• Justiina Huhtakangas, Hanna Lehto, Karri Seppä, Riku Kivisaari, Mika Niemelä, Juha Hernesniemi, and Martin Lehecka.
• From the Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland (J.H., H.L., R.K., M.N., J.H., M.L.); and Finnish Cancer Registry, Helsinki, Finland (K.S.). justiina.huhtakangas@hus.fi.
• Stroke. 2015 Jul 1; 46 (7): 1813-8.

Background And PurposeThere is high case-fatality rate and loss of productive life-years related to aneurysmal subarachnoid hemorrhage (aSAH) but data on long-term survival of patients with aSAH are scarce. We aim to evaluate long-term excess mortality and related risk factors after an aSAH event.MethodsSurvivors (n=3078) of aSAH who had survived for ≥1 year were reviewed for this retrospective follow-up study, which was conducted in the Department of Neurosurgery in Helsinki between 1980 and 2007. Follow-up started 1 year after the aSAH and continued until death or the end of 2012 (48 918 patient-years). Mortality and relative survival ratios were derived using a matched general population.ResultsSurvivors of aSAH after 20 years showed 17% excess mortality compared with the general population. Even young patients and patients with good recovery showed excess mortality. The highest excess mortality was among patients with multiple aneurysms, old age, poor preoperative clinical condition, conservative aneurysm treatment, and unfavorable clinical outcome at 1 year.ConclusionsEven after initially favorable recovery from an aSAH, survivors experience excess mortality in the long run in comparison to a matched general population. Cardiovascular disease at younger age and cerebrovascular events were overrepresented as causes of death, which indicates the importance of treatment of vascular risk factors. Young patients and patients with multiple aneurysms who are recovering from an aSAH should be followed-up and treated most actively.© 2015 American Heart Association, Inc.

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