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Published on: June 18, 2021
Cardiovascular predictors of long-term outcomes after non-traumatic subarachnoid hemorrhage
Jonathan G Zaroff1, Jonathan Leong, Helen Kim
1Kaiser Northern California Division of Research, San Francisco, CA, USA. jonathan.g.zaroff@kp.org
Insights
Subarachnoid hemorrhage (SAH) survivors face higher long-term mortality and stroke risks. SAH-related cardiac injury further elevates the danger of death and heart failure hospitalizations.
Area of Science:
- Neurology
- Cardiology
- Public Health
Background:
- Cardiac injury is a frequent complication following subarachnoid hemorrhage (SAH).
- While early outcomes are known, the long-term effects of SAH on cardiac health remain unclear.
Purpose of the Study:
- To compare long-term mortality, stroke, and cardiac event rates in SAH survivors versus a matched non-SAH population.
- To determine the impact of cardiac injury on these long-term outcomes after SAH.
Main Methods:
- Retrospective cohort study comparing patients with and without non-traumatic SAH.
- Multivariable Cox proportional hazards analysis assessed SAH as a predictor for mortality and stroke.
- Cardiac injury and dysfunction were evaluated as predictors for adverse outcomes.
Main Results:
- SAH patients (n=910) showed significantly higher rates of all-cause mortality (HR 2.6), cerebrovascular mortality (HR 30.6), and stroke (HR 10.2) compared to controls (n=4,695).
- SAH survivors with cardiac injury experienced increased all-cause mortality (HR 5.3), cardiac mortality (HR 7.3), and heart failure admissions (HR 4.3).
Conclusions:
- SAH survivors exhibit elevated long-term mortality and stroke rates compared to the general population.
- Cardiac injury following SAH is a significant risk factor for increased mortality and heart failure.
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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