Evidence for excess long-term mortality after treated subarachnoid hemorrhage

Background and Purpose-The purpose of this study was to examine the long-te rm mortality rate of patients with aneurysmal subarachnoid hemorrhage (SAH) compared with that of the general population. Methods-Aneurysmal SAH patients who were treated for ruptured aneurysm from 1977 through 1998 in a tertiary referral center (n = 1537) were followed u p for a median of 7.5 years. Dates and causes of death were determined. Sta ndardized mortality ratios (observed/expected deaths) according to age, sex , and Glasgow, Outcome Scale at 12 months after surgery were calculated. Results-The mortality rate among patients with good recovery at 12 months w as twice that of the general population. The excess mortality appeared to b e most evident in younger age groups. Cerebrovascular and cardiovascular di seases were the principal causes of premature death. The result was similar among patients without preexisting cardiovascular diseases at the time of SAH. Conclusions-Aneurysmal SAH patients hake an excess mortality rate even afte r Successful treatment of ruptured aneurysms. Therefore, aneurysmal SAH sho uld be viewed more as one aspect of a chronic general vascular disease, and more attention should be given to treatment of risk factors and long-term follow-up of these patients.