Article
Quality of life after poor-grade aneurysmal subarachnoid haemorrhage – prospective data from the hWFNS trial
Lebensqualität nach hochgradiger aneurysmatischer Subarachnoidalblutung – prospektive Daten der hWFNS Studie
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Published: | May 25, 2022 |
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Objective: Poor-grade aneurysmal subarachnoid hemorrhage (aSAH) is associated with high mortality and poor outcome. Data on quality of life (QoL) among survivors is scarce. Here we present QoL- and outcome-data from the prospective multicentric hWFNS-trial (NCT02304328).
Methods: This study enrolled 250 patients suffering from poor-grade aSAH (WFNS grades IV and V) in 8 centers in Switzerland and Germany. Six months after ictus a structured telephone interview was conducted by an independent trained investigator or study nurse blinded to the clinical course to collect QoL- and outcome data. Outcome was measured with the modified Rankin scale. QoL was measured using the EQ-5D-3L questionnaire, which assesses health profiles in five dimensions (mobility, self-care, usual activities, pain and discomfort, anxiety and depression), each of which has three response levels (no problems, some problems, extreme problems). Furthermore, a health state index score was calculated from all individual EQ-5D-3L health profiles using a germany-specific value set of the general population as a reference. Values range from 0 to 1, where 0 is a health state equivalent to death and 1 is equivalent to perfect health.
Results: Of 237 patients that were included in the analysis, 118 (49.8%) were alive after 6 months (mRS 0-5) and 119 (50.2%) were dead (mRS 6). Of those alive, 82 (70%) were at home, 19 (16.3%) received permanent care in a nursing home and 16 (13.7%) were in a rehabilitation clinic. The proportion of patients reporting no problem versus any problem (some problems and extreme problems) for the respective five domians of the EQ-5D-3L were: Mobility: 63 (53.4%) vs 55 (46.6%); selfcare: 69 (58.5%) vs 49 (41.5%); usual activities: 50 (42.4%) vs 68 (57.6%); pain and discomfort: 67 (56.8%) vs. 51 (43.2%); anxiety and depression: 68 (59.7%) vs 46 (40.3%). 22 (19.3%) patients reported no problems in each domain of the EQ-5D. The overall health state index score was 0.75 (±0.29).
Conclusion: The proportion of survivors of poor-grade aSAH with good quality of life six months after ictus is reasonably large. Up to 19% of patients report no restrictions of any health domain of the EQ-5D-3L and 70% are at home. Only a small number of patients report poor quality of life and require permanent care.