BACKGROUND: Cardiac dysfunction is a well-known complication of aneurysmal subarachnoid hemorrhage (aSAH). However, the clinical significance of cardiac complications is largely unknown.
OBJECTIVE: To determine whether cardiac complications are independently related to outcomes and to identify potential predictors associated with these complications.
METHODS: We extracted all hospitalizations for aSAH from the National Inpatient Sample database for years 2002 to 2009. We used generalized estimating equations to determine whether cardiac complications were associated with the patient outcomes and to evaluate potential predictors of cardiac complications.
RESULTS: Among 53 713 cases of aSAH, there were 3609 (6.72%) and 151 (0.28%) incidences of cardiac failure (CF) and myocardial infarction (MI), respectively. The overall in-hospital mortality rate was 24.8%, whereas the mortality rate for patients with CF was 34.4% and the mortality rate for patients with MI was 29.8%. Patients who experienced CF were significantly more likely than other patients to die in the hospital (odds ratio: 1.6, 95% confidence interval: 1.47-1.68; P < .001). The difference in mortality rates between MI patients and other patients, however, was not statistically significant. The generalized estimating equation model identified 7 factors that were predictive of CF: age, sex, race, primary payer, diabetes, smoker, and cardiac disease. For MI, the model identified age, race, and primary payer as significant predictors of MI.
CONCLUSION: Our results suggest that an important association exists between cardiac complications and mortality/morbidity in aSAH patients. aSAH patients with CF appear to have a higher mortality rate, longer hospital length of stay, and higher hospitalization costs compared with those without CF.
ABBREVIATIONS: aSAH, aneurysmal subarachnoid hemorrhage
AUC, area under the receiver-operating characteristic curve
CF, cardiac failure
CI, confidence interval
GEE, generalized estimating equation
LOS, length of stay
MI, myocardial infarction
NIS, Nationwide Inpatient Sample
SAH, subarachnoid hemorrhage
*Department of Neurosurgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Republic of Korea;
‡Department of Neurosurgery, University of Florida, Gainesville, Florida
Correspondence: Brian L. Hoh, MD, Department of Neurosurgery, University of Florida, PO Box 100265, Gainesville, FL 32610. E-mail: firstname.lastname@example.org
Received July 25, 2012
Accepted May 22, 2013