Are diagnoses of unruptured intracranial aneurysms associated with quality of life, psychological distress, health anxiety, or use of healthcare services in untreated individuals? A longitudinal, nested case-control study

Abstract

Introduction: Increasing imaging examination rates leads to a corresponding rise in the detection rates of unruptured intracranial aneurysms (UIAs). There is limited knowledge on how the detection of UIA affects health-related outcomes in untreated patients. Research question: Is the diagnosis of UIA associated with psychosocial outcomes, healthcare services utilisation, or sick leave in untreated individuals? Material and methods: Nested case-control study with 96 participants diagnosed with UIAs through magnetic resonance angiography (MRA) screening, not receiving preventive aneurysm obliteration. Comparisons were made with Control1 (192 participants with negative MRAs) and Control2 (192 individuals not MRA screened). Quality of life, psychological distress, and health anxiety were assessed using EQ-5D-5L including EQ VAS, Hopkins Symptom Checklist-10, and Whiteley Index-6, respectively. Healthcare service utilisation and sick leave was measured using registry data. Median follow-up was 32–55 months for the different outcomes. Results: UIA were in general not associated with psychosocial outcomes, neither compared to pre-screening values nor to controls. The exemption was a lower mean EQ VAS score at follow-up for cases (76.7) versus Control1 (80.0), regression coefficient −3.87 (95% CI (−7.60, −0.14). Cases had significantly higher rates of radiology exams compared to controls, with 1.47 (95% CI 1.25, 1.74) exams per person-year versus 0.91 (C95% CI 0.75, 1.09) for Control1 and 0.95 (95% CI CI 0.79, 1.14) for Control2. No significant differences were observed in other psychosocial outcomes, healthcare services utilisation, or sick-leave. Discussion and conclusions: The overall impact of untreated UIAs appears to be limited when assessed years after diagnosis.

Keywords

• Screening
• Incidental findings
• Intracranial aneurysm
• Quality of life
• Psychological stress
• Services utilisation