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

Rehman, S, Chandra, RV, Lai, LT, Asadi, H, Dubey, A, Froelich, J, Thani, N, Nichols, L ORCID: 0000-0003-3711-993X, Blizzard, L ORCID: 0000-0002-9541-6943, Smith, K, Thrift, AG, Stirling, C ORCID: 0000-0003-2723-8302, Callisaya, M ORCID: 0000-0003-2122-1622, Breslin, M ORCID: 0000-0002-8135-3136, Reeves, MJ and Gall, S ORCID: 0000-0002-5138-2526 2021 , 'Adherence to evidence-based processes of care reduces one-year mortality after aneurysmal subarachnoid hemorrhage (aSAH)' , Journal of the Neurological Sciences, vol. 428 , doi: 10.1016/j.jns.2021.117613.

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Abstract

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 Type: Article
Authors/Creators: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
Keywords: subarachnoid hemorrhage, aneurysm, evidence-based care, guidelines, management, long-term outcome, survival, stroke, hemorrhage, patient care
Journal or Publication Title: Journal of the Neurological Sciences
Publisher: Elsevier BV
ISSN: 0022-510X
DOI / ID Number: 10.1016/j.jns.2021.117613
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Copyright (2021) Elsevier B.V. All rights reserved.

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