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Aneurysmal subarachnoid haemorrhage (aSAH) and age above 70 years: towards predicting a favourable outcome
EANS Academy. Lindegaard K. Sep 27, 2019; 276144; EP01076
Prof. Karl-Fredrik Lindegaard
Prof. Karl-Fredrik Lindegaard

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Abstract
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Long-term favourable outcome in elderly people with aSAH seems to be an understudied topic. We defined 'favourable' as: 1) survival >12 months, 2) independence in activities of daily living, 3) subjective health satisfaction, 4) Rankin score (mRS) of 0, 1 or 2, and 5) able to use public transportation. This paper analyses candidate predictors for a favourable outcome.
123 patients aged 70+ years with acute aSAH were admitted between 1996 and 2004. Their median age was 74.3 years. Aneurysm repair by clips or coils was performed in 96 patients. On grounds of advanced age, 13 patients had no repair. Median 30 months after aSAH, all 67 survivors received a package including the SF-36 health status questionnaire; response rate 91%.
Mortality was 9.4%, 14.8%, 26% and 29.2% after 1, 3, 6 and 12 months. Twelve-month mortality predictors included Fisher score, WFNS score, and acute hydrocephalus.(p< 0.01). The benefit of aneurysm repair was very significant (p< 0,001).
Among candidate predictors for a favourable outcome, only the pre-SAH Karnofsky score reached statistical significance (p=0.033). Postoperative ADL score predicted long-term survival (p=0.033).
By endpoint, March 31, 2018, 36 individuals had outlived their demographically remaining life expectancy, significant predictors were having completed secondary school and expressing satisfaction with their current health at follow-up.
Conclusions: Older patients may do worse after aSAH (than younger ones), but this does not mean that the elderly does poorly just because of her chronological age. Short-term survival hinges primarily on aneurysm repair and other acute phase variables. Due to an unparalleled very long follow-up, this study brings to light variables not commonly considered as aSAH outcome predictors. For the very long-term outcome, factors apart from the aSAH ictus itself become increasingly visible. These factors may therefore escape notice in the management and follow-up of the elderly aSAH patient.
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