Long-term mortality and vascular event risk after aneurysmal subarachnoid haemorrhage

Background: Patients with a history of subarachnoid haemorrhage (SAH) may be at risk for vascular events and excess mortality. Methods: We interviewed 752 patients ( mean age 50 years, 67% women, mean follow-up 8.1 years) clipped between 1985 and 2001 after SAH who had been discharged home or to a rehabilitation facility about new vascular events. We compared age- and sex-specific mortality after SAH with that of the general population by standardised mortality ratios (SMR). The incidence of vascular events in SAH patients was compared with that in patients after a transient ischaemic attack or minor stroke. Results: The SMR for SAH patients was 1.7 (95% CI 1.4 to 2.1) overall and 3.2 ( 95% CI 0.8 to 13.1) for patients,40 years. In the first 10 years after SAH the cumulative incidence of a vascular event was 11.2% ( 95% CI 7.0 to 14.4), which was lower ( hazard ratio 0.43, 95% CI 0.33 to 0.57) than that in patients with a minor stroke. Conclusion: SAH patients who recover to a functional independent state have an excess mortality compared with the general population. The risk of vascular events after SAH is lower than after minor stroke, but higher than the population risks reported in the literature.