Adherence to evidence-based processes of care reduces one-year mortality after aneurysmal subarachnoid hemorrhage (aSAH),Journal of the Neurological Sciences

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Adherence to evidence-based processes of care reduces one-year mortality after aneurysmal subarachnoid hemorrhage (aSAH)
Journal of the Neurological Sciences ( IF 4.4 ) Pub Date : 2021-08-11 , DOI: 10.1016/j.jns.2021.117613
Sabah Rehman ₁ , Ronil V Chandra ₂ , Leon T Lai ₃ , Hamed Asadi ₄ , Arvind Dubey ₅ , Jens Froelich ₆ , Nova Thani ₅ , Linda Nichols ₇ , Leigh Blizzard ₁ , Karen Smith ₈ , Amanda G Thrift ₉ , Christine Stirling ₇ , Michele Callisaya ₁₀ , Monique Breslin ₁ , Mathew J Reeves ₁₁ , Seana Gall ₁₂

Affiliation

Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
NeuroInterventional Radiology, Monash Health, Clayton, Victoria, Australia; School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.
Neurosurgery, Monash Health, Clayton, Victoria, Australia; School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.
NeuroInterventional Radiology, Monash Health, Clayton, Victoria, Australia.
Neurosurgery, Royal Hobart Hospital, Hobart, Tasmania, Australia.
NeuroInterventional Radiology, Royal Hobart Hospital, Hobart, Tasmania, Australia.
School of Nursing, University of Tasmania, Hobart, Tasmania, Australia.
Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia.
Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at, Monash Health, Monash University, Clayton, Victoria, Australia.
Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Peninsula Clinical School, Monash University, Clayton, Victoria, Australia.
Department of Epidemiology, Michigan State University, East Lansing, MI, USA.
Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Monash University, Clayton, Victoria, Australia.

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: Connolly Jr. et al. (2012) (1) antihypertensives prior to aneurysm treatment, Steiner et al. (2013) (2) nimodipine, and (Phan et al., 2019 (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 (Connolly Jr. et al., 2012 (1)) proportion of patients and characteristics associated with receiving processes of care, Steiner et al. (2013) (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.

中文翻译：

坚持循证护理流程可降低动脉瘤性蛛网膜下腔出血 (aSAH) 后一年死亡率

背景

关于提供循证护理及其与动脉瘤性蛛网膜下腔出血 (aSAH) 后结局的关系的研究有限。

宗旨

我们检查了 aSAH 后循证护理的依从性以及与生存和出院目的地的关联。此外，还检查了与循证护理相关的因素，包括年龄、性别、Charlson 合并症指数、严重程度评分以及迟发性脑缺血和梗死，以了解与生存和出院目的地的关联。

方法

在两个综合脑血管中心的所有 aSAH 病例的回顾性队列（2010-2016 年）中，我们从病历中提取了 3 个循证 aSAH 护理指标：Connolly Jr. 等。(2012) (1) 动脉瘤治疗前的抗高血压药物，Steiner 等。(2013) (2) 尼莫地平和 (Phan 等人，2019 (3)) 动脉瘤治疗（卷曲/夹闭）。我们将“最佳护理”定义为接受所有符合条件的护理流程。通过数据链接获得 1 年的存活率。我们估计 (Connolly Jr. 等人，2012 (1)) 与接受护理过程相关的患者比例和特征，Steiner 等人。(2013) (2) 使用 cox 比例风险模型和出院目的地之间的护理过程与 1 年死亡率之间的关联，对数二项式回归调整年龄、性别、aSAH 的严重程度，迟发性脑缺血和/或脑梗塞和合并症。敏感性分析探讨了管理类型（积极与舒适措施）对护理过程和结果之间关联的影响修改。

结果

在 549 名患者（69% 为女性）中，59% 根据指南进行管理。个别指标与较低的 1 年死亡率相关，但与出院目的地无关。在独立于年龄、性别、严重程度、合并症和医院网络的单变量 (HR 0.24 95% CI 0.17–0.35) 和多变量分析 (HR 0.51 95% CI 0.34–0.77) 中，最佳护理降低了 1 年死亡率。