Farzana Khan, Forouhideh Peyvandi, Kevin Clare, Bridget Nolan, Smit Patel, Eric Feldstein, Jonathan V. Ogulnick, Azhar Said, Sabrina Zeller, Yarden Bornovski, Serena Wong, Chaitanya B. Medicherla, Jon Rosenberg, Daniel Miller, George Coritsidis, Karthik Prabhakaran, Stephan A. Mayer, Chirag D. Gandhi, Fawaz Al-Mufti

Aneurysmal Subarachnoid Hemorrhage and Cardiac Related Fatality: Who Dies and Why?

  • Cardiology and Cardiovascular Medicine
  • General Medicine
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Medical complications are a notable source of in-hospital death following aneurysmal subarachnoid hemorrhage (aSAH). However, there is a paucity of literature examining medical complications on a national scale. This study uses a national dataset to analyze the incidence rates, case fatality rates, and risk factors for in-hospital complications and mortality following aSAH. We found that the most common complications in aSAH patients (N = 170, 869) were hydrocephalus (29.3%) and hyponatremia (17.3%). Cardiac arrest was the most common cardiac complication (3.2%) and was associated with the highest case fatality rate overall (82%). Patients with cardiac arrest also had the highest odds of in-hospital mortality [odds ratio (OR), 22.92; 95% confidence interval (CI), 19.24–27.30; P < 0.0001], followed by patients with cardiogenic shock (OR, 2.96; 95% CI, 2.146–4.07; P < 0.0001). Advanced age and National Inpatient Sample-SAH Severity Score were found to be associated with an increased risk of in-hospital mortality (OR, 1.03; 95% CI, 1.03–1.03; P < 0.0001 and OR, 1.70; 95% CI, 1.65–1.75; P < 0.0001, respectively). Renal and cardiac complications are significant factors to consider in aSAH management, with cardiac arrest being the strongest indicator of case fatality and in-hospital mortality. Further research is needed to characterize factors that have contributed to the decreasing trend in case fatality rates identified for certain complications.

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