Risk Factors, Incidence, and Effect of Cardiac Failure and Myocardial Infarction in Aneurysmal Subarachnoid Hemorrhage Patients

Abstract BACKGROUND: Cardiac dysfunction is a well-known complication of aneurysmal subarachnoid hemorrhage (aSAH). However, the clinical significance of cardiac complications is largely unknown. OBJECTIVE: To determine whether cardiac complications are independently related to outcomes and to identify potential predictors associated with these complications. METHODS: We extracted all hospitalizations for aSAH from the National Inpatient Sample database for years 2002 to 2009. We used generalized estimating equations to determine whether cardiac complications were associated with the patient outcomes and to evaluate potential predictors of cardiac complications. RESULTS: Among 53 713 cases of aSAH, there were 3609 (6.72%) and 151 (0.28%) incidences of cardiac failure (CF) and myocardial infarction (MI), respectively. The overall in-hospital mortality rate was 24.8%, whereas the mortality rate for patients with CF was 34.4% and the mortality rate for patients with MI was 29.8%. Patients who experienced CF were significantly more likely than other patients to die in the hospital (odds ratio: 1.6, 95% confidence interval: 1.47-1.68; P < .001). The difference in mortality rates between MI patients and other patients, however, was not statistically significant. The generalized estimating equation model identified 7 factors that were predictive of CF: age, sex, race, primary payer, diabetes, smoker, and cardiac disease. For MI, the model identified age, race, and primary payer as significant predictors of MI. CONCLUSION: Our results suggest that an important association exists between cardiac complications and mortality/morbidity in aSAH patients. aSAH patients with CF appear to have a higher mortality rate, longer hospital length of stay, and higher hospitalization costs compared with those without CF.

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Mortality rates, hospital length of stay, and the cost of treating subarachnoid hemorrhage in older patients: institutional and geographical differences

Neurosurgical FOCUS ◽

10.3171/foc.1997.2.2.1 ◽

1997 ◽

Vol 2 (2) ◽

pp. E1

Author(s):

Christopher L. Taylor ◽

Zhong Yuan ◽

Warren R. Selman ◽

Robert A. Ratcheson ◽

Alfred A. Rimm

Keyword(s):

New York ◽

Subarachnoid Hemorrhage ◽

Mortality Rate ◽

Length Of Stay ◽

Older Patients ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Hospital Length Of Stay ◽

Annual Number ◽

Geographical Differences ◽

The Cost

The risk of disability and death and the cost of medical care are particularly high for patients with aneurysmal subarachnoid hemorrhage (SAH) who are 65 years of age or older. A retrospective analysis of 47,408 Medicare patients treated over an 8-year period was performed to determine whether a relationship exists between the mortality rate and surgical volume for older patients with SAH. The mortality rate, length of stay in the hospital, and cost of treatment for patients with SAH in California and New York were also compared. The mortality rate was 14.3% for patients with SAH who were 65 years old or older and who were treated surgically in hospitals in which an average of five or more craniotomies were performed per year; in hospitals averaging between one and five craniotomies annually the mortality rate was 18.4%; and in those averaging less than one such operation per year the rate was 20.5% (trend p = 0.01). There was no difference in the mortality rate for patients in California versus the rate for those in New York. Surgically and medically treated patients, respectively, left the hospital an average of 6.7 and 5.1 days sooner in California than in New York. The unadjusted average reimbursement from Medicare to hospitals for surgically treated patients averaged $1468 more in New York than in California (p < 0.0001), but was equivalent for medically treated patients in the two states. The mortality rate in older patients who are treated surgically for SAH may be inversely correlated with the annual number of craniotomies performed for SAH in patients 65 years of age or older at a given institution. Hospital stays for patients with SAH are significantly shorter in California than in New York.

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Mortality rates, hospital length of stay, and the cost of treating subarachnoid hemorrhage in older patients: institutional and geographical differences

Journal of Neurosurgery ◽

10.3171/jns.1997.86.4.0583 ◽

1997 ◽

Vol 86 (4) ◽

pp. 583-588 ◽

Cited By ~ 61

Author(s):

Christopher L. Taylor ◽

Zhong Yuan ◽

Warren R. Selman ◽

Robert A. Ratcheson ◽

Alfred A. Rimm

Keyword(s):

New York ◽

Subarachnoid Hemorrhage ◽

Mortality Rate ◽

Length Of Stay ◽

Older Patients ◽

Aneurysmal Subarachnoid Hemorrhage ◽

New York State ◽

Hospital Length Of Stay ◽

Annual Number ◽

The Cost

✓ The risk of disability and death and the cost of medical care are particularly high for patients with aneurysmal subarachnoid hemorrhage (SAH) who are 65 years of age or older. A retrospective analysis of 47,408 Medicare patients treated over an 8-year period was performed to determine whether a relationship exists between the mortality rate and surgical volume for older patients with SAH. The mortality rate, length of stay in the hospital, and cost of treatment for patients with SAH in California and New York state were also compared. The mortality rate was 14.3% for patients with SAH who were 65 years old or older and who were treated surgically in hospitals in which an average of five or more craniotomies were performed per year; in hospitals averaging between one and five craniotomies annually the mortality rate was 18.4%; and in those averaging less than one such operation per year the rate was 20.5% (trend p = 0.01). There was no difference in the mortality rate for patients in California versus the rate for those in New York. Surgically and medically treated patients, respectively, left the hospital an average of 6.7 and 5.1 days sooner in California than in New York. The unadjusted average reimbursement from Medicare to hospitals for surgically treated patients averaged $1468 more in New York than in California (p < 0.0001), but was equivalent for medically treated patients in the two states. The mortality rate in older patients who are treated surgically for SAH may be inversely correlated with the annual number of craniotomies performed for SAH in patients 65 years of age or older at a given institution. Hospital stays for patients with SAH are significantly shorter in California than in New York.

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Alanine Aminotransferase Predicts Outcomes in Elderly Patients with Aneurysmal Subarachnoid Hemorrhage

Current Neurovascular Research ◽

10.2174/1567202616666190130094631 ◽

2019 ◽

Vol 16 (1) ◽

pp. 89-95

Author(s):

Jianfeng Zheng ◽

Rui Xu ◽

Zongduo Guo ◽

Xiaochuan Sun

Keyword(s):

Subarachnoid Hemorrhage ◽

Elderly Patients ◽

Clinical Outcomes ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Laboratory Data ◽

Cardiac Complications ◽

World Population ◽

Systemic Complications ◽

Poor Outcome ◽

Poor Outcomes

Objective: With the aging of the world population, the number of elderly patients suffering from aneurysmal subarachnoid hemorrhage (aSAH) is gradually growing. We aim to investigate the potential association between plasma ALT level and clinical complications of elderly aSAH patients, and explore its predictive value for clinical outcomes of elderly aSAH patients. Methods: Between January 2013 and March 2018, 152 elderly aSAH patients were analyzed in this study. Clinical information, imaging findings and laboratory data were reviewed. According to the Glasgow Outcome Scale (GOS), clinical outcomes at 3 months were classified into favorable outcomes (GOS 4-5) and poor outcomes (GOS 1-3). Logistic regression analysis was used to assess the indicators associated with poor outcomes, and receiver curves (ROC) and corresponding area under the curve (AUC) were used to detect the accuracy of the indicator. Results: A total of 48 (31.6 %) elderly patients with aSAH had poor outcome at 3 months. In addition to ICH, IVH, Hunt-Hess 4 or 5 Grade and Modified Fisher 3 or 4 Grade, plasma ALT level was also strongly associated with poor outcome of elderly aSAH patients. After adjusting for other covariates, plasma ALT level remained independently associated with pulmonary infection (OR 1.05; 95% CI 1.00–1.09; P = 0.018), cardiac complications (OR 1.05; 95% CI 1.01–1.08; P = 0.014) and urinary infection (OR 1.04; 95% CI 1.00–1.08; P = 0.032). Besides, plasma ALT level had a predictive ability in the occurrence of systemic complications (AUC 0.676; 95% CI: 0.586– 0.766; P<0.001) and poor outcome (AUC 0.689; 95% CI: 0.605–0.773; P<0.001) in elderly aSAH patients. Conclusion: Plasma ALT level of elderly patients with aSAH was significantly associated with systemic complications, and had additional clinical value in predicting outcomes. Given that plasma ALT levels on admission could help to identify high-risk elderly patients with aSAH, these findings are of clinical relevance.

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Abstract P536: Impact of the Covid-19 Pandemic on the Volumes and Outcomes of Acute Ischemic Stroke and Myocardial Infarction

Stroke ◽

10.1161/str.52.suppl_1.p536 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Raul Nogueira ◽

Katherine Etter ◽

Thanh Nguyen ◽

Shelly Ikeme ◽

Michael R Frankel ◽

...

Keyword(s):

Myocardial Infarction ◽

Ischemic Stroke ◽

Length Of Stay ◽

Hospital Mortality ◽

Acute Ischemic Stroke ◽

Intravenous Thrombolysis ◽

Clinical Severity ◽

Hospital Length Of Stay ◽

Healthcare Database ◽

Hospitalization Costs

Introduction: The COVID-19 pandemic has wreaked havoc on the presentation, care and outcomes of patients with acute cerebrovascular and cardiovascular conditions. We sought to measure the national impact of COVID-19 on the care for acute ischemic stroke (AIS) and acute myocardial infarction (AMI). Methods: In this retrospective, observational study, we used the Premier Healthcare Database to evaluate the changes in the volume of care and hospital outcomes for AIS and AMI in relation to the pandemic. The pandemic months were defined from March 1, 2020- April 30, 2020 and compared to the same period in the year prior. Outcome measures were volumes of hospitalization and reperfusion treatment for AIS and AMI (including intravenous thrombolysis [IVT] and/or mechanical thrombectomy [MT] for AIS and percutaneous coronary interventions [PCI] for AMI) as well as in-hospital mortality, hospital length of stay (LOS) and hospitalization costs were compared across a 2-month period at the height of the pandemic versus the corresponding period in the prior year. Results: There were 95,453 AIS patients across 145 hospitals and 19,744 AMI patients across 126 hospitals. There was a significant nation-wide decline in the absolute number of hospitalizations for AIS (-38.94%;95%CI,-34.75% to -40.71%) and AMI (-38.90%;95%CI,-37.03% to -40.81%) as well as IVT (-30.32%;95%CI,-27.02% to -33.83%), MT (-23.54%;95%CI,-19.84% to -27.70%), and PCI (-35.05%;95%CI,-33.04% to -37.12%) during the first two months of the pandemic. This occurred across low-, mid-, and high-volume centers and in all geographic regions. Higher in-hospital mortality was observed in AIS patients (5.7% vs.4.2%, p=0.0037;OR 1.41,95%CI 1.1-1.8) but not AMI patients. A shift towards an increase in the proportion of admitted AIS and AMI patients receiving reperfusion therapies suggests a greater clinical severity among patients that were hospitalized for these conditions during the pandemic. A shorter length of stay (AIS: -17%, AMI: -20%), and decreased hospitalization costs (AIS: -12%, AMI: -19%) were observed. Conclusions: Our findings shed light on the combined health outcomes and economic impact the COVID-19 pandemic has had on acute stroke and cardiac emergency care.

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Abstract 2792: Cardiac Complications After Aneurysmal Subarachnoid Hemorrhage Are Associated With Outcome: A Meta-analysis

Circulation ◽

10.1161/circ.116.suppl_16.ii_620-a ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Ivo A van der Bilt ◽

Djo Hasan ◽

W. P Vandertop ◽

Arthur A Wilde ◽

Ale Algra ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Meta Analysis ◽

Prognostic Significance ◽

Delayed Cerebral Ischemia ◽

Myocardial Damage ◽

Future Research ◽

Cardiac Complications ◽

Pathophysiological Mechanism ◽

Cardiac Abnormalities

Cardiac complications after subarachnoid hemorrhage (SAH) occur frequently, but their prognostic significance remains unclear. We performed a meta-analysis to assess whether echocardiographic wall motion abnormalities (WMA), electrocardiographic (ECG) changes, or elevated markers for myocardial damage are related to the occurrence of delayed cerebral ischemia (DCI) or death. Methods All articles that reported on cardiac abnormalities after aneurysmal SAH, that met predefined criteria, and were published between 1960 and 2007 were assessed. Data were extracted on predefined methodological criteria, patient characteristics, prevalence of cardiac abnormalities, and DCI or death. We calculated pooled relative risks (RR) with corresponding 95% confidence intervals (CI) for the separate cardiac abnormalities and outcome. Results We included 25 studies (16 prospective), comprising 2690 patients (mean age 53 years; 35% was male). The figure shows the univariable RRs of the determinants for death. For DCI we found a significant association with WMA (RR 2.10 [CI 1.17, 3.78]); Troponin RR 3.15 [CI 2.27, 4.38]; CK-MB RR: 2.90 [CI 1.86, 4.52]; BNP RR: 4.52 [CI 1.79, 11.39]; and ST depression RR: 2.40 [CI 1.2, 4.9]. No significant associations were found for DCI and ST elevation RR: 2.1 [CI 0.7, 5.7]; T wave abnormality RR: 0.9 [CI 0.5, 1.7]; U wave RR: 0.7 [CI 0.4, 1.3] or prolonged QT RR: 1.0 [CI 0.5, 2.3]. Conclusion Cardiac abnormalities increase the risk of DCI and death after SAH. Future research should be directed towards elucidating the multivariable relationship between the cardiac prognosticators, the pathophysiological mechanism and potential treatment options.

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Length of hospital stay in aneurysmal subarachnoid hemorrhage patients without vasospasm on angiography: potential for a fast-track discharge cohort

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2021-017424 ◽

2021 ◽

pp. neurintsurg-2021-017424

Author(s):

Joshua S Catapano ◽

Visish M Srinivasan ◽

Kavelin Rumalla ◽

Mohamed A Labib ◽

Candice L Nguyen ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Length Of Stay ◽

Hospital Stay ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Length Of Hospital Stay ◽

Hospital Length Of Stay ◽

Neurologic Outcome ◽

Angiographic Vasospasm ◽

Fisher Grade ◽

Tertiary Center

BackgroundPatients with aneurysmal subarachnoid hemorrhage (aSAH) frequently suffer from vasospasm. We analyzed the association between absence of early angiographic vasospasm and early discharge.MethodsAll aSAH patients treated from August 1, 2007, to July 31, 2019, at a single tertiary center were reviewed. Patients undergoing diagnostic digital subtraction angiography (DSA) on post-aSAH days 5 to 7 were analyzed; cohorts with and without angiographic vasospasm (angiographic reports by attending neurovascular surgeons) were compared. Primary outcome was hospital length of stay; secondary outcomes were intensive care unit length of stay, 30 day return to the emergency department (ED), and poor neurologic outcome, defined as a modified Rankin Scale (mRS) score >2.ResultsA total of 298 patients underwent DSA on post-aSAH day 5, 6, or 7. Most patients (n=188, 63%) had angiographic vasospasm; 110 patients (37%) did not. Patients without vasospasm had a significantly lower mean length of hospital stay than vasospasm patients (18.0±7.1 days vs 22.4±8.6 days; p<0.001). The two cohorts did not differ significantly in the proportion of patients with mRS scores >2 at last follow-up or those returning to the ED before 30 days. After adjustment for Hunt and Hess scores, Fisher grade, admission Glasgow Coma Scale score, and age, logistic regression analysis showed that the absence of vasospasm on post-aSAH days 5–7 predicted discharge on or before hospital day 14 (OR 3.4, 95% CI 1.8 to 6.4, p<0.001).ConclusionLack of angiographic vasospasm 5 to 7 days after aSAH is associated with shorter hospitalization, with no increase in 30 day ED visits or poor neurologic outcome.

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