Functional outcome, return to work and quality of life in patients with non-aneurysmal subarachnoid hemorrhage

Abstract

Background: Non-aneurysmal, non-traumatic subarachnoid hemorrhage (nSAH) refers to cases where a causative aneurysm cannot be identified. We studied six-months outcomes in nSAH patients. Methods: From a prospective SAH registry of all nSAH patients admitted between 2012 and 2023, relevant complications and outcomes were collected. Functional outcome and return-to-work at six months were assessed using the modified Rankin Scale (mRS), quality of life with the EuroQol-5Dimensions (EQ-5D) and Hospital Anxiety & Depression Scale (HADS), and an institutional 14-item questionnaire for assessment of residual symptoms. Results: 325 consecutive nSAH patients were included (191 non-perimesencephalic, non-aneurysmal subarachnoid hemorrhage [NPSAH]; 134 perimesencephalic subarachnoid hemorrhage [PMSAH]). 303 (93%; 179 NPSAH and 124 PMSAH) were available at follow-up (7 patients died). Favorable functional outcome (mRS-score 0-2) was reported in 271 (89%) patients and did not differ between NPSAH- and PMSAH. 141 (77%) patients returned to work, whereas only 71 (39%) patients reached their previous level of work. PMSAH patients were more likely to return to work (68/96 (71%) NPSAH and 73/87 (84%) PMSAH, respectively, p=0.01). Furthermore, PMSAH patients were more likely to fully return to work (p=.034). The mean (SD) EQ-5D and EQ-VAS scores were 0.827 (0.184) and 74 (16), respectively. The HADS-A and -D scores were deviant (score >7 points) in 53 (23%) and 48 (21%) patients, respectively. Only 39 patients (16%) denied experiencing residual symptoms. Increased fatigue (n=164; 68%), increased concentration difficulties (n=130; 54%), and increased forgetfulness (n=121; 50%) were the most frequently reported residual symptoms. Conclusions: This study reveals that the majority of nSAH patients reports residual symptoms and did not return to their previous level of work at six months follow-up, despite a favorable functional outcome. These findings nuance the perception of a good outcome, as suggested in previous studies, warranting further research on possible rehabilitative interventions and counseling in these patients.