Compared with 4,695 members without SAH, the 910 SAH patients had higher rates of all-cause mortality (hazard ratio [HR 2.6], 95% confidence intervals [CI] 2.0–3.4), cerebrovascular mortality (HR 30.6, CI 13.5–69.4), and stroke (HR 10.2, CI 7.5–13.8). Compared with the non-SAH group, the SAH patients with cardiac injury had increased rates of all-cause mortality (HR 5.3, CI 3.0–9.3), cardiac mortality (HR 7.3, CI 1.7–31.6), and heart failure (HR 4.3, CI 1.53–11.88).

Conclusions

SAH survivors have increased long-term mortality and stroke rates compared with a matched non-SAH population. SAH-induced cardiac injury is associated with an increased risk of death and heart failure hospitalization.

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Acknowledgments

The Sources of Funding are Kaiser Foundation Research Institute: Community Benefits awards program and NIH: K23 NS058357-01 and R01 NS034949.

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Authors and Affiliations

  1. Kaiser Northern California Division of Research, San Francisco, CA, USA

    Jonathan G. Zaroff, Michael Sorel, Charles P. Quesenberry Jr. & Steve Sidney

  2. Kaiser San Francisco Medical Center, 2350 Geary Boulevard, Room 206, San Francisco, CA, 94115, USA

    Jonathan Leong

  3. University of California San Francisco Center for Cerebrovascular Research, San Francisco, CA, USA

    Helen Kim & William L. Young

  4. Kaiser Redwood City Medical Center, 1150 Veterans Blvd, Redwood City, CA, 94063, USA

    Sean P. Cullen & Vivek A. Rao

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  1. Jonathan G. Zaroff
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  2. Jonathan Leong
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  3. Helen Kim
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  7. Michael Sorel
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  8. Charles P. Quesenberry Jr.
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  9. Steve Sidney
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Correspondence to Jonathan G. Zaroff.

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Zaroff, J.G., Leong, J., Kim, H. et al. Cardiovascular Predictors of Long-Term Outcomes After Non-Traumatic Subarachnoid Hemorrhage. Neurocrit Care 17, 374–381 (2012). https://doi.org/10.1007/s12028-011-9592-x

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  • DOI: https://doi.org/10.1007/s12028-011-9592-x

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