By Matthew E. Fink, MD

Professor and Chairman, Department of Neurology, Weill Cornell Medical College; Neurologist-in-Chief, New York Presbyterian Hospital

Dr. Fink reports he is a retained consultant for Procter & Gamble and Pfizer.

SOURCE: Mackey J, Khoury JC, Alwell K, et al. Stable incidence but declining case-fatality rates of subarachnoid hemorrhage in a population. Neurology 2016;87:2192-2197.

Aneurysmal subarachnoid hemorrhage continues to be one of the most morbid stroke subtypes with a continuing high mortality. However, in most advanced centers around the world, mortality has been declining, but this has not been documented in the United States. The investigators analyzed data that was collected prospectively from a series of stroke registries during five discrete annual time periods, beginning in 1988 and ending in 2010. The incidence of SAH in the five study periods (age-, race-, and sex-adjusted to the 2000 U.S. population) was 8.8 (95% confidence interval, 6.8-10.7), 9.2 (7.2-11.2), 10.0 (8.0-12.0), 9.0 (7.1-10.9), and 7.7 (6.0-9.4) per 100,000, respectively; the trend in incidence rates from 1988 to 2010 was not statistically significant (P = 0.22).

During these time intervals, advanced neurovascular imaging, endovascular coiling, and neurologic intensive care unit availability increased significantly over time. All-cause, five-day mortality declined from 32% to 18%, 30-day mortality declined from 46% to 25%, and 90-day mortality declined from 49% to 29%, from 1988 to 2010, and these changes were statistically significant. The investigators attributed the decline in mortality to advances in medical and surgical therapies, changes in triage of patients directly to specialized centers, and the emergence of neurocritical care units at hospitals that care for such patients. The findings in this Greater Cincinnati/Northern Kentucky region study are consistent with published reports from Western Europe and Japan.