title: Cardiovascular predictors of long-term outcomes after non-traumatic subarachnoid hemorrhage.
abstract: OBJECTIVE
  Cardiac injury is common after subarachnoid hemorrhage (SAH) and is associated with adverse early outcomes, but long-term effects are unknown. The first aim of this study was to compare the long-term rates of death, stroke, and cardiac events in SAH survivors versus a matched population without SAH. The second aim was to quantify the effects of cardiac injury on the outcome rates.
  
  
  METHODS
  This was a retrospective cohort study of patients with and without non-traumatic SAH. For aim #1, the predictor variable was SAH and the outcome variables were all-cause and cerebrovascular mortality, stroke, cardiac mortality, acute coronary syndrome (ACS), and heart failure (HF) admission. A multivariable Cox proportional hazards analysis was performed. For aim #2, the predictor variables were cardiac injury (elevated serum cardiac enzymes or a diagnosis code for ACS) and dysfunction (pulmonary edema on X-Ray or a diagnosis code for HF).
  
  
  RESULTS
  Compared with 4,695 members without SAH, the 910 SAH patients had higher rates of all-cause mortality (hazard ratio [HR 2.6], 95% confidence intervals [CI] 2.0-3.4), cerebrovascular mortality (HR 30.6, CI 13.5-69.4), and stroke (HR 10.2, CI 7.5-13.8). Compared with the non-SAH group, the SAH patients with cardiac injury had increased rates of all-cause mortality (HR 5.3, CI 3.0-9.3), cardiac mortality (HR 7.3, CI 1.7-31.6), and heart failure (HR 4.3, CI 1.53-11.88).
  
  
  CONCLUSIONS
  SAH survivors have increased long-term mortality and stroke rates compared with a matched non-SAH population. SAH-induced cardiac injury is associated with an increased risk of death and heart failure hospitalization.
authors.affiliation: Kaiser Northern California Division of Research, San Francisco, CA, USA. jonathan.g.zaroff@kp.org
authors.forename: Jonathan G
authors.initials: JG
authors.lastname: Zaroff
authors.forename: Jonathan
authors.initials: J
authors.lastname: Leong
authors.forename: Helen
authors.initials: H
authors.lastname: Kim
authors.forename: William L
authors.initials: WL
authors.lastname: Young
authors.forename: Sean P
authors.initials: SP
authors.lastname: Cullen
authors.forename: Vivek A
authors.initials: VA
authors.lastname: Rao
authors.forename: Michael
authors.initials: M
authors.lastname: Sorel
authors.forename: Charles P
authors.initials: CP
authors.lastname: Quesenberry
authors.forename: Steve
authors.initials: S
authors.lastname: Sidney
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality* / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002140:California / Q000453:epidemiology; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000473:pathology; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000401:mortality; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000401:mortality*; D013345:Subarachnoid Hemorrhage / Q000401:mortality*; D016896:Treatment Outcome; D055815:Young Adult