Adherence to evidence-based processes of care reduces one-year mortality after aneurysmal subarachnoid hemorrhage (aSAH)

Sabah Rehman; Ronil V. Chandra; Leon T. Lai; Hamed Asadi; Arvind Dubey; Jens Froelich; Nova Thani; Linda Nichols; Leigh Blizzard; Karen Smith; Amanda G. Thrift; Christine Stirling; Michele Callisaya; Monique Breslin; Mathew J. Reeves; Seana Gall

doi:10.1016/j.jns.2021.117613

Adherence to evidence-based processes of care reduces one-year mortality after aneurysmal subarachnoid hemorrhage (aSAH)

Sabah Rehman, Ronil V. Chandra, Leon T. Lai, Hamed Asadi, Arvind Dubey, Jens Froelich, Nova Thani, Linda Nichols, Leigh Blizzard, Karen Smith, Amanda G. Thrift, Christine Stirling, Michele Callisaya, Monique Breslin, Mathew J. Reeves, Seana Gall

Research output: Contribution to journal › Article › Research › peer-review

4 Citations (Scopus)

Abstract

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.

Original language	English
Article number	117613
Number of pages	5
Journal	Journal of the Neurological Sciences
Volume	428
DOIs	https://doi.org/10.1016/j.jns.2021.117613
Publication status	Published - 15 Sept 2021

Keywords

Aneurysm
Evidence-based care
Guidelines
Long-term outcome
Management
Subarachnoid hemorrhage
Survival

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10.1016/j.jns.2021.117613

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Rehman, S., Chandra, R. V., Lai, L. T., Asadi, H., Dubey, A., Froelich, J., Thani, N., Nichols, L., Blizzard, L., Smith, K., Thrift, A. G., Stirling, C., Callisaya, M., Breslin, M., Reeves, M. J., & Gall, S. (2021). Adherence to evidence-based processes of care reduces one-year mortality after aneurysmal subarachnoid hemorrhage (aSAH). Journal of the Neurological Sciences, 428, Article 117613. https://doi.org/10.1016/j.jns.2021.117613

@article{588435baa02b4481b2a93b2fa99d542c,

title = "Adherence to evidence-based processes of care reduces one-year mortality after aneurysmal subarachnoid hemorrhage (aSAH)",

abstract = "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 {\textquoteleft}optimal care{\textquoteright} 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.",

keywords = "Aneurysm, Evidence-based care, Guidelines, Long-term outcome, Management, Subarachnoid hemorrhage, Survival",

author = "Sabah Rehman and Chandra, {Ronil V.} and Lai, {Leon T.} and Hamed Asadi and Arvind Dubey and Jens Froelich and Nova Thani and Linda Nichols and Leigh Blizzard and Karen Smith and Thrift, {Amanda G.} and Christine Stirling and Michele Callisaya and Monique Breslin and Reeves, {Mathew J.} and Seana Gall",

note = "Funding Information: This study was funded by the National Health and Medical Research Council of Australia ( APP1143155 ). Funding Information: A.G. Thrift was supported by a National Health and Medical Research Council (Australia) fellowship (1042600). Dr. Thrift reports grants from National Health and Medical Research Council (NHMRC), Australia, during the conduct of the study, outside the submitted work. Funding Information: Sabah Rehman is funded by a Tasmania Graduate Research Scholarship co-funded by the University of Tasmania and the Menzies Institute for Medical Research. Funding Information: S. Gall is funded by a National Heart Foundation of Australia Future Leader Fellowship (FLF 102061). Dr. Gall reports grants from National Health and Medical Research Council, grants from National Heart Foundation of Australia, during the conduct of the study. Publisher Copyright: {\textcopyright} 2021 Elsevier B.V. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.",

year = "2021",

month = sep,

day = "15",

doi = "10.1016/j.jns.2021.117613",

language = "English",

volume = "428",

journal = "Journal of the Neurological Sciences",

issn = "0022-510X",

publisher = "Elsevier BV",

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Rehman, S, Chandra, RV, Lai, LT, Asadi, H, Dubey, A, Froelich, J, Thani, N, Nichols, L, Blizzard, L, Smith, K , Thrift, AG, Stirling, C, Callisaya, M, Breslin, M, Reeves, MJ & Gall, S 2021, 'Adherence to evidence-based processes of care reduces one-year mortality after aneurysmal subarachnoid hemorrhage (aSAH)', Journal of the Neurological Sciences, vol. 428, 117613. https://doi.org/10.1016/j.jns.2021.117613

TY - JOUR

T1 - Adherence to evidence-based processes of care reduces one-year mortality after aneurysmal subarachnoid hemorrhage (aSAH)

AU - Rehman, Sabah

AU - Chandra, Ronil V.

AU - Lai, Leon T.

AU - Asadi, Hamed

AU - Dubey, Arvind

AU - Froelich, Jens

AU - Thani, Nova

AU - Nichols, Linda

AU - Blizzard, Leigh

AU - Smith, Karen

AU - Thrift, Amanda G.

AU - Stirling, Christine

AU - Callisaya, Michele

AU - Breslin, Monique

AU - Reeves, Mathew J.

AU - Gall, Seana

N1 - Funding Information: This study was funded by the National Health and Medical Research Council of Australia ( APP1143155 ). Funding Information: A.G. Thrift was supported by a National Health and Medical Research Council (Australia) fellowship (1042600). Dr. Thrift reports grants from National Health and Medical Research Council (NHMRC), Australia, during the conduct of the study, outside the submitted work. Funding Information: Sabah Rehman is funded by a Tasmania Graduate Research Scholarship co-funded by the University of Tasmania and the Menzies Institute for Medical Research. Funding Information: S. Gall is funded by a National Heart Foundation of Australia Future Leader Fellowship (FLF 102061). Dr. Gall reports grants from National Health and Medical Research Council, grants from National Heart Foundation of Australia, during the conduct of the study. Publisher Copyright: © 2021 Elsevier B.V. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2021/9/15

Y1 - 2021/9/15

N2 - 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.

AB - 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.

KW - Aneurysm

KW - Evidence-based care

KW - Guidelines

KW - Long-term outcome

KW - Management

KW - Subarachnoid hemorrhage

KW - Survival

UR - http://www.scopus.com/inward/record.url?scp=85112746152&partnerID=8YFLogxK

U2 - 10.1016/j.jns.2021.117613

DO - 10.1016/j.jns.2021.117613

M3 - Article

C2 - 34418669

AN - SCOPUS:85112746152

SN - 0022-510X

VL - 428

JO - Journal of the Neurological Sciences

JF - Journal of the Neurological Sciences

M1 - 117613

ER -

Adherence to evidence-based processes of care reduces one-year mortality after aneurysmal subarachnoid hemorrhage (aSAH)

Abstract

Keywords

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REDucing Delays In aneurysmal Subarachnoid Haemorrhage: the REDDISH study

NHMRC Research Fellowship

Cite this

Adherence to evidence-based processes of care reduces one-year mortality after aneurysmal subarachnoid hemorrhage (aSAH)

Abstract

Keywords

Access to Document

Other files and links

Projects

REDucing Delays In aneurysmal Subarachnoid Haemorrhage: the REDDISH study

NHMRC Research Fellowship

Cite this