Beta blockade and clinical outcomes in aneurysmal subarachnoid hemorrhage

Melody M. Chang, Ronak N. Raval, Jessie J. Southerland, Dare A. Adewumi, Khaled A. Bahjri, Rajeev K. Samuel, Rafeek O. Woods, Olaide O. Ajayi, Bryan S. Lee, Frank P K Hsu, Richard Lee Applegate, Ihab R. Dorotta

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Aneurysmal subarachnoid hemorrhages are frequently complicated by hypertension and neurogenic myocardial stunning. Beta blockers may be used for management of these complications. We sought to investigate sympathetic nervous system modulation by beta blockers and their effect on radiographic vasospasm, delayed cerebral infarction, discharge destination and death. Methods: Retrospective chart review of 218 adults admitted to the ICU between 8/2004 and 9/2010 was performed. Groups were identified relevant to beta blockade: 77 were never beta blocked (No/No), 123 received post-admission beta blockers (No/Yes), and 18 were continued on their home beta blockers (Yes/Yes). Records were analyzed for baseline characteristics and the development of vasospasm, delayed cerebral infarction, discharge destination and death, expressed as adjusted odds ratio. Results: Of the 218 patients 145 patients developed vasospasm, 47 consequently infarcted, and 53 died or required care in a long-term facility. When compared to No/No patients, No/Yes patients had significantly increased vasospasm (OR 2.11 (1.06-4.16)). However, these patients also had significantly fewer deaths or need for long term care (OR 0.17 (0.05-0.64)), with decreased tendency for infarcts (OR 0.70 (0.32-1.55)). When compared to No/No patients, Yes/Yes patients demonstrated a trend toward increased vasospasm (OR 1.61 (0.50-5.29)) that led to infarction (OR 1.51 (0.44-5.13)), but with decreased mortality or need for long term care in a facility (OR 0.13 (0.01-1.30)). Conclusion: Post-admission beta blockade in aneurysmal subarachnoid hemorrhage patients was associated with increased incidence of vasospasm. However, despite the increased occurrence of vasospasm, beta blockers were associated with improved discharge characteristics and fewer deaths.

Original languageEnglish (US)
Pages (from-to)155-163
Number of pages9
JournalOpen Neurology Journal
Volume10
DOIs
StatePublished - Dec 1 2016

Fingerprint

Subarachnoid Hemorrhage
Cerebral Infarction
Long-Term Care
Myocardial Stunning
Sympathetic Nervous System
Infarction
Odds Ratio
Hypertension
Mortality
Incidence

Keywords

  • aSAH
  • Beta blockade
  • CT angiogram
  • GCS
  • Subarachnoid hemorrhage

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Psychiatry and Mental health

Cite this

Chang, M. M., Raval, R. N., Southerland, J. J., Adewumi, D. A., Bahjri, K. A., Samuel, R. K., ... Dorotta, I. R. (2016). Beta blockade and clinical outcomes in aneurysmal subarachnoid hemorrhage. Open Neurology Journal, 10, 155-163. https://doi.org/10.2174/1874205X01610010155

Beta blockade and clinical outcomes in aneurysmal subarachnoid hemorrhage. / Chang, Melody M.; Raval, Ronak N.; Southerland, Jessie J.; Adewumi, Dare A.; Bahjri, Khaled A.; Samuel, Rajeev K.; Woods, Rafeek O.; Ajayi, Olaide O.; Lee, Bryan S.; Hsu, Frank P K; Applegate, Richard Lee; Dorotta, Ihab R.

In: Open Neurology Journal, Vol. 10, 01.12.2016, p. 155-163.

Research output: Contribution to journalArticle

Chang, MM, Raval, RN, Southerland, JJ, Adewumi, DA, Bahjri, KA, Samuel, RK, Woods, RO, Ajayi, OO, Lee, BS, Hsu, FPK, Applegate, RL & Dorotta, IR 2016, 'Beta blockade and clinical outcomes in aneurysmal subarachnoid hemorrhage', Open Neurology Journal, vol. 10, pp. 155-163. https://doi.org/10.2174/1874205X01610010155
Chang MM, Raval RN, Southerland JJ, Adewumi DA, Bahjri KA, Samuel RK et al. Beta blockade and clinical outcomes in aneurysmal subarachnoid hemorrhage. Open Neurology Journal. 2016 Dec 1;10:155-163. https://doi.org/10.2174/1874205X01610010155
Chang, Melody M. ; Raval, Ronak N. ; Southerland, Jessie J. ; Adewumi, Dare A. ; Bahjri, Khaled A. ; Samuel, Rajeev K. ; Woods, Rafeek O. ; Ajayi, Olaide O. ; Lee, Bryan S. ; Hsu, Frank P K ; Applegate, Richard Lee ; Dorotta, Ihab R. / Beta blockade and clinical outcomes in aneurysmal subarachnoid hemorrhage. In: Open Neurology Journal. 2016 ; Vol. 10. pp. 155-163.
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abstract = "Background: Aneurysmal subarachnoid hemorrhages are frequently complicated by hypertension and neurogenic myocardial stunning. Beta blockers may be used for management of these complications. We sought to investigate sympathetic nervous system modulation by beta blockers and their effect on radiographic vasospasm, delayed cerebral infarction, discharge destination and death. Methods: Retrospective chart review of 218 adults admitted to the ICU between 8/2004 and 9/2010 was performed. Groups were identified relevant to beta blockade: 77 were never beta blocked (No/No), 123 received post-admission beta blockers (No/Yes), and 18 were continued on their home beta blockers (Yes/Yes). Records were analyzed for baseline characteristics and the development of vasospasm, delayed cerebral infarction, discharge destination and death, expressed as adjusted odds ratio. Results: Of the 218 patients 145 patients developed vasospasm, 47 consequently infarcted, and 53 died or required care in a long-term facility. When compared to No/No patients, No/Yes patients had significantly increased vasospasm (OR 2.11 (1.06-4.16)). However, these patients also had significantly fewer deaths or need for long term care (OR 0.17 (0.05-0.64)), with decreased tendency for infarcts (OR 0.70 (0.32-1.55)). When compared to No/No patients, Yes/Yes patients demonstrated a trend toward increased vasospasm (OR 1.61 (0.50-5.29)) that led to infarction (OR 1.51 (0.44-5.13)), but with decreased mortality or need for long term care in a facility (OR 0.13 (0.01-1.30)). Conclusion: Post-admission beta blockade in aneurysmal subarachnoid hemorrhage patients was associated with increased incidence of vasospasm. However, despite the increased occurrence of vasospasm, beta blockers were associated with improved discharge characteristics and fewer deaths.",
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AU - Chang, Melody M.

AU - Raval, Ronak N.

AU - Southerland, Jessie J.

AU - Adewumi, Dare A.

AU - Bahjri, Khaled A.

AU - Samuel, Rajeev K.

AU - Woods, Rafeek O.

AU - Ajayi, Olaide O.

AU - Lee, Bryan S.

AU - Hsu, Frank P K

AU - Applegate, Richard Lee

AU - Dorotta, Ihab R.

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KW - aSAH

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KW - CT angiogram

KW - GCS

KW - Subarachnoid hemorrhage

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