Quality of life and healthcare resource use associated with angiographic vasospasm after aneurysmal subarachnoid hemorrhage.
OBJECTIVE
In this analysis of data from a large clinical trial in aneurysmal subarachnoid hemorrhage, the impact of angiographic vasospasm (aVSP) on specific patient outcomes and inpatient healthcare resource use was assessed.


METHODS
This was a post hoc analysis of exploratory end points collected for 409 patients with aneurysmal subarachnoid hemorrhage in the Clazosentan to Overcome Neurological Ischemia and Infarction Occurring After Subarachnoid Hemorrhage (CONSCIOUS-1) trial. Central reviewers graded severity of aVSP as none, mild, moderate, or severe based on comparison of catheter angiograms obtained at baseline and 7 to 11 days after aneurysmal subarachnoid hemorrhage. Assessments of cognitive status (Mini-Mental State Examination) and patient-relevant outcomes (EuroQol total score and visual analog scale and Functional Status Examination) were administered at Week 12. The relationship between severity of aVSP and these end points as well as inpatient healthcare resource use (intensive care, general ward, and total hospital lengths of stay) was assessed using univariate and multivariate analyses.


RESULTS
Cognitive status and all patient-relevant outcome measures varied significantly (P<0.0001) with severity of aVSP (mean for severe aVSP versus no aVSP, respectively: Mini-Mental State Examination, 18.0 versus 27.6; EuroQol total, 0.38 versus 0.74; EuroQol visual analog scale, 50.9 versus 75.5; Functional Status Examination, 20.5 versus 11.7). A significant inverse relationship with severity of aVSP was observed for total hospital days (P=0.008) and days in the intensive care unit (P<0.0001). On average, patients with severe aVSP stayed in the hospital 5 days longer than those with no aVSP.


CONCLUSIONS
Severe aVSP is associated with poor cognition, worse patient-relevant outcomes, and greater inpatient healthcare resource use. Future studies assessing new aVSP treatments should include outcome measures that evaluate quality of recovery among survivors.
Division of Neurosurgery, St Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada. macdonaldlo@smh.ca
R Loch
RL
Macdonald
Elke
E
Hunsche
René
R
Schüler
John
J
Wlodarczyk
Stephan A
SA
Mayer
D000293:Adolescent; D000328:Adult; D000368:Aged; D002533:Cerebral Angiography; D003071:Cognition; D003072:Cognition Disorders / Q000000981:diagnostic imaging / Q000209:etiology; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care; D011788:Quality of Life; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D013997:Time Factors; D020301:Vasospasm, Intracranial / Q000209:etiology / Q000628:therapy