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Beks H, Walsh SM, Wood S, Clayden S, Alston L, Coffee NT, Versace VL. Application of the Australian Bureau of Statistics Socio-Economic Indexes for Areas in cardiovascular disease research: a scoping review identifying implications for research. AUST HEALTH REV 2024; 48:414-454. [PMID: 38616107 DOI: 10.1071/ah23239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/08/2024] [Indexed: 04/16/2024]
Abstract
Objective To scope how the Australian Bureau of Statistics Socio-Economic Indexes for Areas (SEIFA) has been applied to measure socio-economic status (SES) in peer-reviewed cardiovascular disease (CVD) research. Methods The Joanna Briggs Institute's scoping review methodology was used. Results The search retrieved 2788 unique citations, and 49 studies were included. Studies were heterogeneous in their approach to analysis using SEIFA. Not all studies provided information as to what version was used and how SEIFA was applied in analysis. Spatial unit of analysis varied between studies, with participant postcode most frequently applied. Study quality varied. Conclusions The use of SEIFA in Australian CVD peer-reviewed research is widespread, with variations in the application of SEIFA to measure SES as an exposure. There is a need to improve the reporting of how SEIFA is applied in the methods sections of research papers for greater transparency and to ensure accurate interpretation of CVD research.
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Affiliation(s)
- Hannah Beks
- Deakin Rural Health, Deakin University, PO Box 423, Warrnambool, Vic. 3280, Australia
| | - Sandra M Walsh
- Department of Rural Health, University of South Australia, Whyalla, SA, Australia
| | - Sarah Wood
- Deakin Rural Health, Deakin University, PO Box 423, Warrnambool, Vic. 3280, Australia
| | - Suzanne Clayden
- Specialist Physicians Clinic, Southwest Healthcare, Warrnambool, Vic., Australia
| | | | - Neil T Coffee
- Deakin Rural Health, Deakin University, PO Box 423, Warrnambool, Vic. 3280, Australia
| | - Vincent L Versace
- Deakin Rural Health, Deakin University, PO Box 423, Warrnambool, Vic. 3280, Australia
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Kam JKP, Dodds JM, Kam JKT, Dawes BH, Ghani M. Outcomes after inter-hospital transfer of intensive care patients with haemorrhagic stroke: a 5-year retrospective review. ANZ J Surg 2023; 93:1957-1963. [PMID: 36947603 DOI: 10.1111/ans.18426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 03/11/2023] [Accepted: 03/13/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND Inter-hospital transfer (IHT) of intensive care patients is a limited resource. We assessed the outcomes of patients with haemorrhagic stroke requiring IHT and intensive care and aimed to identify early prognostic factors of poor neurological outcome. METHODS We conducted a retrospective observational cohort study of patients admitted to a single tertiary intensive care unit (ICU) with haemorrhagic stroke after IHT between January 2014 and December 2018. Primary outcome was poor neurological outcome (modified Rankin Scale ≥4 at time of discharge from hospital or rehabilitation unit). Secondary outcomes were mortality rate, rate of intervention, rate of organ donation surgery (ODS) and potentially avoidable transfer (PAT). PAT was defined as transfer where the patient did not receive an intervention and had a poor neurological outcome. RESULTS Ninety patients were included in this study, 48 with intracerebral haemorrhage (ICH) and 42 with subarachnoid haemorrhage (SAH). Fifty-one (56.7%) patients had a poor neurological outcome, including 30 (33%) who died. Factors significantly associated with poor neurological outcome included age > 80 years, lower presenting Glasgow Coma Score (GCS) and bilaterally fixed and dilated pupils. Stepwise logistic regression demonstrated history of hypertension as significantly associated with poor neurological outcome in patients with ICH (P = 0.021). Seven (7.8%) patients had ODS. Sixty-four (71.1%) patients received intervention and 20 (22.2%) transfers were potentially avoidable. CONCLUSIONS Patients in this cohort are at high risk of poor neurological outcome. Prognostic factors identified in this study may help referring, retrieval and receiving clinicians to discuss futility prior to pursuing IHT.
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Affiliation(s)
- Jeffrey K P Kam
- Department of Intensive Care Medicine, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- Department of Intensive Care Medicine, Monash Health, Melbourne, Victoria, Australia
| | - Jarron M Dodds
- Department of Intensive Care Medicine, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Jeremy K T Kam
- Department of Neurosurgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Neurosurgery, Monash Health, Melbourne, Victoria, Australia
| | - Bryden H Dawes
- Department of Neurosurgery, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Manisa Ghani
- Department of Intensive Care Medicine, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
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Burns M, Bally J, Burles M, Peacock S. Critically Ill Patients: Family Experiences of Interfacility Transfers From Rural to Urban Centers and Impact on Family Relationships. JOURNAL OF FAMILY NURSING 2023; 29:74-88. [PMID: 36172740 PMCID: PMC9850375 DOI: 10.1177/10748407221124254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
A critical illness event is intensely stressful for family members and can lead to negative psychological, emotional, social and financial consequences. In geographically rural areas, critically ill patients may require an interfacility transfer to an urban centre for advanced critical care services. In this context, research suggests that these family members from rural areas experience additional burdens, yet little is known about these experiences. An interpretive phenomenological approach was used to explore lived experiences of family members from rural areas whose critically ill relative undergoes an interfacility transfer to an urban centre for advanced critical care services. Participants described feelings of vulnerability in the urban centre, the need to protect the critically ill patient and other relatives, maintaining responsibilities at home, navigating family relationships, and a loss of connection during the transfer window. These findings may better position nurses to address family members' stress and anxiety during this experience.
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Affiliation(s)
- Margie Burns
- University of Prince Edward Island,
Charlottetown, Canada
| | - Jill Bally
- University of Saskatchewan, Saskatoon,
Canada
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Microsurgical treatment of ruptured aneurysms beyond 72 hours after rupture: implications for advanced management. Acta Neurochir (Wien) 2022; 164:2431-2439. [PMID: 35732841 DOI: 10.1007/s00701-022-05283-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/03/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Aneurysmal subarachnoid hemorrhage (aSAH) patients admitted to primary stroke centers are often transferred to neurosurgical and endovascular services at tertiary centers. The effect on microsurgical outcomes of the resultant delay in treatment is unknown. We evaluated microsurgical aSAH treatment > 72 h after the ictus. METHODS All aSAH patients treated at a single tertiary center between August 1, 2007, and July 31, 2019, were retrospectively reviewed. The additional inclusion criterion was the availability of treatment data relative to time of bleed. Patients were grouped based on bleed-to-treatment time as having acute treatment (on or before postbleed day [PBD] 3) or delayed treatment (on or after PBD 4). Propensity adjustments were used to correct for statistically significant confounding covariables. RESULTS Among 956 aSAH patients, 92 (10%) received delayed surgical treatment (delayed group), and 864 (90%) received acute endovascular or surgical treatment (acute group). Reruptures occurred in 3% (26/864) of the acute group and 1% (1/92) of the delayed group (p = 0.51). After propensity adjustments, the odds of residual aneurysm (OR = 0.09; 95% CI = 0.04-0.17; p < 0.001) or retreatment (OR = 0.14; 95% CI = 0.06-0.29; p < 0.001) was significantly lower among the delayed group. The OR was 0.50 for rerupture, after propensity adjustments, in the delayed setting (p = 0.03). Mean Glasgow Coma Scale scores at admission in the acute and delayed groups were 11.5 and 13.2, respectively (p < 0.001). CONCLUSIONS Delayed microsurgical management of aSAH, if required for definitive treatment, appeared to be noninferior with respect to retreatment, residual, and rerupture events in our cohort after adjusting for initial disease severity and significant confounding variables.
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Barriers and facilitators to more timely treatment of aneurysmal subarachnoid haemorrhage across two tertiary referral centres in Australia: A thematic analysis. Australas Emerg Care 2022; 25:267-272. [PMID: 35125318 DOI: 10.1016/j.auec.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/20/2021] [Accepted: 01/23/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Delays in treatment of aSAH appear to be common but the causes are not well understood. We explored facilitators and barriers to timely treatment of aSAH. METHODS We used a multiple case study with cases of aSAH surviving> 1 day identified prospectively. We conducted semi-structured interviews with the patient, their next-of-kin and health professionals involved in the case. Within-case analysis identified barriers and facilitators in 4 phases (pre-hospital, presentation, transfer, in-hospital) followed by thematic analysis across cases using a case-study matrix. RESULTS Twenty-seven cases with 90 interviewees yielded five themes related to facilitators or barriers of timely treatment. "Early recognition" led to urgent response. "Accessibility to health care" depended on patient's location, transport, and environmental conditions. Good "Coordination" between and within health services was a key facilitator. "Complexity" of patient's condition affected time to treatment in multiple time periods. "Availability of resources" was identified most frequently during the diagnostic and treatment phases as both barrier and facilitator. CONCLUSIONS The identified themes may be modifiable at the patient/health professional level and health system level and may improve timely treatment of aSAH through targeted interventions, subsequently contributing to improve morbidity and mortality of patients with aSAH.
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Buscot MJ, Chandra RV, Mainguard J, Nichols L, Blizzard L, Stirling C, Smith K, Lai L, Asadi H, Froelich J, Reeves MJ, Thani N, Thrift A, Gall S. Association of Onset-to-Treatment Time With Discharge Destination, Mortality, and Complications Among Patients With Aneurysmal Subarachnoid Hemorrhage. JAMA Netw Open 2022; 5:e2144039. [PMID: 35061040 PMCID: PMC8783267 DOI: 10.1001/jamanetworkopen.2021.44039] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
IMPORTANCE Rapid access to specialized care is recommended to improve outcomes after aneurysmal subarachnoid hemorrhage (SAH), but understanding of the optimal onset-to-treatment time for aneurysmal SAH is limited. OBJECTIVE To assess the optimal onset-to-treatment time for aneurysmal SAH that maximized patient outcomes after surgery. DESIGN, SETTING, AND PARTICIPANTS This cohort study assessed 575 retrospectively identified cases of first-ever aneurysmal SAH occurring within the referral networks of 2 major tertiary Australian hospitals from January 1, 2010, to December 31, 2016. Individual factors, prehospital factors, and hospital factors were extracted from the digital medical records of eligible cases. Data analysis was performed from March 1, 2020, to August 31, 2021. EXPOSURES Main exposure was onset-to-treatment time (time between symptom onset and aneurysm surgical treatment in hours) derived from medical records. MAIN OUTCOMES AND MEASURES Clinical characteristics, complications, and discharge destination were extracted from medical records and 12-month survival obtained from data linkage. The associations of onset-to-treatment time (in hours) with (1) discharge destination of survivors (home vs rehabilitation), (2) 12-month survival, and (3) neurologic complications (rebleed, delayed cerebral ischemia, meningitis, seizure, hydrocephalus, and delayed cerebral injury) were investigated using natural cubic splines in multivariable Cox proportional hazards and logistic regression models. RESULTS Of the 575 patients with aneurysmal SAH, 482 patients (mean [SD] age, 55.0 [14.5] years; 337 [69.9%] female) who received endovascular coiling or neurosurgical clipping were studied. A nonlinear association of treatment delay was found with the odds of being discharged home vs rehabilitation (effective df = 3.83 in the generalized additive model, χ2 test P = .002 for the 4-df cubic spline), with a similar nonlinear association remaining significant after adjustment for sex, treatment modality, severity, Charlson Comorbidity Index, history of hypertension, and hospital transfer (likelihood ratio test: df = 3, deviance = 9.57, χ2 test P = .02). Both unadjusted and adjusted cox regression models showed a nonlinear association between time to treatment and 12-month mortality with the lowest hazard of death with receipt of treatment at 12.5 hours after symptom onset, although the nonlinear term became nonsignificant upon adjustment. The odds of being discharged home were higher with treatment before 20 hours after onset, with the probability of being discharged home compared with rehabilitation or other hospital increased by approximately 10% when treatment was received within the first 12.5 hours after symptom onset and increased by an additional 5% from 12.5 to 20 hours. Time to treatment was not associated with any complications. CONCLUSIONS AND RELEVANCE This cohort study found evidence that more favorable outcomes (discharge home and survival at 12 months) were achieved when surgical treatment occurred at approximately 12.5 hours. These findings provide more clarity around optimal timelines of treatment with people with aneurysmal SAH; however, additional studies are needed to confirm the findings.
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Affiliation(s)
- Marie-Jeanne Buscot
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Ronil V. Chandra
- NeuroInterventional Radiology, Monash Health, Melbourne, Victoria, Australia
- School of Clinical Sciences Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Julian Mainguard
- NeuroInterventional Radiology, Monash Health, Melbourne, Victoria, Australia
| | - Linda Nichols
- School of Nursing, University of Tasmania, Hobart, Tasmania, Australia
| | - Leigh Blizzard
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | | | - Karen Smith
- Ambulance Victoria, Melbourne, Victoria, Australia
| | - Leon Lai
- School of Clinical Sciences Monash Health, Monash University, Melbourne, Victoria, Australia
- Department of Neurosurgery, Monash Health, Melbourne, Victoria, Australia
| | - Hamed Asadi
- NeuroInterventional Radiology, Monash Health, Melbourne, Victoria, Australia
| | - Jens Froelich
- NeuroInterventional Radiology, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Mathew J. Reeves
- Department of Epidemiology, Michigan State University, East Lansing
| | - Nova Thani
- Department of Neurosurgery, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Amanda Thrift
- School of Clinical Sciences Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Seana Gall
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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Aditya RS, Yusuf A, Razeeni DMA, Al-Sayaghi KM, Solikhah FK. "We Are at The Forefront of Rural Areas" Emergency Nurse's Experience During Pandemic: A Qualitative Study. Health Equity 2021; 5:818-825. [PMID: 35018314 PMCID: PMC8742295 DOI: 10.1089/heq.2021.0080] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2021] [Indexed: 12/12/2022] Open
Abstract
Purpose: The pandemic makes everyone alert, including nurses who are in emergency rooms at community health centers, the importance of their experiences is a lesson for nurses to maintain themselves and be effectivein providing services. This study aimed to explore the experience of nurses who are in emergency rooms at rural area during the coronavirus disease pandemic. Methods: This qualitative research was conducted based on the Nvivo 12 analysis method using in-depth semistructured interviews. Data saturation was reached after 20 interviews were completed. Data collection lasted for 1 month from February to March 2020. Results: Semistructured interviews with 20 nurse participants obtained the following participant characteristics. Eight participants were males and 12 were females with an age ranged from 28 to 43 years (average age 36.4 years). The majority had vocational education (75%), with long experience that ranged from 5 to 15 years (average 11 years). The findings of four themes and seven subthemes. The theme of the findings is Expressions of care, Compliance increases using Personal Protective Equipment (PPE), Focus to refer to, Triage at the forefront. Conclusion: This research reveals that Expressions of care, Compliance increases using PPE, Focus to refer to, Triage at the forefront is the main theme identified in this study. Further investigation of the readiness of nurses in handling patients in the emergency room is considered to be of benefit to the results of this study.
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Affiliation(s)
- Ronal Surya Aditya
- Sekolah Tinggi Ilmu Kesehatan (STIKes) Kepanjen Malang, Malang, Indonesia
| | - Ah Yusuf
- Faculty of Nursing, Universitas Airlangga Surabaya, Surabaya, Indonesia
| | - Daifallah M. Al Razeeni
- Department of EMS, Vice Dean for Academic Affair Prince Sultan Bin Abdalziz College for EMS (PSEMS), King Saud University (KSU), Riyadh, Saudi Arabia
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Phuong Nguyen T, Rehman S, Stirling C, Chandra R, Gall S. Time and predictors of time to treatment for aneurysmal subarachnoid haemorrhage (aSAH): a systematic review. Int J Qual Health Care 2021; 33:6127110. [PMID: 33533408 DOI: 10.1093/intqhc/mzab019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/17/2021] [Accepted: 02/02/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Aneurysmal subarachnoid haemorrhage (aSAH) is a serious form of stroke, for which rapid access to specialist neurocritical care is associated with better outcomes. Delays in the treatment of aSAH appear to be common and may contribute to poor outcomes. We have a limited understanding of the extent and causes of these delays, which hinders the development of interventions to reduce delays and improve outcomes. The aim of this systematic review was to quantify and identify factors associated with time to treatment in aSAH. METHODS This systematic review was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines and was registered in PROSPERO (Reg. No. CRD42019132748). We searched four electronic databases (MEDLINE, EMBASE, Web of Science and Google Scholar) for manuscripts published from January 1998 using pre-designated search terms and search strategy. Main outcomes were duration of delays of time intervals from onset of aSAH to definitive treatment and/or factors related to time to treatment. RESULTS A total of 64 studies with 16 different time intervals in the pathway of aSAH patients were identified. Measures of time to treatment varied between studies (e.g. cut-off timepoints or absolute mean/median duration). Factors associated with time to treatment fell into two categories-individual (n = 9 factors, e.g. age, sex and clinical characteristics) and health system (n = 8 factors, e.g. pre-hospital delay or presentation out-of-hours). Demographic factors were not associated with time to treatment. More severe aSAH reduced treatment delay in most studies. Pre-hospital delays (patients delay, late referral, late arrival of ambulance, being transferred between hospitals or arriving at the hospital outside of office hours) were associated with treatment delay. In-hospital factors (patients with complications, procedure before definitive treatment, slow work-up and type of treatment) were less associated with treatment delay. CONCLUSIONS The pathway from onset to definitive treatment of patients with aSAH consists of multiple stages with multiple influencing factors. This review provides the first comprehensive understanding of extent and factors associated with time to treatment of aSAH. There is an opportunity to target modifiable factors to reduce time to treatment, but further research considering more factors are needed.
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Affiliation(s)
- Thuy Phuong Nguyen
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, Tasmania 7000, Australia
| | - Sabah Rehman
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, Tasmania 7000, Australia
| | - Christine Stirling
- School of Nursing, University of Tasmania, Tasmania 71 Brooker Avenue, Hobart, Tasmania 7001, Australia
| | - Ronil Chandra
- Neuro Interventional Radiology, Monash Health, 246 Clayton Road, Clayton, Victoria 3168, Australia.,Medicine Monash Health, Monash University, Wellington Rd, Clayton, Victoria 3800, Australia
| | - Seana Gall
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, Tasmania 7000, Australia.,Medicine Monash Health, Monash University, Wellington Rd, Clayton, Victoria 3800, Australia
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Nichols L, Gall S, Stankovich J, Stirling C. Associations between socioeconomic status and place of residence with survival after aneurysmal subarachnoid haemorrhage. Intern Med J 2020; 51:2095-2103. [PMID: 32893943 DOI: 10.1111/imj.15044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 08/19/2020] [Accepted: 08/25/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study aims to understand early (< 24 h post ictus) and late (up to 12 months) survival post aneurysmal subarachnoid haemorrhage (aSAH), with a focus on rurality and socioeconomic status. METHODS A statewide population-based cohort of aSAH cases in Tasmania, Australia, was established from 2010-2014 utilising multiple overlapping sources. Clinical data were collected from medical records and the Tasmanian Death Registry, with area-level rurality and socioeconomic status geocoded to participants' residential address. RESULTS From a cohort of 237 (70% women, 36% disadvantaged, 38% rural) individuals over a 5-year period, 12-month mortality was 52.3% with 54.0% of these deaths occurring within 24 h post ictus. In univariable analysis of 12-month survival, outcome was not influenced by socioeconomic status but rural geographical location was associated with a non-significant increase in death (HR 1.22 95% CI 0.85-1.75) along with hypertension (HR 1.78 95% CI 1.07-2.98) and hypercholesterolemia (HR 1.70 95% CI 0.99-2.91). Multivariable analysis demonstrated a statistically significant increase in death to 12 months after aSAH for both hypertension (HR 1.81 95% CI 1.08-3.03) and hypercholesterolemia (HR 1.71 95% CI 1.00-2.94) but not socioeconomic status or geographic location. CONCLUSION We found high early death in this population-based aSAH Australian population. Survival to 12 months after aSAH was not related to either geographical location or socioeconomic status but modifiable risk factors increased the risk of death. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Linda Nichols
- School of Nursing, University of Tasmania, 71 Brooker Ave Glebe, 7001, Hobart, Tasmania, Australia
| | - Seana Gall
- Menzies Institute for Medical Research, University of Tasmania
| | - Jim Stankovich
- Department of Neuroscience, Central Clinical School, Monash University
| | - Christine Stirling
- School of Nursing, University of Tasmania, 71 Brooker Ave Glebe, 7001, Hobart, Tasmania, Australia
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