Outcome in Patients over 70 with Subarachnoid Hemorrhage

Martien Oranje

2012

1728

10

Per 100.000 persons

Hospitalizations

418

2,5

252 < 70y

1,7

166 > 70y

9,0

    581 < 65y

21

Sources: 1

Per 100.000 persons

Deaths

So...

Entire SAH population

Case Fatality Rate

Population

Age < 65y with SAH

Age > 65y with SAH

24%

18%

37%

Entire population

Relative Risk (of Death)

Age > 70 compared to

Age < 70y

3,6

5,3

Being old and suffering from SAH is a bad combination

AND YET...

Sources: 2, 3, 4, 5, 6, 7 

Maybe age isn't a very good predictor of clinical outcome?

Methods

Patient characteristics
Logistic regression model

  • Elderly and outcome
  • Crude and Final

DESIGN

Patients

PERIOD

END

Retrospective cohort

All SAH patients

Nov 2008 - June 2011

Follow-up or Death

Variables

Treatment modality,
DCI, hypertension,
anticoagulant drugs,
rebleeds

Analysis

Outcome

Modified Rankin Scale

SAH Protocol

Sources: iPortal AMC, SAB protocol (2008)

Results

CFR 20,3%

CFR 33,3%

Results

Crude model (mRS vs age)

Final model (MRS VS AGE, INCL. confounders)

Age (70 and older): OR 1,9 CI 0,76 to 5,01 

Age (70 and older): OR 1,2 CI 0,41 to 3,65 

The relationship between age and clinical outcome was not supported.

Discussion

The elderly did not fare worse than the young

 

AMC

  • Endovascular coiling 6,7,8
  • Aggressive and invasive treatment 5,9

 

Limitations

  • Follow-up, selection bias and small sample size

Sources: 5, 6, 7, 8, 9

Sources

  1. CBS - Statline

  2. Koffijberg H, Buskens E, Rinkel GJE. Aneurysm occlusion in elderly patients with aneurysmal subarachnoid haemorrhage: a cost-utility analysis. J. Neurol. Neurosurg. Psychiatry 2011;82(7):718-27.

  3. Schöller, K., Massmann, M., Markl, G., Kunz, M., Fesl, G., Brückmann, H., … Schichor, C. (2013). Aneurysmal subarachnoid hemorrhage in elderly patients: long-term outcome and prognostic factors in an interdisciplinary treatment approach. Journal of Neurology, 260(4), 1052–60.

  4. Degos, V., Gourraud, P., & Tursis, V. (2012). Elderly age as a prognostic marker of 1-year poor outcome for subarachnoid hemorrhage patients through its interaction with admission hydrocephalus. Anesthesiology, (6), 1289–1299.

  5. Awe, O. O., Gonzalez, L. F., Hasan, D., Maltenfort, M., Rossenwasser, R., & Jabbour, P. (2011). Treatment outcome of aneurysmal subarachnoid hemorrhage in patients aged 70 years and older. Neurosurgery, 68(3), 753–8; discussion 758.

  6. Shimamura, N., Matsuda, N., Satou, J., Nakano, T., & Ohkuma, H. (2014). Early ambulation produces favorable outcome and nondemential state in aneurysmal subarachnoid hemorrhage patients older than 70 years of age. World Neurosurgery, 81(2), 330–4.

  7. Connolly, E. S., Rabinstein, A. A., Carhuapoma, J. R., Derdeyn, C. P., Dion, J., Higashida, R. T., … Vespa, P. (2012). Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/american Stroke Association. Stroke; a Journal of Cerebral Circulation, 43(6), 1711–37.

  8. Mutoh, T., Kazumata, K., Terasaka, S., Taki, Y., Suzuki, A., & Ishikawa, T. (2014). Early intensive versus minimally invasive approach to postoperative hemodynamic management after subarachnoid hemorrhage. Stroke; a Journal of Cerebral Circulation, 45(5), 1280–4.

  9. Garbossa, D., Panciani, P. P., Fornaro, R., Crobeddu, E., Marengo, N., Fronda, C., … Fontanella, M. (2012). Subarachnoid hemorrhage in elderly: advantages of the endovascular treatment. Geriatrics & Gerontology International, 12(1), 46–9. 

The End

Thank you

Special thanks to: Dagmar, David, Jantien en René

QALY

Sources: 2

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