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QOL issues may persist after aneurysmal SAH

Friday March 15, 2013
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Ten years after subarachnoid hemorrhage caused by a ruptured aneurysm, surviving patients have persistent difficulties in several areas affecting quality of life, according to a study.

The long-term impact of SAH highlights the need for survivorship care plans comparable to those made for long-term cancer survivors, according to the report by Ann-Christin von Vogelsang, MSN, PhD, and colleagues with Karolinska University Hospital, Stockholm.

For a report that appears in the March issue of Neurosurgery, the official journal of the Congress of Neurological Surgeons, the researchers performed a long-term follow-up study in 217 patients who had survived SAH caused by a ruptured aneurysm.

Approximately 10 years after treatment for ruptured aneurysm and SAH, the patients completed a questionnaire evaluating key areas of health-related quality of life. Responses were compared with a general population sample of similar age and sex. The aneurysm survivors were 154 women and 63 men, average age 61. Most underwent surgery for treatment for their ruptured aneurysm.

At 10 years’ follow-up, 30% rated themselves as "fully recovered." But compared with the general population, the SAH survivors had increased problems in 4 of 5 dimensions of quality of life: mobility, self-care, usual activities and anxiety/depression. (The only area not significantly worse was pain/discomfort.) On a 100-point scale, overall quality of life score averaged 71 for the aneurysm survivors, compared with 78 for the general population group.

Patients who were more disabled after their SAH had lower quality-of-life scores after 10 years, as did those who rated themselves as less than fully recovered. Patients with comorbid conditions also had more difficulties affecting quality of life.

Previous studies have evaluated quality of life for survivors of ruptured aneurysm, but few have looked at outcomes more than five years after the event, according to the researchers of the latest study. One recent study suggested that patients may show continued improvement even more than a decade after SAH.

The new findings show that survivors of ruptured aneurysm have decreased quality of life and an increased rate of health problems. "The implications for healthcare from our study are that aneurysmal SAH patients need to be followed up and that support needs to be provided long term after the onset," the researchers wrote. Unrealistic expectations of recovery may be a key issue.

The researchers said patients who have experienced a ruptured aneurysm might benefit from survivorship care plans, similar to those used for long-term cancer survivors. Such a plan "aims to inform the patient of long-term effects, to identify psychosocial resources in their community and to provide guidance on follow-up care, prevention and health maintenance," the researchers wrote. They call for further research on how best to provide follow-up and support for SAH survivors, including studies to explore patients’ expectations for recovery.

The full study is available at http://journals.lww.com/neurosurgery/Fulltext/2013/03000/Health_Related_Quality_of_Life_10_Years_After.9.aspx.


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