title: Predictors of Poor Quality of Life 1 Year After Subarachnoid Hemorrhage.
abstract: BACKGROUND
  Risk factors for poor quality of life (QOL) after subarachnoid hemorrhage (SAH) remain poorly described.
  
  
  OBJECTIVE
  To identify the frequency and predictors of poor QOL 1 year after SAH.
  
  
  METHODS
  We studied 1-year QOL in a prospectively collected cohort of 1181 consecutively admitted SAH survivors between July 1996 and May 2013. Patient clinical, radiographic, surgical, and acute clinical course information was recorded. Reduced QOL (overall, physical, and psychosocial) at 1 year was assessed with the Sickness Impact Profile and defined as 2 SD below population-based normative Sickness Impact Profile values. Logistic regression leveraging multiple imputation to handle missing data was used to evaluate reduced QOL.
  
  
  RESULTS
  Poor overall QOL was observed in 35% of patients. Multivariable analysis revealed that nonwhite ethnicity, high school education or less, history of depression, poor clinical grade (Hunt-Hess Grade ≥3), and delayed infarction were predictors of poor overall and psychosocial QOL. Poor physical QOL was additionally associated with older age, hydrocephalus, pneumonia, and sepsis. At 1 year, patients with poor QOL had increased difficulty concentrating, cognitive dysfunction, depression, and reduced activities of daily living. More than 91% of patients with poor QOL failed to fully return to work. These patients frequently received physical rehabilitation, but few received cognitive rehabilitation or emotional-behavioral support.
  
  
  CONCLUSIONS
  Reduced QOL affects as many as one-third of SAH survivors 1 year after SAH. Delayed infarction is the most important in-hospital modifiable factor that affects QOL. Increased attention to cognitive and emotional difficulties after hospital discharge may help patients achieve greater QOL.
authors.affiliation: *Department of Neurology, Columbia University Medical Center, New York, New York; ‡Institute of Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; §Department of Neurosurgery, Columbia University Medical Center, New York, New York.
authors.forename: Zahrah
authors.initials: Z
authors.lastname: Taufique
authors.forename: Teresa
authors.initials: T
authors.lastname: May
authors.forename: Emma
authors.initials: E
authors.lastname: Meyers
authors.forename: Cristina
authors.initials: C
authors.lastname: Falo
authors.forename: Stephan A
authors.initials: SA
authors.lastname: Mayer
authors.forename: Sachin
authors.initials: S
authors.lastname: Agarwal
authors.forename: Soojin
authors.initials: S
authors.lastname: Park
authors.forename: E Sander
authors.initials: ES
authors.lastname: Connolly
authors.forename: Jan
authors.initials: J
authors.lastname: Claassen
authors.forename: J Michael
authors.initials: JM
authors.lastname: Schmidt
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000328:Adult; D000368:Aged; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology / Q000523:psychology; D015331:Cohort Studies; D003863:Depression / Q000175:diagnosis / Q000209:etiology / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology*; D012307:Risk Factors; D018434:Sickness Impact Profile; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000175:diagnosis* / Q000523:psychology*; D013997:Time Factors