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Adherence to evidence-based processes of care reduces one-year mortality after aneurysmal subarachnoid hemorrhage (aSAH)


Rehman, S and Chandra, RV and Lai, LT and Asadi, H and Dubey, A and Froelich, J and Thani, N and Nichols, L and Blizzard, L and Smith, K and Thrift, AG and Stirling, C and Callisaya, M and Breslin, M and Reeves, MJ and Gall, S, Adherence to evidence-based processes of care reduces one-year mortality after aneurysmal subarachnoid hemorrhage (aSAH), Journal of the Neurological Sciences, 428 Article 117613. ISSN 0022-510X (2021) [Refereed Article]

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DOI: doi:10.1016/j.jns.2021.117613


Background: There is limited research on the provision of evidence-based care and its association with outcomes after aneurysmal subarachnoid hemorrhage (aSAH).

Aims: We examined adherence to evidence-based care after aSAH and associations with survival and discharge destination. Also, factors associated with evidence-based care including age, sex, Charlson comorbidity index, severity scores, and delayed cerebral ischemia and infarction were examined for association with survival and discharge destination.

Methods: In a retrospective cohort (2010-2016) of all aSAH cases across two comprehensive cerebrovascular centres, we extracted 3 indicators of evidence-based aSAH care from medical records: (1) antihypertensives prior to aneurysm treatment, (2) nimodipine, and (3) aneurysm treatment (coiling/clipping). We defined 'optimal care' as receiving all eligible processes of care. Survival at 1 year was obtained by data linkage. We estimated (1) proportion of patients and characteristics associated with receiving processes of care, (2) associations between processes of care with 1-year mortality using cox-proportional hazard model and discharge destination with log binomial regression adjusting for age, sex, severity of aSAH, delayed cerebral ischemia and/or cerebral infarction and comorbidities. Sensitivity analyses explored effect modification of the association between processes of care and outcome by management type (active versus comfort measures).

Results: Among 549 patients (69% women), 59% were managed according to the guidelines. Individual indicators were associated with lower 1-year mortality but not discharge destination. Optimal care reduced mortality at 1 year in univariable (HR 0.24 95% CI 0.17-0.35) and multivariable analyses (HR 0.51 95% CI 0.34-0.77) independent of age, sex, severity, comorbidities, and hospital network.

Conclusion: Adherence to processes of care reduced 1-year mortality after aSAH. Many patients with aSAH do not receive evidence-based care and this must be addressed to improve outcomes.

Item Details

Item Type:Refereed Article
Keywords:subarachnoid hemorrhage, aneurysm, evidence-based care, guidelines, management, long-term outcome, survival, stroke, hemorrhage, patient care
Research Division:Biomedical and Clinical Sciences
Research Group:Cardiovascular medicine and haematology
Research Field:Cardiology (incl. cardiovascular diseases)
Objective Division:Health
Objective Group:Provision of health and support services
Objective Field:Inpatient hospital care
UTAS Author:Rehman, S (Dr Sabah Rehman)
UTAS Author:Nichols, L (Mrs Linda Nichols)
UTAS Author:Blizzard, L (Professor Leigh Blizzard)
UTAS Author:Stirling, C (Professor Christine Stirling)
UTAS Author:Callisaya, M (Dr Michele Callisaya)
UTAS Author:Breslin, M (Dr Monique Breslin)
UTAS Author:Gall, S (Associate Professor Seana Gall)
ID Code:150795
Year Published:2021
Deposited By:Menzies Institute for Medical Research
Deposited On:2022-06-30
Last Modified:2022-07-07

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