Health-related quality of life after spontaneous subarachnoid hemorrhage - a prospective cohort study

Reduced health-related quality of life (HR-QoL) is common after spontaneous subarachnoid hemorrhage (SAH). Here, we aimed to describe the prevalence of HR-QoL impairment one year after SAH and to identify associated factors.

In this prospective cohort study, HR-QoL was assessed in 183 patients one year after SAH. We used the Short-Form-36 (SF-36) questionnaire, which consists of eight health domains that can be subdivided into mental and physical health components. Participants responded to scales on subjective attention deficit, mental health symptoms, and fatigue. Functional outcome was assessed with the modified Rankin Scale (mRS). Multivariable regression analysis was used to identify factors associated with reduced HR-QoL (MCS or PCS < 40).

Patients were 53 years of age (IQR, 46-61) and presented with a median Hunt&Hess score of 2 (2-3). HR-QoL was reduced in 66/183 patients (36%) with the highest abnormality in physical and emotional role. A lower Hunt&Hess score (p = 0.036), female sex (p = 0.017), self-reported depression (p = 0.001), fatigue (p < 0.001), and reduction of drive (p = 0.019) were associated with overall reduced HR-QoL and explained 68.9% of the observed variance. 26% (n = 48) scored below the normal range on the MCS, and independent associations emerged for self-reported anxiety and depression, fatigue, and reduction of drive. A reduction in the PCS was reported by 35 (19%) patients and independent associations were found for worse three-month functional outcome and fatigue.

One in three patients reported a reduction in HR-QoL one year after SAH. Mental health problems and fatigue had a significant impact on HR-QoL.