Adherence to evidence-based processes of care reduces one-year mortality after aneurysmal subarachnoid hemorrhage (aSAH).
BACKGROUND
There is limited research on the provision of evidence-based care and its association with outcomes after aneurysmal subarachnoid hemorrhage (aSAH).


AIMS
We examined adherence to evidence-based care after aSAH and associations with survival and discharge destination. Also, factors associated with evidence-based care including age, sex, Charlson comorbidity index, severity scores, and delayed cerebral ischemia and infarction were examined for association with survival and discharge destination.


METHODS
In a retrospective cohort (2010-2016) of all aSAH cases across two comprehensive cerebrovascular centres, we extracted 3 indicators of evidence-based aSAH care from medical records: (1) antihypertensives prior to aneurysm treatment, (2) nimodipine, and (3) aneurysm treatment (coiling/clipping). We defined 'optimal care' as receiving all eligible processes of care. Survival at 1 year was obtained by data linkage. We estimated (1) proportion of patients and characteristics associated with receiving processes of care, (2) associations between processes of care with 1-year mortality using cox-proportional hazard model and discharge destination with log binomial regression adjusting for age, sex, severity of aSAH, delayed cerebral ischemia and/or cerebral infarction and comorbidities. Sensitivity analyses explored effect modification of the association between processes of care and outcome by management type (active versus comfort measures).


RESULTS
Among 549 patients (69% women), 59% were managed according to the guidelines. Individual indicators were associated with lower 1-year mortality but not discharge destination. Optimal care reduced mortality at 1 year in univariable (HR 0.24 95% CI 0.17-0.35) and multivariable analyses (HR 0.51 95% CI 0.34-0.77) independent of age, sex, severity, comorbidities, and hospital network.


CONCLUSION
Adherence to processes of care reduced 1-year mortality after aSAH. Many patients with aSAH do not receive evidence-based care and this must be addressed to improve outcomes.
['Rehman|Sabah|S|', 'Chandra|Ronil V|RV|', 'Lai|Leon T|LT|', 'Asadi|Hamed|H|', 'Dubey|Arvind|A|', 'Froelich|Jens|J|', 'Thani|Nova|N|', 'Nichols|Linda|L|', 'Blizzard|Leigh|L|', 'Smith|Karen|K|', 'Thrift|Amanda G|AG|', 'Stirling|Christine|C|', 'Callisaya|Michele|M|', 'Breslin|Monique|M|', 'Reeves|Mathew J|MJ|', 'Gall|Seana|S|']
D002545:Brain Ischemia D015331:Cohort Studies D005260:Female D006801:Humans D002532:Intracranial Aneurysm D008297:Male D012189:Retrospective Studies D013345:Subarachnoid Hemorrhage
Aneurysm Subarachnoid hemorrhage Evidence-based care Survival Management Guidelines Long-term outcome