Incidence, case-fatality and 10-year survival of subarachnoid hemorrhage in a population-based registry

OBJECTIVE: To evaluate incidence, case fatalities and prognosis of subarachnoid hemorrhage (SAH). Subjects and METHODS: Prospective population-based registry (1994-1998) including patients with a first-ever stroke followed up to 10 years. RESULTS: In a 5-year period we included 118 patients (55 men and 63 women; mean age +/- SD 60.7 +/- 15.9 years) with an SAH. The crude annual incidence rate was 7.93 cases per 100,000 inhabitants (95% CI 6.46-9.63), 7.60 per 100,000 when standardized to the 2006 European population and 5.27 per 100,000 when standardized to the 2005 world population. The 7-day case-fatality rate was 16.1% (95% CI 9.5-22.7), 30-day case-fatality rate was 34.7% (95% CI 21.2-43.3), and 1-year case-fatality rate was 44.9% (95% CI 35.9-53.9). At the end of the 1-year follow-up, 53 patients (44.9%) had a good recovery [modified Rankin scale (mRS) 0-2] and 12 (10.2%) had a severe disability (mRS 3-5). The 10-year survival rate was 46.4% (95% CI 36.0-57.8). CONCLUSION: In our district, the SAH incidence rate was similar to what is reported in most European countries. Since more than half of the patients with SAH remained severely disabled or died, results from our population-based study strongly support the notion that the most appropriate treatments should be made available for all patients in comprehensive centers and the call for an urgent implementation of telemedicine in the rural areas of our district.