Health-Related Quality-of-Life Outcomes: Comparing Patients With Aneurysmal and Nonaneurysmal Subarachnoid Hemorrhage.
Subarachnoid hemorrhage (SAH) is divided into two major types (aneurysmal [ASAH] and nonaneurysmal [NASAH]) because, in approximately 15% of the patients who experience SAH, no source of hemorrhage can be identified. Anecdotal evidence and contradictory research suggest that patients with NASAH experience some of the same health-related quality of life (HRQOL) issues as patients with ASAH. This quantitative survey design study compared 1-3 years after hemorrhage the HRQOL in patients who had experienced an NASAH with those who had experienced an ASAH. This is the first U.S. study to specifically investigate HRQOL in NASAH and the second to compare HRQOL outcomes between patients with ASAH and NASAH. These study results corroborate those of the first-that the two groups are much more similar than different. It confirms that the impact on employment for both hemorrhage groups is significant, and it also finds an even greater inability to return to work for the patients with NASAH. Physical symptom complaints were more common in the group with NASAH, whereas the group with ASAH experienced more emotional symptoms. Both groups had low levels of posttraumatic stress disorder (PTSD), with those levels not differing significantly between groups. However, PTSD and social support were shown to impact HRQOL for both groups. The authors recommend that clinicians assess all patients with SAH for PTSD and institute treatment early. This may include offering psychological services or social work early in the hospital course. Further research and policy changes are needed to assist in interventions that improve vocational reintegration after SAH. Patients with NASAH should no longer be described as having experienced a "benign hemorrhage." They have had a life-changing hemorrhage that may forever change their lives and impact their HRQOL.
Questions or comments about this article may be directed to Arthur P. McIntosh, PhD, APRN BC, at amcintos@bidmc.harvard.edu. He is the Director of Clinical Quality Value Analysis and a Nurse Practitioner in Neurosurgery, Beth Israel Deaconess Medical Center, Boston, MA. Ajith Thomas, MD, is Chief at the Section of Cerebrovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA.
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D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000451:nursing* / Q000523:psychology* / Q000534:rehabilitation; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000451:nursing* / Q000523:psychology* / Q000534:rehabilitation; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D009788:Occupational Therapy / Q000451:nursing / Q000523:psychology; D026741:Physical Therapy Modalities / Q000451:nursing / Q000523:psychology; D011788:Quality of Life / Q000523:psychology*; D012050:Rehabilitation, Vocational / Q000523:psychology; D012944:Social Support; D013313:Stress Disorders, Post-Traumatic / Q000451:nursing / Q000523:psychology; D013345:Subarachnoid Hemorrhage / Q000451:nursing* / Q000523:psychology* / Q000534:rehabilitation; D016896:Treatment Outcome