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Descriptive Epidemiology in Relation to Gender Differences and Treatment Modalities 10 Years After Intracranial Aneurysm Rupture in the Stockholm Cohort 1996–1999
Red Cross University College of Nursing. Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm.
Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm.
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm.
Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm.
2013 (English)In: World Neurosurgery, ISSN 1878-8750, E-ISSN 1878-8769, Vol. 80, no 3-4, 328-334 p.Article in journal (Refereed) Published
Abstract [en]

Objective

To describe epidemiology in relation to gender differences and treatment modalities 10 years after intracranial aneurysm rupture in the Stockholm cohort 1996–1999.

Methods

A total of 468 consecutive patients with aneurysmal subarachnoid hemorrhage were followed-up in a retrospective cohort design 10 years after rupture. Information on medical history, clinical variables, and treatments were obtained from patient records. Causes of death were obtained from patient records and The Swedish Cause of Death Register. Incidence of ruptured aneurysms per 100,000 people were calculated from male, female, and overall population data per year from 1996–1999.

Results

Ten years after aneurysm rupture 63.9% (n = 296) of patients were still alive. The overall 28-day case fatality was 19.4%; most often deaths were due to the initial hemorrhage. There were no significant differences in survival time between patients treated with clipping (8.4 years, 95% confidence interval 8.1–8.8), compared with endovascularly treated patients (8.2 years, 95% confidence interval 7.4–9.1) (log rank P = 0.550). The female incidence was higher than that of men, and women were significantly older at the onset of aneurysm rupture (55.7 vs. 52.8 years, P = 0.027).

Conclusions

Ten years after rupture, most treated patients were still alive. The mortality was highest in the first month after rupture, due to the initial hemorrhage. Gender differences were apparent in incidence, but 10 years after the rupture mortality rates and survival times were equal between men and women. Survival time was equal between patients within active treatment modalities.

Place, publisher, year, edition, pages
Elsevier, 2013. Vol. 80, no 3-4, 328-334 p.
Keyword [en]
epidemiology, gender, intracranial aneurysm, subarachnoid hemorrhage
National Category
Nursing
Identifiers
URN: urn:nbn:se:rkh:diva-500DOI: 10.1016/j.wneu.2012.06.041PubMedID: 22898030OAI: oai:DiVA.org:rkh-500DiVA: diva2:606548
Note

Som manuskript i avhandling. As manuscript in dissertation

Available from: 2013-02-19 Created: 2013-02-19 Last updated: 2014-11-07Bibliographically approved
In thesis
1. Impact on life after intracranial aneurysm rupture: health-related quality of life and epidemiologic outcomes
Open this publication in new window or tab >>Impact on life after intracranial aneurysm rupture: health-related quality of life and epidemiologic outcomes
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to describe impact on life up to ten years after intracranial aneurysm rupture in terms of health-related quality of life, changes in everyday life and descriptive epidemiology with the intention to contribute to an increased understanding of the long-term perceived consequences of that impact.

Study I aimed to describe changes and transitions in everyday life during the first two years following an intracranial aneurysm rupture. A consecutive sample of 88 patients was followed-up at three time points. A majority of respondents perceived changes in their everyday life during the first two years following aneurysm rupture. Transitions were revealed within changes in personality, changed social roles and relationships, and changed abilities and behavior.

In Study II epidemiology in relation to gender differences and treatment modalities ten years after aneurysm rupture was investigated. Ten years after the onset, 63.9% of the 468 admitted patients were still alive. The incidence in women was higher than that of men; they were older at onset and were diagnosed with more aneurysms. There were no significant differences in survival times between patients treated with different active aneurysm treatments, or between men and women.

In Study III survivors from study II (n=217) were followed-up with questionnaires and telephone interviews, aiming to describe psychological, physical and cognitive functions ten years after intracranial aneurysm rupture. Compared to reference groups, the aneurysm respondents scored higher levels of anxiety and depression. Respondents with ruptured aneurysms in the posterior circulation of the brain scored significantly more symptoms of anxiety and depression. A small proportion, 2.8%, scored for severe physical disability and 21.7% scored below the cut-off value, indicating cognitive impairments.

Study IV used the same sample as study III (n=217), and a general population sample (n=434) from the Stockholm Public Health Survey, matched by age and sex. The aim was to measure health-related quality of life (HRQoL), and to explore factors affecting HRQoL, ten years after intracranial aneurysm rupture. Compared to general population, the aneurysm sample reported significantly more problems with mobility, self-care, usual activities and anxiety/depression and had significantly lower overall HRQoL values. HRQoL in the aneurysm sample was most affected in respondents with worse neurological outcome, respondents with comorbidities, and respondents with low perceived recovery.

In conclusion, intracranial aneurysm ruptures impacts upon life in several ways for an extensive period of time after the onset. The results indicate a need for follow-up and support, and to identify subgroups of aneurysm patients who might benefit from support: patients with ruptured aneurysms in the posterior circulation of the brain; patients with worse neurological outcome at hospital discharge; patients with comorbidities; and patients with low perceived recovery. Ten years after the onset of aneurysm rupture the majority of patients were still alive. Differences between men and women were apparent in incidence and clinical presentation at the onset of aneurysm rupture, not in survival times. Survival time was equal between patients within active treatment modalities.

Place, publisher, year, edition, pages
Stockholm: Karolinska Institutet, 2012. 70 p.
Keyword
intracranial aneurysm rupture, quality of life
National Category
Nursing
Identifiers
urn:nbn:se:rkh:diva-701 (URN)978-91-7457-927-7 (ISBN)
Public defence
2012-12-14, Kugelbergsalen, Karolinska Universitetssjukhuset, Solna, 14:00
Opponent
Supervisors
Available from: 2014-09-17 Created: 2013-08-01 Last updated: 2014-09-17Bibliographically approved

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