Clinical Outcomes of Subarachnoid Hemorrhage in Patients With Nicotine Dependence: A Longitudinal Study of 43 315 Patients.

Background and objectives: Previous studies have demonstrated that current and/or past nicotine use disorder may worsen mortality and complications in patients experiencing subarachnoid hemorrhage (SAH). This retrospective study examines clinical outcomes in nontraumatic SAH patients with nicotine dependence.

Methods: The TriNetX Research Network was used to analyze data from adult patients (≥18 years old) with a history of nontraumatic SAH. Patients were further stratified by nicotine dependence (International Classification of Disease Tenth Revision Code F17) vs no nicotine dependence. Along with patient demographics and comorbidities, the primary outcomes that were examined included mortality, vasospasm, hydrocephalus, and delayed cerebral ischemia (DCI).

Results: A total of 209 970 patients diagnosed with nontraumatic SAH were included in the analysis. Of these, 43 315 patients had nicotine dependence (International Classification of Disease Tenth Revision Code F17). Patients with nicotine dependence were younger (P < .0001) and more likely to be male (P < .0001), White (P < .0001), and non-Hispanic or Latino (P < .0001). After SAH, patients with nicotine dependence had increased hazards of mortality (HR = 1.24; 95% CI: 1.20, 1.27), compared with patients with no nicotine dependence. Patients with nicotine dependence also had increased hazards of vasospasm (HR: 1.47; 95% CI: 1.40, 1.55) and DCI (HR: 1.35; 95% CI: 1.31, 1.39).

Conclusion: SAH patients with nicotine dependence have increased risks of mortality, vasospasm, and DCI. Understanding the risk that nicotine dependence poses to patients who experience SAH underscores the importance of counseling for smoking cessation, which is vital for improving the long-term management of these patients.