Subarachnoid haemorrhage impact could be ‘drastically reduced’

While early detection of ‘thunderclap headache’ which may herald subarachnoid haemorrhage (SAH) remains paramount, new research shows GPs can contribute to preventing the disease through supporting patients in managing lifestyle factors.
 
A new cross-sectional analysis, based on the Global Burden of Disease 2021 study, has investigated the burden of SAH from 1990 to 2021, finding that while its burden has more than halved relative to the world’s population, the absolute number of cases is increasing.
 
However, ‘over 70% of the SAH-related burden appears to be attributed to modifiable risk factors, most importantly to high systolic blood pressure and smoking,’ researchers concluded.
 
Currently, non-traumatic SAH is the third most common cause of stroke, accounting for up to 10% of global cerebrovascular events.
 
In Australia in 2021, there were an estimated 40,700 stroke events, and in 2022, stroke was the underlying cause of 4.4% of all deaths.
 
The new research assessed 14 risk factors, finding a number were linked to increased risk of SAH-related stroke, with systolic blood pressure linked to around 50% of SAH cases and smoking linked to around 14%.
 
The researchers are now calling for more supportive public health policies and better resourcing for preventive health activities, saying lifestyle modification has the potential to drastically decrease global impacts of SAH.
 
‘Given the substantial and potentially preventable impact of SAH on global health, consideration of its distinct features from other stroke types in evidence-based public health planning, resource allocation, and prevention strategies is warranted,’ they said.
 
Chair of RACGP Expert Committee – Quality Care Professor Mark Morgan said he is optimistic GPs can put these new research findings into practice.
 
‘Urgent assessment and treatment for patients presenting with stroke symptoms remains an important public health message,’ he told newsGP.
 
‘The incidence rates suggest that a GP will have a person on their books who has a SAH several times in a career.
 
‘Luckily the modifiable risk factors align with other targets for prevention. These include control of hypertension and smoking cessation.’
 
The study analysed data from 204 countries and territories, showing the overall rate of global burden from SAH decreased over time, with the disability adjusted life year rate decreasing by 54.6%.
 
Globally incidence decreased by 28.8%, prevalence by 16.1% and mortality by 56.1%.
 
However, while the relative burden halved over the 30-year period, the absolute numbers of strokes from SAH increased, raising the continued importance of measures to detect and prevent the disease.
 
Professor Morgan highlighted the importance of using evidence-based health screening, with available resources outlining a preventative framework for GPs.
 
‘The RACGP Red Book recommends opportunistic screening for hypertension from the age of 18 years no more often than every two years,’ he said.
 
‘Then from the age of 45-79 years calculating cardiovascular disease risk every five years, or more frequently if there is elevated risk.
 
‘For Aboriginal and Torres Strait Islander people follow advice in the National Guide.’
 
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cardiovascular disease CVD stroke subarachnoid haemorrhage