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Aim: To describe the detailed health-related quality of life (HRQoL) in survivors from the TTM-trial and to investigate potential differences related to sex and age. Methods: This is a cross-sectional study originating from a large prospective international, multicentre trial, including 442 respondents who answered the Short Form-36 item Questionnaire Health Survey version 2® (SF-36v2®) at a structured follow-up 6 months after out-of-hospital cardiac arrest (OHCA). Statistical analysis between independent groups were performed with Mann-Whitney U or Chi-square. Age was analysed primarily as a dichotomised variable. Results: Although overall physical and mental health were within the normal range, a substantial proportion of respondents had impaired function at domain-specific levels, particularly in Role-Physical (50%) and Role-Emotional (35%). Females scored significantly lower than males in; Physical Functioning (41.7 vs. 47.9, p < 0.001), Role-Physical (40.4 vs. 44.3, p = 0.02), General Health (47.0 vs. 50.5, p = 0.02), Vitality (47.2 vs. 52.7, p < 0.001), and Role-Emotional (41.5 vs. 46.2, p = 0.009). Those ≤65 years scored significantly better in Physical Functioning (47.9 vs. 44.1 p < 0.001), while those >65 years scored significantly better in Vitality (50.8 vs. 53.7, p = 0.006) and Mental Health (50.3 vs. 52.6, p = 0.04). Conclusions: Many OHCA survivors demonstrated impaired function in HRQoL at a domain level, despite most patients reporting an acceptable general HRQoL. Females reported worse HRQoL than males. Older age was associated with a worse Physical Functioning but better Vitality and Mental Health. Role-Physical and Role-Emotional aspects of health were especially affected, even when effects of age and sex where accounted for.

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... 444,449,450 Physical problems, including rib fractures, muscle weakness and ambulation difficulties, have also been reported. 437,444,451,452 However, the impact of survival on physical function has received little attention; when compared with age and gender-matched populations, reduced physical functioning has been reported in survivors at 3-months, 453 6-months, 452 12months, 434 and three years. 451 Almost half of survivors report limitations because of physical difficulties at 6-months, 452 with up to 40% describing mobility problems 434,439,444,454 and limitations in usual activities at 12-months. ...
... 444,449,450 Physical problems, including rib fractures, muscle weakness and ambulation difficulties, have also been reported. 437,444,451,452 However, the impact of survival on physical function has received little attention; when compared with age and gender-matched populations, reduced physical functioning has been reported in survivors at 3-months, 453 6-months, 452 12months, 434 and three years. 451 Almost half of survivors report limitations because of physical difficulties at 6-months, 452 with up to 40% describing mobility problems 434,439,444,454 and limitations in usual activities at 12-months. ...
... 437,444,451,452 However, the impact of survival on physical function has received little attention; when compared with age and gender-matched populations, reduced physical functioning has been reported in survivors at 3-months, 453 6-months, 452 12months, 434 and three years. 451 Almost half of survivors report limitations because of physical difficulties at 6-months, 452 with up to 40% describing mobility problems 434,439,444,454 and limitations in usual activities at 12-months. 434,444,454 After discharge, most survivors are able to return home and only a small percentage (1À10%) need to be admitted to a long-term care facility. ...
Article
The European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM) have collaborated to produce these post-resuscitation care guidelines for adults, which are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. The topics covered include the post-cardiac arrest syndrome, diagnosis of cause of cardiac arrest, control of oxygenation and ventilation, coronary reperfusion, haemodynamic monitoring and management, control of seizures, temperature control, general intensive care management, prognostication, long-term outcome, rehabilitation, and organ donation.
... 147,160,161 In a Swiss study, only 29% of cardiac arrest survivors (n = 50) reported no complaints, 153 while in another study almost 43% of survivors (n = 442) at 6 months post-arrest reported their health as worse than one year ago. 162 It is of note that HRQoL has been reported to continue to improve for at least the first year after cardiac arrest. 159 The most prevalent patient-reported symptom after cardiac arrest is fatigue, reported by 50À71% of survivors. ...
... 167 After three months, emotional status was reported by different studies to be stable, 159 better, 168 or worse 151 compared with twelve months post-arrest. Emotional problems were more common in females, 168À170 younger patients, 162,164,168,170 those with cognitive problem, 170 and those with comorbidities. 168 Cardiac arrest survivors with hypoxic-ischaemic brain injury also have an increased risk of emotional problems, 171 but as these patients are often missing from analyses, the frequency of emotional problems in cardiac arrest survivors may be underestimated. ...
... 175,178 Physical problems after cardiac arrest have received limited attention but results from HRQoL measurement show that many cardiac arrest survivors report physical problems. 158,162,175,179 Half of cardiac arrest survivors described problems working or performing other activities because of physical problems, 162 and 30À50% reported problems with physical health, 175 physical function, 162 or mobility. 159,161,169 Physical problems are more common in older survivors 162,175 and females. ...
Article
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In this section of the European Resuscitation Council Guidelines 2021, key information on the epidemiology and outcome of in and out of hospital cardiac arrest are presented. Key contributions from the European Registry of Cardiac Arrest (EuReCa) collaboration are highlighted. Recommendations are presented to enable health systems to develop registries as a platform for quality improvement and to inform health system planning and responses to cardiac arrest.
... In most studies, the mean or median values of the HRQOL scores at 6-12 months from ROSC were not different from those of the comparable population norm [65,[73][74][75]. However, up to 55% of patients reported a decrease in their HRQOL post-arrest [75,76] most often because of limitations in their work or other daily activities as a result of physical or emotional problems [76]. The rates of anxiety and depression are usually similar to these of the population norm [65,77,78], while fatigue is very common. ...
... In most studies, the mean or median values of the HRQOL scores at 6-12 months from ROSC were not different from those of the comparable population norm [65,[73][74][75]. However, up to 55% of patients reported a decrease in their HRQOL post-arrest [75,76] most often because of limitations in their work or other daily activities as a result of physical or emotional problems [76]. The rates of anxiety and depression are usually similar to these of the population norm [65,77,78], while fatigue is very common. ...
... Recent studies [65,[75][76][77]79] have consistently reported that females have a significantly worse HRQOL after cardiac arrest than males. This difference persisted even after adjustment for major confounders. ...
Article
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Post-cardiac arrest brain injury (PCABI) is caused by initial ischaemia and subsequent reperfusion of the brain following resuscitation. In those who are admitted to intensive care unit after cardiac arrest, PCABI manifests as coma, and is the main cause of mortality and long-term disability. This review describes the mechanisms of PCABI, its treatment options, its outcomes, and the suggested strategies for outcome prediction.
... Most studies have reported limited aspects on health, often based on composite scores. A few studies have performed a more detailed analysis, identifying health problems especially in physical and psychological dimensions [7,14]. However, since these studies have included selective groups of participants, e.g. ...
... However, since these studies have included selective groups of participants, e.g. OHCA survivors treated with targeted temperature management (TTM) [14] or with an implantable cardioverter defibrillator (ICD) [7], the results may not be transferable to the CA survivors in general. Additionally, aspects of social health and satisfaction of life are seldom considered. ...
... No other differences in relation to place of arrest were detected using EQ-5D-5L (Fig. 1). Suggested presence of mood disorder (8-10), n (%) 25 (11.8) 13 (9.6) 12 (16) Probable presence of mood disorder (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21), n (%) 13 (6.2) 9 (6.6) 4 (5. The median value of HI total score was 29 (IQR = 5). ...
Article
Full-text available
Background Self-reported health and life satisfaction are considered important outcomes in people surviving cardiac arrest. However, most previous studies have reported limited aspects on health, often based on composite scores, and few studies have focused on life satisfaction. Investigating health aspects with a broad and detailed perspective is important to increase the knowledge of life after cardiac arrest from the perspective of survivors. In addition, the knowledge of potential differences in health among survivors related to place of arrest (in-hospital cardiac arrest; IHCA or out-of-hospital cardiac arrest; OHCA) is scarce. The aim was to describe and compare self-reported health and life satisfaction in IHCA and OHCA survivors. Methods This observational cross-sectional study included adult cardiac arrest survivors six months after resuscitation, treated at five Swedish hospitals between 2013 and 2018. Participants received a study specific questionnaire including Health Index (HI), EQ-5D 5 Levels (EQ-5D-5L), Minimal Insomnia Sleeping Scale (MISS), Multidimensional Scale of Perceived Social Support (MSPSS), Hospital Anxiety and Depression Scale (HADS), and Satisfaction With Life Scale (SWLS). In order to present characteristics descriptive statistics were applied. The Mann-Whitney U test, chi-square test or Fishers’ exact test were used to compare differences in self-reported health and life satisfaction between in-hospital- and out-of-hospital cardiac arrest survivors Results In total, 212 survivors participated. Based on scale scores and general measures, the median scores of health and life satisfaction among survivors were high: HI total = 29, EQ VAS = 80, and SWLS = 20. According to HI, most problems were reported for tiredness (37.3 %) and strength (26.4 %), while pain/discomfort (57.5 %) and anxiety/depression (42.5 %) where most common according to EQ-5D-5L. Except for EQ-5D-5L mobility ( p = 0.023), MSPSS significant other ( p = 0.036), and MSPSS family ( p = 0.043), no health differences in relation to place of arrest were identified. Conclusions Although general health and life satisfaction were good among cardiac arrest survivors, several prevalent health problems were reported regardless of place of arrest. To achieve an improved understanding of health in cardiac arrest survivors, it is important to assess specific symptoms as a complement to composite scores of general, physical, emotional, and social health.
... Von Müdigkeit wird ebenfalls häufig berichtet, diese tritt nach 6 Monaten bei etwa 70 % der Überlebenden auf und besteht ein Jahr nach dem Ereignis bei der Hälfte der Überlebenden [446,451,452]. Über körperliche Probleme, einschließlich Rippenfrakturen, Muskelschwäche und Gehschwierigkeiten, wurde ebenfalls berichtet [439,446,453,454]. Der Einfluss des Überlebens auf die körperliche Funktion hat jedoch bisher wenig Beachtung gefunden. ...
... Der Einfluss des Überlebens auf die körperliche Funktion hat jedoch bisher wenig Beachtung gefunden. Im Vergleich zu alters-und geschlechtsentsprechenden Bevölkerungsgruppen wurde bei Überlebenden nach 3 Monaten [455], nach 6 Monaten [454], nach 12 Monaten [436] und 3 Jahren von einer verminderten körperlichen Funktionsfähigkeit berichtet [453]. Fast die Hälfte der Überlebenden gibt Einschränkungen aufgrund körperlicher Schwierigkeiten nach 6 Monaten an [454], wobei bis zu 40 % Mobilitätsprobleme beschreiben und Einschränkungen bei üblichen Aktivitäten nach 12 Monaten [436,446,456]. ...
... Im Vergleich zu alters-und geschlechtsentsprechenden Bevölkerungsgruppen wurde bei Überlebenden nach 3 Monaten [455], nach 6 Monaten [454], nach 12 Monaten [436] und 3 Jahren von einer verminderten körperlichen Funktionsfähigkeit berichtet [453]. Fast die Hälfte der Überlebenden gibt Einschränkungen aufgrund körperlicher Schwierigkeiten nach 6 Monaten an [454], wobei bis zu 40 % Mobilitätsprobleme beschreiben und Einschränkungen bei üblichen Aktivitäten nach 12 Monaten [436,446,456]. ...
Article
The European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM) have collaborated to produce these post-resuscitation phase guidelines for adults, which are based on the 2020 International Liaison Committee on Resuscitation consensus on cardiopulmonary resuscitation.The topics covered include post-cardiac arrest syndrome, the differential diagnosis of the causes of cardiac arrest, control of oxygenation and ventilation, coronary reperfusion, haemodynamic monitoring and management, control of seizures, temperature control, general intensive care management, prognostication, long-term outcome, rehabilitation and organ donation.
... Trotzdem zeigten detaillierte Analysen, dass mehrere HRQoL-Subdomänen bei Überlebenden nach Kreislaufstillstand schlechter sind, und symptomspezifische Fragebögen zeigen, dass nuancierte kardiale, kognitive, physische und emotionale Probleme häufig sind [148,161,162]. IneinerSchweizerStudie gaben nur 29 % der Überlebenden nach Kreislaufstillstand (n = 50) keine Beschwerden an [154], in einer anderen Studie beschrieben fast 43 % der Überlebenden (n = 442) 6 Monate nach ihrem Kreislaufstillstand, dass ihr Gesundheitszustand schlechter sei als vor einem Jahr [163]. Es ist anzumerken, dass sich die HRQoL mindestens im ersten Jahr nach dem Kreislaufstillstand weiter verbessert [160]. ...
... Ein weiteres häufig von Patienten berichtetes Ergebnis sind emotionale Probleme, die in den ersten Wochen nach dem Kreislaufstillstand am schwerwiegendsten [160,166,167] und mit einer schlechteren HRQoL verbunden sind [168]. Nach drei Monaten wurde der emotionale Status in verschiedenen Studien als stabil gemeldet [160], besser [169] oder schlimmer [152] im Vergleich zu zwölf Monate nach dem Kreislaufstillstand. Emotionale Probleme waren häufiger bei Frauen [169][170][171], jüngeren Patienten [163,165,169,171], bei Patienten mit kognitiven Problemen [171] und solchen mit Komorbiditäten [169]. ...
... Körperliche Probleme nach Kreislaufstillstand haben nur begrenzte Aufmerksamkeit erhalten, aber die Ergebnisse der HRQoL-Messung zeigen, dass viele Überlebende nach Kreislaufstillstand über körperliche Probleme berichten [159,163,176,180]. Die Hälfte der Überlebenden nach Kreislaufstillstand beschrieb Probleme beim Arbeiten oder Ausführen anderer Aktivitäten aufgrund körperlicher Probleme [163], und 30-50 % berichteten von Problemen mit körperlicher Gesundheit [176], körperlicher Funktion [163] oder Mobilität [160,162,170]. ...
Article
In this section of the European Resuscitation Council Guidelines 2021, key information on the epidemiology and outcome of in- and out-of-hospital cardiac arrest are presented. Key contributions from the European Registry of Cardiac Arrest (EuReCa) collaboration are highlighted. Recommendations are presented to enable health systems to develop registries as a platform for quality improvement and to provide support for health system planning and responses to cardiac arrest.
... Fatigue is also frequently reported and is present in approximately 70% of the survivors at 6 months and remains in half of the survivors 1 year after the event [444,449,450]. Physical problems, including rib fractures, muscle weakness and ambulation difficulties, have also been reported [437,444,451,452]. However, the impact of survival on physical function has received little attention; when compared with age and gendermatched populations, reduced physical functioning has been reported in survivors at 3 months [453], 6 months [452], 12 months [434] and 3 years [451]. ...
... Physical problems, including rib fractures, muscle weakness and ambulation difficulties, have also been reported [437,444,451,452]. However, the impact of survival on physical function has received little attention; when compared with age and gendermatched populations, reduced physical functioning has been reported in survivors at 3 months [453], 6 months [452], 12 months [434] and 3 years [451]. Almost half of survivors report limitations because of physical difficulties at 6 months [452], with up to 40% describing mobility problems [434,439,444,454] and limitations in usual activities at 12 months [434,444,454]. ...
... However, the impact of survival on physical function has received little attention; when compared with age and gendermatched populations, reduced physical functioning has been reported in survivors at 3 months [453], 6 months [452], 12 months [434] and 3 years [451]. Almost half of survivors report limitations because of physical difficulties at 6 months [452], with up to 40% describing mobility problems [434,439,444,454] and limitations in usual activities at 12 months [434,444,454]. ...
Article
The European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM) have collaborated to produce these post-resuscitation care guidelines for adults, which are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. The topics covered include the post-cardiac arrest syndrome, diagnosis of cause of cardiac arrest, control of oxygenation and ventilation, coronary reperfusion, haemodynamic monitoring and management, control of seizures, temperature control, general intensive care management, prognostication, long-term outcome, rehabilitation and organ donation.
... The reported completion rate of HRQoL tools of approximately 67 % in the cardiac arrest population compares favourably with other studies, including well-resourced randomised controlled trials, although some studies have reported completion rates of around 90 %. 6,16,17 Evidence from both the wider literature and cardiac arrest literature indicates that individuals who complete HRQoL outcome tools are often systematically different to responders. 5,7,8,18 In cardiac arrest survivors, a key concern is that non-responders may be more likely to have neurological impairment than responders, and therefore experience a worse quality of life. ...
... 19,20 Contrasting the results of the Kimmoun et al. with that of Bohm et al. provides an insight in to the potential effect of including data from proxy responders. 1,17 In particular Bohm et al., who permitted proxy responses and thereby achieved a response rate of about 90 %, reported PCS and MCS values in cardiac arrest survivors that were markedly lower than those reported in the current study. ...
... Among the 2125 survivors, 1752 (82.5%) participated in the interviews, and adjusted odds ratios (ORs) (95% confidence intervals [CIs]) of females versus males for good functional recovery, living at home without care, the EuroQol-5D (EQ-5D) index score of 1 unit increase, the 12-Item Short Form First, Bohm et al. also reported the risk of OHCA survivors with special reference to sex and age by 6-months follow-up. 2 Healthrelated quality of life (HRQoL) scores in females were significantly lower than those in males. Patients with age 65 years presented significantly better score in Physical Functioning, but presented significantly worse scores in Vitality and Mental Health. ...
... 29 However, using the SF-36, our CA population had a similar HRQOL to those previously reported in CA patients. 6,11,30,31 No comparison of HRQOL has been published to date between CA and non-CA patients discharged from ICU. Furthermore, our study shows that physical capacities are consistently better in CA compared to non-CA patients for all studied time points. ...
Article
Objective: While cardiac arrest (CA) patients discharged alive from intensive care unit (ICU) are considered to have good one-year survival but potential neurological impairment, comparisons with other ICU sub-populations non-admitted for CA purpose are still lacking. This study aimed to compare long-term outcome and health-related quality of life (HRQOL) between CA patients and patients admitted to ICU for all other causes. Methods: In 1635 patients discharged alive from 21 European ICUs in an ancillary analysis of a prospective multicentric cohort, we compared CA causes of ICU admission to all other causes of ICU admissions (named non-CAs). The primary endpoint was one-year survival rate after ICU discharge. Secondary endpoints included HRQOL at 3, 6 and 12 months after ICU discharge using the outcome survey short form-36 (SF36). Propensity score matching was used to consider the probability of having CA. Results: Of the 1635 patients, 1561 were included in this study comprised of 1447 non-CAs and 114 CAs. At one-year in the non-matched population, survival rate was greater in the CA group 89% versus the non-CA group 78% (log rank p = 0.0056). In the matched population, this difference persisted between CAs and non-CAs (log rank p = 0.049). The physical component summary of the SF36 scale was higher in the CA group than in the non-CA group at all time points in both non-matched and matched populations. Conclusions: CA patients discharged alive from ICU have a better one-year survival and a better HRQOL specifically on physical functions than patients admitted to ICU for other causes. Trial registration: ClinicalTrials.gov NCT01367093; registered on June 6, 2011.
... Recent studies had shown that OHCA survivors tended to experience cognitive and emotional issues. [29][30][31] Since NH residents were often admitted from a lack of social support, further study is needed on the cognitive and emotional needs of this population. Local studies had also found that ACP was often undertaken in acute hospitals. ...
Article
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Introduction: Nursing home (NH) residents with out-of-hospital cardiac arrests (OHCA) have unique resuscitation priorities. This study aimed to describe OHCA characteristics in NH residents and identify independent predictors of survival. Materials and methods: OHCA cases between 2010-16 in the Pan-Asian Resuscitation Outcomes Study were retrospectively analysed. Patients aged <18 years old and non-emergency cases were excluded. Primary outcome was survival at discharge or 30 days. Good neurological outcome was defined as a cerebral performance score between 1-2. Results: A total of 12,112 cases were included. Of these, 449 (3.7%) were NH residents who were older (median age 79 years, range 69-87 years) and more likely to have a history of stroke, heart and respiratory diseases. Fewer NH OHCA had presumed cardiac aetiology (62% vs 70%, P <0.01) and initial shockable rhythm (8.9% vs 18%, P <0.01), but had higher incidence of bystander cardiopulmonary resuscitation (74% vs 43%, P <0.01) and defibrillator use (8.5% vs 2.8%, P <0.01). Non-NH (2.8%) residents had better neurological outcomes than NH (0.9%) residents (P <0.05). Factors associated with survival for cardiac aetiology included age <65 years old, witnessed arrest, bystander defibrillator use and initial shockable rhythm; for non-cardiac aetiology, these included witnessed arrest (adjusted odds ratio [AOR] 3.8, P <0.001) and initial shockable rhythm (AOR 5.7, P <0.001). Conclusion: Neurological outcomes were poorer in NH survivors of OHCA. These findings should inform health policies on termination of resuscitation, advance care directives and do-not-resuscitate orders in this population.
... Bohm Q12 et al found the same results: they evaluated HR-QOL of Targeted Temperature Management (TTM) trial survivors 32 and found that, despite general HR-QOL reported acceptable by many survivors, it was impaired for many others. 33 The current study results agree with those findings and reinforce them: unlike previous studies, we explored HR-QOL at different times and found that HR-QOL remained stable throughout the study period. Whether HR-QOL could improve in those patients beyond M18 remains to be determined. ...
Article
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Background Long-term outcomes of awakened survivors of out-of-hospital cardiac arrest (OHCA) is poorly known. Research Question What are the month (M)-18 outcomes of survivors of out-of-hospital cardiac arrest (OHCA) who awakened during the first 2 weeks post-OHCA and their poor-outcome risk factors? Study Design and Methods: All OHCA survivors with Glasgow coma score ≥12 during the first 2 weeks post-OHCA were enrolled in six ICUs and followed at M3, M6, M12 and M18. The primary outcome measure was Glasgow outcome scale-extended (GOS-E) at M18. Secondary outcome measures included evaluation of neurological, behavioral and cognitive disabilities, health-related quality of life (HR-QOL), anxiety and depression, and poor-outcome risk factors (GOS-E≤6) at M18. Results Among 139 included patients, 98 were assessable for the primary outcome measure. At M18, 64 (65%) had full recovery or minor disabilities (GOS-E>6), 18 (18%) had moderate disabilities but were autonomous for daily-life activities (GOS-E=6), 12 (12%) had poor autonomy (GOS-E<6 but >1) and 4 had died. Percentages of GOS-E>6 patients increased significantly over the 18-month study period. At M18, no patients had major neurological disabilities, 20% had cognitive disabilities, 32% had anxiety symptoms, 25% had depression symptoms, and their HR-QOL was impaired as compared to sex- and age-matched population. Low-flow time, Sequential Organ-Failure Assessment Score at admission, coma duration >3 days after CA or mechanical ventilation on days 3 and 7 were associated with poor functional outcome. Interpretation Among patients who awoke (GCS≥12) in the 14 days following OHCA, 35% had moderate-to-severe disabilities or had died at M18. Interestingly, patients improved until M18 post-OHCA. Risk factors associated with poor functional outcome were low-flow time, clinical severity at ICU admission, prolonged coma duration and mechanical ventilation.
... Bohm et al 32 found the same results: they evaluated HR-QOL of Targeted Temperature Management (TTM) trial survivors 33 and found that, despite general HR-QOL reported acceptable by many survivors, it was impaired for many others. 32 The current study results agree with those findings and reinforce them: unlike previous studies, we explored HR-QOL at different times and found that HR-QOL remained stable throughout the study period. Whether HR-QOL could improve in those patients beyond M18 remains to be determined. ...
... Another study on self-reported cardiacanxiety among CA-survivors showed that 11À15% avoid physical activities due to concerns about their heart 26 . Other factors related to physical activity are age and gender 24,27 . ...
Article
Full-text available
Aims The primary aim of this study is to investigate whether out-of-hospital cardiac arrest (OHCA) survivors have lower levels of self-reported physical activity compared to a non-cardiac arrest (CA) control group who had acute myocardial infarction (MI). Additional aims are to explore potential predictors of physical inactivity (older age, female gender, problems with general physical function, global cognition, mental processing speed/attention, anxiety symptoms, depression symptoms, kinesiophobia, fatigue), and to investigate the relationship between self-reported and objectively measured physical activity among OHCA-survivors. Methods The Targeted Hypothermia versus Targeted Normothermia after Out-of-Hospital Cardiac Arrest trial (TTM2-trial) collects information regarding age, gender, self-reported physical activity, general physical function, global cognition and mental processing speed/attention at 6 months after OHCA. In this TTM2-trial cross-sectional prospective sub-study, participants at selected sites are invited to an additional follow-up meeting within 4 weeks from the main study follow-up. At this meeting, information regarding anxiety symptoms, depression symptoms, kinesiophobia and fatigue is collected. The OHCA-survivors are then provided with an objective measure of physical activity, a hip-placed accelerometer, to wear for one week, together with a training diary. At the end of the week, participants are asked to once again answer two self-reported questions regarding physical activity for that specific week. MI-controls attend a single follow-up meeting and perform the same assessments as the OHCA-survivors, except from wearing the accelerometer. We aim to include 110 OHCA-survivors and 110 MI-controls in Sweden, Denmark and the United Kingdom. Conclusion The results from this sub-study will provide novel information about physical activity among OHCA-survivors. Trial registration Registered at ClinicalTrials.gov: NCT03543332, date of registration June 1, 2018
... 10 Importantly, PCS and MCS do not necessarily reflect all individual dimensions of SF-36, 31 indicating that conclusions relying on summary scores should be drawn with caution. 5 The presence of anxiety and depression was low among our patients. Mean HADS scores were comparable to the reference population, but with a trend towards a lower score for anxiety. ...
Article
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Background Health-related quality of life (HRQoL) is affected after out-of-hospital cardiac arrest (OHCA), but data several years after the arrest are lacking. We assessed long-term HRQoL in OHCA survivors and how known outcome predictors impact HRQoL. Methods In adult OHCA survivors, HRQoL was assessed five years post-arrest using Short-form 36 (SF-36), EQ-5D-3 L (EQ-5D) and Hospital Anxiety and Depression Scale (HADS) among others. Results were compared to the next of kins’ estimates and to a Norwegian reference population. Results Altogether 96 survivors were included mean 5.3 (range 3.6-7.2) years after OHCA. HRQoL compared well to the reference population, except for lower score for general health with 67.2 (95%CI (62.1; 72.3) vs. 72.9 (71.9; 74.0)), p = 0.03. Younger (≤58 years) vs. older survivors scored lower for general health with mean (SD) of 62.1 (27.5) vs. 73.0 (19.5), p = 0.03, vitality (55.2 (20.5) vs. 64.6 (17.3), p = 0.02, social functioning (75.3 (28.7) vs. 94.1 (13.5), p < 0.001 and mental component summary (49.0 (9.9) vs. 55.8 (6.7), p < 0.001. They scored higher for HADS-anxiety (4.8 (3.6 vs. 2.7 (2.5), p = 0.001, and had lower EQ-5D index (0.72 (0.34) vs. 0.84 (0.19), p = 0.04. Early vs. late awakeners had higher EQ-5D index (0.82 (0.23) vs. 0.71 (0.35), p = 0.04 and lower HADS-depression scores (2.5 (2.9) vs. 3.8 (2.3), p = 0.04. Next of kin estimated HRQoL similar to the survivors´ own estimates. Conclusions HRQoL five years after OHCA was good and mainly comparable to a matched reference population. Stratified analyses revealed impaired HRQoL among younger survivors and those awakening late, mainly for mental domains.
... 7 However, if and how HRQoL changes over longer time periods is more uncertain. While two studies showed impaired HRQoL six and 18 months after out-of-hospital cardiac arrest (OHCA), 8,9 we recently showed that HRQoL was comparable to an age-and gender-matched population five years after OHCA. 10 These differences could be explained by different treatment strategies, evaluation methods, outcome parameters or, primarily, different cohorts. Given the increasing life expectancy for CA survivors, 11 information about long-term prognosis regarding health status and HRQoL is of crucial importance for patients, their relatives, and health care workers. ...
Article
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Background Brain injury in out-of-hospital cardiac arrest (OHCA) survivors affects health status and health-related quality of life (HRQoL). It is unknown how HRQoL evolves over time, and assessments at different time points may lead to different results. Methods In a NORCAST sub study, OHCA survivors eligible for health status (EQ-5D-3L) and HRQoL (SF-36) assessments were examinated six months and five years after OHCA. At five-year follow-up, survivors also retrospectively assessed their health status for each consecutive year following OHCA. The next of kin independently assessed health status and HRQoL of their respective OHCA survivors. Results Among 138 survivors alive after six months and 117 after five years, 80 (88% male) completed both follow-ups. Health status and HRQoL remained stable over time, except for increasing SF-36 mental summary score and decreasing physical functioning and physical component score. Anxiety and depression levels were generally low, although younger survivors stated more anxiety than older survivors. Retrospective assessment showed reduced health status for the first two years, which increased only from the third year. Explorative analyses revealed that younger age, longer time to return of spontaneous circulation (tROSC) and late awakening affected health status, particularly in the first two years post-arrest. Conclusions OHCA survivors showed stable health status and HRQoL with only minor differences between six months and five years. Younger survivors with long tROSC, late awakening, and more anxiety and depression symptoms at six months, had reduced health status the first two years with significant improvements towards the fourth year.
... Out-of-hospital cardiac arrest (OHCA) survivors generally report a good or acceptable health-related quality of life (HRQoL) using questionnaires. [1][2][3][4][5][6] Compared to other health domains physical aspects seem to be more affected, 2 but so far limitations in physical function after surviving OHCA have received little attention. 7,8 Hypoxic-ischemic brain injury increases the risk for long-term physical, cognitive, and emotional problems as well as fatigue in OHCA survivors. ...
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Title Self-reported limitations in physical function are common 6 months after out-of-hospital cardiac arrest. Background Out-of-hospital cardiac arrest (OHCA) survivors generally report good health-related quality of life, but physical aspects of health seem more affected than other domains. Limitations in physical function after surviving OHCA have received little attention. Aims To describe physical function 6 months after OHCA and compare it with a group of ST elevation myocardial infarction (STEMI) controls, matched for country, age, sex and time of the cardiac event. A second aim was to explore variables potentially associated with self-reported limitations in physical function in OHCA survivors. Methods A cross-sectional sub-study of the Targeted Temperature Management at 33 °C versus 36 °C (TTM) trial with a follow-up 6 months post-event. Physical function was the main outcome assessed with the self-reported Physical Functioning-10 items scale (PF-10). PF-10 is presented as T-scores (0–100), where 50 represents the norm mean. Scores <47 at a group level, or <45 at an individual level indicate limitations in physical function. Results 287 OHCA survivors and 119 STEMI controls participated. Self-reported physical function by PF-10 was significantly lower for OHCA survivors compared to STEMI controls (mean 46.0, SD 11.2 vs. 48.8, SD 9.0, p = 0.025). 38% of OHCA survivors compared to 26% of STEMI controls reported limitations in physical function at an individual level (p = 0.022). The most predictive variables for self-reported limitations in physical function in OHCA survivors were older age, female sex, cognitive impairment, and symptoms of anxiety and depression after 6 months. Conclusion Self-reported limitations in physical function are more common in OHCA survivors compared to STEMI controls. Trial registration ClinicalTrials.gov Identifier: NCT01946932.
... Response rates vary markedly across trials. 288,308,309 A key concern is that respondents may be systematically different to non-respondents. 310 In cardiac arrest research, survivors with poor outcome are less likely to respond, leading to bias. ...
Article
These European Resuscitation Council Ethics guidelines provide evidence-based recommendations for the ethical, routine practice of resuscitation and end-of-life care of adults and children. The guideline primarily focus on major ethical practice interventions (i.e. advance directives, advance care planning, and shared decision making), decision making regarding resuscitation, education, and research. These areas are tightly related to the application of the principles of bioethics in the practice of resuscitation and end-of-life care.
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Background Approximately 100,000 patients suffer from sudden cardiac arrest (CA) annually in Germany. The causes for CA are cardiac in 75% of these cases. The present study aims to investigate the medical prehistory of patients who suffered from out-of-hospital cardiac arrest (OHCA) in a town with 250,000 inhabitants during 5 years and how many of these patients had already been previously treated at the local cardiac arrest center (CAC). Case presentation All resuscitations due to OHAC were retrospectively analyzed for the cause of OHCA, preexisting cardiac conditions and treatment, lay resuscitation, and outcome from January 1, 2012, to December 31, 2016, in Aachen, Germany. Data analysis was based on the resuscitation protocols and data from the CAC clinical information system. More than 50% of the patients with CA from cardiovascular origin were already known at the receiving respective CAC. Almost 60% of all patients already had cardiac preexisting conditions. Nevertheless, lay resuscitation occurred in only 34.1% of all cases. It was not performed in more than 60% although the probability of discharge can be significantly increased by lay resuscitation. Conclusion The rate of lay resuscitation is relatively low although many patients suffering from CA have cardiac preexisting conditions. These findings show the importance of better priming their relatives for emergencies to improve lay resuscitation and improve the chances for a better outcome.
Article
These European Resuscitation Council Ethics guidelines provide evidence-based recommendations for the ethical, routine practice of resuscitation and end-of-life care of adults and children. The guideline primarily focus on major ethical practice interventions (i.e. advance directives, advance care planning, and shared decision making), decision making regarding resuscitation, education, and research. These areas are tightly related to the application of the principles of bioethics in the practice of resuscitation and end-of-life care.
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Aims To describe burden and health-related quality of life amongst caregivers of out-of-hospital cardiac arrest survivors and explore the potential association with cognitive function of the survivors. Caregivers of patients with ST-elevation myocardial infarction were used as controls. Methods Data were collected from the cognitive substudy of the Targeted Temperature Management-trial. Caregiver burden was assessed with the 22-item Zarit Burden Interview, with scores ≤20 considered as no burden. Health-related quality of life was assessed with the SF-36v2®, with T-scores 47-53 representing the norm. Cardiac arrest survivors were categorized based on the results from cognitive assessments as having “no cognitive impairment” or “cognitive impairment”. Results Follow-up 6 months post event was performed for caregivers of 272 cardiac arrest survivors and 108 matched myocardial infarction controls, included at an intended ratio of 2:1. In general, caregivers of cardiac arrest survivors and controls reported similar caregiver burden. The overall scores for quality of life were within normative levels and similar for caregivers of cardiac arrest survivors and control patients. Compared to those with no cognitive impairment, caregivers of cognitively impaired cardiac arrest survivors (n=126) reported higher levels of burden (median 18 versus 8, p<0.001) and worse quality of life in five of eight domains, particularly “Role-Emotional” (mean 45.7 versus 49.5, p=0.002). Conclusions In general, caregivers of cardiac arrest survivors and myocardial infarction controls reported similar levels of burden and quality of life. Cognitive outcome and functional dependency of the cardiac arrest survivor impact burden and quality of life of the caregiver.
Article
As more people are surviving cardiac arrest, focus needs to shift towards improving neurological outcomes and quality of life in survivors. Brain injury after resuscitation, a common sequela following cardiac arrest, ranges in severity from mild impairment to devastating brain injury and brainstem death. Effective strategies to minimise brain injury after resuscitation include early intervention with cardiopulmonary resuscitation and defibrillation, restoration of normal physiology, and targeted temperature management. It is important to identify people who might have a poor outcome, to enable informed choices about continuation or withdrawal of life-sustaining treatments. Multimodal prediction guidelines seek to avoid premature withdrawal in those who might survive with a good neurological outcome, or prolonging treatment that might result in survival with severe disability. Approximately one in three admitted to intensive care will survive, many of whom will need intensive, tailored rehabilitation after discharge to have the best outcomes.
Article
More patients are surviving cardiac arrest than ever before; however, the burden now lies with estimating neurological prognoses in a large number of patients who were initially comatose, in whom the ultimate outcome is unclear. Neurologists, neurointensivists, and clinical neurophysiologists must accurately balance the concern that overly conservative prognostication could leave patients in a severely disabled state, with the possibility that inaccurately pessimistic prognostication could lead to the withdrawal of life-sustaining treatment in patients who might otherwise have a good functional outcome. Prognostic tools have improved greatly, including electrophysiological tests, neuroimaging, and chemical biomarkers. Conclusions about the prognosis should be delayed at least 72 h after arrest to allow for the clearance of sedative drugs. Cognitive impairments, emotional problems, and fatigue are common among patients who have survived cardiac arrest, and often go unrecognised despite being related to caregiver burden and a decreased participation in society. Through simple screening, these problems can be identified, and patients can be provided with adequate information and rehabilitation.
Article
Introduction: Following cardiac arrest, return of spontaneous circulation (ROSC) in patients may be followed by spontaneous neurological recovery, which may decrease the potential adverse effects of treatments in post-cardiac arrest care, including those of Targeted Temperature Management (TTM). We investigated the percentage of post-arrest patients who experienced spontaneous neurological recovery, and the characteristics and neurological outcomes of these patients. Methods: A total of 540 patients with ROSC were retrospectively enrolled in this single-center observational study. The patients' motor responses were documented immediately and at 3 hours following ROSC. Predictors of spontaneous neurological recovery were assessed by multiple logistic regression analysis. Results: A total of 221 patients (41%) showed a change in their GCS (Glasgow Coma Score) M score (motor score) during the 3-h interval following ROSC, with improvement evident in 215 patients. Among 96 patients with GCS M6 at 3 hours, 83 (86%) were discharged with a favorable neurological outcome. GCS M6 at 3 hours post ROSC, was an independent predictor for a favorable neurological outcome, but GCS M6 at ROSC was not. There were four factors predicting the GCS M6 at 3 hours; including in-hospital cardiac arrest (OR 3.057; 95% CI: 1.370-6.824, P = 0.006); bystander CPR (OR 13.311; 95% CI: 6.455-27.447, P < 0.0001); the CPR duration (OR, 0.941; 95% CI: 0.91-0.974; P < 0.0001), and the initial shockable rhythm (OR, 4.41; 95% CI: 2.44 -7.95; P < 0.0001). Conclusions: A significant portion of patients had spontaneous neurological recovery to GCS M6 within 3 hours post ROSC, and had a favorable neurological outcome. Close monitoring of GCS and later initiation of TTM should be considered in those patients with a substantial likelihood of neurological recovery.
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Aim: The aim of this systematic review was to assess the effectiveness of rehabilitation interventions on the secondary physical, neurological and psychological consequences of cardiac arrest (CA) for adult survivors. Methods: A literature search of electronic databases (MEDLINE, Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica database, Psychological Information Database, Web of Science and Cochrane Central Register of Controlled trials) was conducted for randomised controlled trials (RCTs) and observational studies up to 18 April 2021. The primary outcome was health-related quality of life (HRQoL) and main secondary outcome was neurological function with additional secondary outcomes being survival, rehospitalisation, safety (serious and non-serious adverse events), psychological well-being, fatigue, exercise capacity and physical capacity. Two authors independently screened studies for eligibility, extracted data and assessed risk of bias. Results: Three RCTs and 11 observational studies were included (total 721 participants). Study duration ranged from 8 weeks to 2 years. Pooled data from two RCTs showed low-quality evidence for no effect on physical HRQoL (standardised mean difference (SMD) 0.19, (95% CI: -0.09 to 0.47)) and no effect on mental HRQoL (SMD 0.27 (95% CI: -0.01 to 0.55)).Regarding secondary outcomes, very low-quality evidence was found for improvement in neurological function associated with inpatient rehabilitation for CA survivors with acquired brain injury (SMD 0.71, (95% CI: 0.45 to 0.96)) from five observational studies. Two small observational studies found exercise-based rehabilitation interventions to be safe for CA survivors, reporting no serious or non-serious events. Conclusions: Given the overall low quality of evidence, this review cannot determine the effectiveness of rehabilitation interventions for CA survivors on HRQoL, neurological function or other included outcomes, and recommend further high-quality studies be conducted. In the interim, existing clinical guidelines on rehabilitation provision after CA should be followed to meet the high burden of secondary consequences suffered by CA survivors. Prospero registration number: CRD42018110129.
Article
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Importance: Data on long-term survival beyond 12 months after out-of-hospital cardiac arrest (OHCA) of a presumed cardiac cause are scarce. Objective: To investigate the long-term survival of adult patients after surviving the initial hospital stay for an OHCA. Data Sources: A systematic search of the EMBASE and MEDLINE databases was performed from database inception to March 25, 2021. Study Selection: Clinical studies reporting long-term survival after OHCA were selected based on predefined inclusion and exclusion criteria according to a preregistered study protocol. Data Extraction and Synthesis: Patient data were reconstructed from Kaplan-Meier curves using an iterative algorithm and then pooled to generate survival curves. As a separate analysis, an aggregate data meta-analysis was performed. Main Outcomes and Measures: The primary outcome was long-term survival (>12 months) after OHCA for patients surviving to hospital discharge or 30 days after OHCA. Results: The search identified 15 347 reports, of which 21 studies (11 800 patients) were included in the Kaplan-Meier–based meta-analysis and 33 studies (16 933 patients) in an aggregate data meta-analysis. In the Kaplan-Meier–based analysis, the median survival time for patients surviving to hospital discharge was 5.0 years (IQR, 2.3-7.9 years). The estimated survival rates were 82.8% (95% CI, 81.9%-83.7%) at 3 years, 77.0% (95% CI, 75.9%-78.0%) at 5 years, 63.9% (95% CI, 62.3%-65.4%) at 10 years, and 57.5% (95% CI, 54.8%-60.1%) at 15 years. Compared with patients with a nonshockable initial rhythm, patients with a shockable rhythm had a lower risk of long-term mortality (hazard ratio, 0.30; 95% CI, 0.23-0.39; P < .001). Different analyses, including an aggregate data meta-analysis, confirmed these results. Conclusions and Relevance: In this comprehensive systematic review and meta-analysis, long-term survival after 10 years in patients surviving the initial hospital stay after OHCA was between 62% and 64%. Additional research is needed to understand and improve the long-term survival in this vulnerable patient population.
Article
Purpose of review: Accurate and relevant assessment is essential to determining the impact of ill-health and the relative benefit of healthcare. This review details the recent development of a core outcome set for cardiac arrest effectiveness trials - the COSCA initiative. Recent findings: The reported heterogeneity in outcome assessment and a lack of outcome reporting guidance were key triggers for the development of the COSCA. The historical failure of existing research to adequately capture the perspective of survivors and their family members in defining survival is described. Working collaboratively with international stakeholders - including survivors, family members and advocates - as research partners and participants ensured that a range of perspectives were considered throughout all stages of COSCA development. Three core domains and methods of assessment were recommended: survival - at 30 days or hospital discharge; neurological function assessed at 30 days or hospital discharge with the modified Rankin Scale; and health-related quality of life assessed at 90 days (as a minimum) with one of three generic measures. Summary: The COSCA recommendation describes a small group of outcomes that should be reported as a minimum across large, randomized clinical effectiveness trials for cardiac arrest.
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Background: A cardiac arrest can lead to hypoxic brain injury, which can affect all levels of functioning. Objective: To investigate 1-year outcome and the pattern of recovery after surviving a cardiac arrest. Methods: This was a multicenter, prospective longitudinal cohort study with 1 year of follow-up (measurements 2 weeks, 3 months, 1 year). On function level, physical/cardiac function (New York Heart Association Classification), cognition (Cognitive Log [Cog-log], Cognitive Failures Questionnaire), emotional functioning (Hospital Anxiety and Depression Scale, Impact of Event Scale), and fatigue (Fatigue Severity Scale) were assessed. In addition, level of activities (Frenchay Activities Index, FAI), participation (Community Integration Questionnaire [CIQ] and return to work), and quality of life (EuroQol 5D, EuroQol Visual Analogue Scale, SF-36, Quality of Life after Brain Injury) were measured. Results: In this cohort, 141 cardiac arrest survivors were included. At 1 year, 14 (13%) survivors scored below cutoff on the Cog-log. Both anxiety and depression were present in 16 (15%) survivors, 29 (28%) experienced posttraumatic stress symptoms and 55 (52%), severe fatigue. Scores on the FAI and the CIQ were, on average, respectively 96% and 92% of the prearrest scores. Of those previously working, 41 (72%) had returned to work. Most recovery of cognitive function and quality of life occurred within the first 3 months, with further improvement on some domains of quality of life up to 12 months. Conclusions: Overall, long-term outcome in terms of activities, participation, and quality of life after cardiac arrest is reassuring. Nevertheless, fatigue is common; problems with cognition and emotions occur; and return to work can be at risk.
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Aim: Survivors of out-of-hospital cardiac arrest (OHCA) may experience psychological distress but the actual prevalence is unknown. The aim of this study was to investigate anxiety and depression within a large cohort of OHCA-survivors. Methods: OHCA-survivors randomized to targeted temperature of 33°C or 36°C within the Target Temperature Management trial (TTM-trial) attended a follow-up after 6 months that included the questionnaire Hospital Anxiety and Depression Scale (HADS). A control group with ST-elevation myocardial infarction (STEMI) completed the same follow-up. Correlations to variables assumed to be associated with anxiety and depression in OHCA-survivors were tested. Results: At follow-up 278 OHCA-survivors and 119 STEMI-controls completed the HADS where 24% of OHCA-survivors (28% in the 33°C group/22% in the 36°C group, p=0.83) and 19% of the STEMI-controls reported symptoms of anxiety (OR 1.32; 95% CI (0.78-2.25), p=0.30). Depressive symptoms were reported by 13% of OHCA-survivors (equal in both intervention groups, p=0.96) and 8% of STEMI-controls (OR 1.76, 95% CI (0.82-3.79), p=0.15). Anxiety and depression among OHCA-survivors correlated to Health-Related Quality-of-Life, and subjectively reported cognitive deterioration by patient or observer. In addition, depression was associated with a poor neurological outcome. Conclusion: One fourth of OHCA-survivors reported symptoms of anxiety and/or depression at six months which was similar to STEMI-controls and previous normative data. Subjective cognitive problems were associated with an increased risk for psychological distress. Since psychological distress affect long-term prognosis of cardiac patients in general it should be addressed during follow-up of survivors with OHCA due to a cardiac cause. ClinicalTrials.gov NCT01020916/NCT01946932.
Article
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There is growing interest in the long-term outcomes of patients surviving out-of-hospital cardiac arrest (OHCA). This paper aims to summarise the available literature on the long-term cognitive, health-related quality of life (QoL) and mental health outcomes of survivors of OHCA. Between 30% and 50% of survivors of OHCA experience cognitive deficits for up to several years post-discharge. Deficits of attention, declarative memory, executive function, visuospatial abilities and verbal fluency are commonly reported. Survivors of OHCA appear to report high rates of mental illness, with up to 61% experiencing anxiety, 45% experiencing depression and 27% experiencing post-traumatic stress. Fatigue appears to be a commonly reported long-term outcome for survivors of OHCA. Investigations of long-term QoL for these patients have produced mixed findings. Carers of survivors of OHCA report high rates of depression, anxiety and post-traumatic stress, with insufficient social and financial support. The heterogeneous range of instruments used to assess cognitive function and QoL prevent any clear conclusions being drawn from the available literature. The potential biases inherent in this patient population and the interaction between QoL, cognitive performance and mental health warrant further investigation, as does the role of post-discharge support services in improving long-term patient outcomes.
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For survivors of out-of-hospital cardiac arrest (OHCA) with good outcomes, it is not known whether and how health-related quality of life is affected by the cognitive impairments frequently observed in these patients. This study explores how neuropsychological tests of memory, exe-cutive and psychomotor functioning relate to the physical and mental aspects of health-related quality of life in functionally independent and community dwelling OHCA survivors discharged early from hospital. The study included 42 adult survivors (mean age 62 years, 38 males). Health-related quality of life was measured approximately 3 months post-OHCA with the Medical Outcome Study Short Form 36 (SF-36). Cognition was measured with established neuropsychological tests. Regression analyses were used to examine associations between neuropsychological domains and physical and mental health-related quality of life, respectively, when controlling for age, education and length of coma. The physical, but not the mental, component of the SF-36 was significantly worse than Norwegian population data. Neuropsychological tests showed frequent impairments most often in the memory domain. Worse psychomotor functioning was associated with worse physical health-related quality of life, whereas worse memory performance was associated with worse mental health-related quality of life. The cognitive impairments frequently reported in OHCA survivors with good outcomes may compromise health-related quality of life. Cognitive functioning should be addressed even in survivors with rapid recovery.
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Background: Unconscious survivors of out-of-hospital cardiac arrest have a high risk of death or poor neurologic function. Therapeutic hypothermia is recommended by international guidelines, but the supporting evidence is limited, and the target temperature associated with the best outcome is unknown. Our objective was to compare two target temperatures, both intended to prevent fever. Methods: In an international trial, we randomly assigned 950 unconscious adults after out-of-hospital cardiac arrest of presumed cardiac cause to targeted temperature management at either 33°C or 36°C. The primary outcome was all-cause mortality through the end of the trial. Secondary outcomes included a composite of poor neurologic function or death at 180 days, as evaluated with the Cerebral Performance Category (CPC) scale and the modified Rankin scale. Results: In total, 939 patients were included in the primary analysis. At the end of the trial, 50% of the patients in the 33°C group (235 of 473 patients) had died, as compared with 48% of the patients in the 36°C group (225 of 466 patients) (hazard ratio with a temperature of 33°C, 1.06; 95% confidence interval [CI], 0.89 to 1.28; P=0.51). At the 180-day follow-up, 54% of the patients in the 33°C group had died or had poor neurologic function according to the CPC, as compared with 52% of patients in the 36°C group (risk ratio, 1.02; 95% CI, 0.88 to 1.16; P=0.78). In the analysis using the modified Rankin scale, the comparable rate was 52% in both groups (risk ratio, 1.01; 95% CI, 0.89 to 1.14; P=0.87). The results of analyses adjusted for known prognostic factors were similar. Conclusions: In unconscious survivors of out-of-hospital cardiac arrest of presumed cardiac cause, hypothermia at a targeted temperature of 33°C did not confer a benefit as compared with a targeted temperature of 36°C. (Funded by the Swedish Heart-Lung Foundation and others; TTM ClinicalTrials.gov number, NCT01020916.).
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In cardiac arrest patients (in hospital and pre hospital) does resuscitation produce a good Quality of Life (QoL) for survivors after discharge from the hospital? Embase, Medline, The Cochrane Database of Systematic Reviews, Academic Search Premier, the Central Database of Controlled Trials and the American Heart Association (AHA) Resuscitation Endnote Library were searched using the terms ('Cardiac Arrest' (Mesh) OR 'Cardiopulmonary Resuscitation' (Mesh) OR 'Heart Arrest' (Mesh)) AND ('Outcomes' OR 'Quality of Life' OR 'Depression' OR 'Post-traumatic Stress Disorder' OR 'Anxiety OR 'Cognitive Function' OR 'Participation' OR 'Social Function' OR 'Health Utilities Index' OR 'SF-36' OR 'EQ-5D' as text term. There were 9 inception (prospective) cohort studies (LOE P1), 3 follow up of untreated control groups in randomised control trials (LOE P2), 11 retrospective cohort studies (LOE P3) and 47 case series (LOE P4). 46 of the studies were supportive with respect to the search question, 17 neutral and 7 negative. The majority of studies concluded that QoL after cardiac arrest is good. This review demonstrated a remarkable heterogeneity of methodology amongst studies assessing QoL in cardiac arrest survivors. There is a requirement for consensus development with regard to quality of life and patient centred outcome assessment in this population.
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To study factors related to quality of life after a hypoxic period due to cardiac arrest. Retrospective cohort study. Eighty-eight survivors of out-of-hospital cardiac arrest, admitted to a Dutch academic hospital between 2001 and 2006. Patients received a set of questionnaires at home. The main outcome measures were physical and mental quality of life (Medical Outcomes Study 36-item Short Form Health Survey; SF-36). Potential determinants were cognitive complaints, emotional problems depression/anxiety), post-traumatic stress, fatigue, daily functioning and participation in society. Multiple linear regression analyses were performed with physical and mental quality of life as dependent variables. Sixty-three (72%) patients responded. Mean time since cardiac arrest was 36 months (standard deviation (SD) 19). Backward regression analyses showed that physical quality of life was significantly (p < 0.001, adjusted R2 = 0.531) related to cognitive complaints (beta = -0.378), instrumental daily life activities (beta = 0.262), post-traumatic stress (beta = -0.246) and fatigue (beta = -0.226). Mental quality of life was significantly (p < 0.001, adjusted R2 = 0.664) explained by anxiety/depression (beta = -0.609), fatigue (beta = -0.177) and cognitive complaints (beta = -0.175). Quality of life is related to cognitive complaints, fatigue, anxiety/depression, post-traumatic stress and difficulties in daily activities in survivors of out-of-hospital cardiac arrest. Rehabilitation programmes for this group should specifically address these topics.
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Standard scoring algorithms were recently made available for aggregating scores from the eight SF-36 subscales in two distinct, higher-order summary scores: Physical Component Summary (PCS) and Mental Component Summary (MCS). Recent studies have suggested, however, that PCS and MCS scores are not independent and may in part be measuring the same constructs. The aims of this paper were to examine and illustrate (1) relationships between SF-36 subscale and PCS, MCS scores, (2) relationships between PCS and MCS scores, and (3) their implications for interpreting research findings. Simulation analyses were conducted to illustrate the contributions of various aspects of the scoring algorithm to potential discrepancies between subscale profile and summary component scores. Using the Swedish SF-36 normative database, correlation and regression analyses were performed to estimate the relationship between the two components, as well as the relative contributions of the subscales to the components. Discrepancies between subscale profile and component scores were identified and explained. Significant correlations (r = -0.74, -0.67) were found between PCS and MCS scores at their respective upper scoring intervals, indicating that the components are not independent. Regression analyses revealed that in these ranges PCS primarily measures aspects of mental health (57% of variance) and MCS measures physical health (65% of variance). Implications of the findings were discussed. It was concluded that the current PCS MCS scoring procedure inaccurately summarizes subscale profile scores and should therefore be revised. Until then, component scores should be interpreted with caution and only in combination with profile scores.
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Recently, an increasing number of systematic reviews have been published in which the measurement properties of health status questionnaires are compared. For a meaningful comparison, quality criteria for measurement properties are needed. Our aim was to develop quality criteria for design, methods, and outcomes of studies on the development and evaluation of health status questionnaires. Quality criteria for content validity, internal consistency, criterion validity, construct validity, reproducibility, longitudinal validity, responsiveness, floor and ceiling effects, and interpretability were derived from existing guidelines and consensus within our research group. For each measurement property a criterion was defined for a positive, negative, or indeterminate rating, depending on the design, methods, and outcomes of the validation study. Our criteria make a substantial contribution toward defining explicit quality criteria for measurement properties of health status questionnaires. Our criteria can be used in systematic reviews of health status questionnaires, to detect shortcomings and gaps in knowledge of measurement properties, and to design validation studies. The future challenge will be to refine and complete the criteria and to reach broad consensus, especially on quality criteria for good measurement properties.
Article
Background: The aim of this study was to describe out-of-hospital cardiac arrest (OHCA) survivors' ability to participate in activities of everyday life and society, including return to work. The specific aim was to evaluate potential effects of cognitive impairment. Methods and results: Two hundred eighty-seven OHCA survivors included in the TTM trial (Target Temperature Management) and 119 matched control patients with ST-segment-elevation myocardial infarction participated in a follow-up 180 days post-event that included assessments of participation, return to work, emotional problems, and cognitive impairment. On the Mayo-Portland Adaptability Inventory-4 Participation Index, OHCA survivors (n=270) reported more restricted participation In everyday life and in society (47% versus 30%; P<0.001) compared with ST-segment-elevation myocardial infarction controls (n=118). Furthermore, 27% (n=36) of pre-event working OHCA survivors (n=135) compared with 7% (n=3) of pre-event working ST-segment-elevation myocardial infarction controls (n=45) were on sick leave (odds ratio, 4.9; 95% confidence interval, 1.4-16.8; P=0.01). Among the OHCA survivors assumed to return to work (n=135), those with cognitive impairment (n=55) were 3× more likely (odds ratio, 3.3; 95% confidence interval, 1.2-9.3; P=0.02) to be on sick leave compared with those without cognitive impairment (n=40; 36%, n=20, versus 15%, n=6). For OHCA survivors, the variables that were found most predictive for a lower participation were depression, restricted mobility, memory impairment, novel problem-solving difficulties, fatigue, and slower processing speed. Conclusions: OHCA survivors reported a more restricted societal participation 6 months post-arrest, and their return to work was lower compared with ST-segment-elevation myocardial infarction controls. Cognitive impairment was significantly associated with lower participation, together with the closely related symptoms of fatigue, depression, and restricted mobility. These predictive variables may be used during follow-up to identify OHCA survivors at risk of a less successful recovery that may benefit from further support and rehabilitation. Clinical trial registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01946932.
Article
Aim: High quality evidence of out-of-hospital cardiac arrest (OHCA) survivors' health-related quality of life (HRQoL) can measure the long-term impact of CA. The aim of this study was to critically appraise the evidence of psychometric quality and acceptability of measures used in the assessment of HRQoL in cardiac arrest survivors. Methods: Systematic literature searches (2004-2017) and named author searches to identify articles pertaining to the measurement of HRQoL. Data on study quality, measurement and practical properties were extracted and assessed against international standards. Results: From 356 reviewed abstracts, 69 articles were assessed in full. 25 provided evidence for 10 measures of HRQoL: one condition-specific; three generic profile measures; two generic index; and four utility measures. Although limited, evidence for measurement validity was strongest for the HUI3 and SF-36. However, evidence for reliability, content validity, responsiveness and interpretability and acceptability was generally limited or not available in the CA population for all measures. Conclusions: This review has demonstrated that a measure of quality of life specific to OHCA survivors is not available. Limited evidence of validity exists for one utility measure - the HUI3 - and a generic profile - the SF-36. Robust evidence of the quality and acceptability of HRQoL measures in OHCA was limited or not available. Future collaborative research must seek to urgently establish the relevance and acceptability of these measures to OHCA survivors, to establish robust evidence of essential measurement and practical properties over the short and long-term, and to inform future HRQoL assessment in the OHCA population.
Article
Aim: The aim was to describe fatigue-related problems reported by post-cardiac arrest adults with chronic fatigue and energy conservation strategies generated using an Energy Conservation plus Problem Solving Therapy intervention. Methods: Following an introduction to the intervention process outlined in a Participant Workbook, participants engaged in the telephone intervention by identifying one to two fatigue-related problems. They then brainstormed with the interventionist to identify potential strategies to reduce fatigue, tested them, and either modified the strategies or moved to the next problem over three to five sessions. Results: Eighteen cardiac arrest survivors with chronic fatigue identified instrumental activities of daily living and leisure activities as fatigue-related activities more frequently than basic activities of daily living. Energy Conservation strategies used most frequently were: plan ahead, pace yourself, delegate to others, and simplify the task. Conclusion: Post-cardiac arrest adults living in the community with chronic fatigue can return to previous daily activities by using energy conservation strategies such as planning ahead, pacing tasks, delegating tasks, and simplifying tasks.
Article
Aim: To describe health status and psychological distress among in-hospital cardiac arrest (IHCA) survivors in relation to gender. Methods: This national register study consists of data from follow-up registration of IHCA survivors 3-6 months post cardiac arrest (CA) in Sweden. A questionnaire was sent to the survivors, including measurements of health status (EQ-5D-5L) and psychological distress (HADS). Results: Between 2013 and 2015, 594 IHCA survivors were included in the study. The median values for EQ-5D-5L index and EQ VAS among survivors were 0.78 (q1-q3=0.67-0.86) and 70 (q1-q3=50-80) respectively. The values were significantly lower (p<0.001) in women compared to men. In addition, women reported more problems than men in all dimensions of EQ-5D-5L, except self-care. A majority of the respondents reported no problems with anxiety (85.4%) and/or symptoms of depression (87.0%). Women reported significantly more problems with anxiety (p<0.001) and symptoms of depression (p<0.001) compared to men. Gender was significantly associated with poorer health status and more psychological distress. No interaction effects for gender and age were found. Conclusions: Although the majority of survivors reported acceptable health status and no psychological distress, a substantial proportion reported severe problems. Women reported worse health status and more psychological distress compared to men. Therefore, a higher proportion of women may be in need of support. Health care professionals should make efforts to identify health problems among survivors and offer individualised support when needed.
Article
Introduction: Although a number of validated health-related quality of life (HR-QOL) instruments exist for critical care populations, a standardised approach to assessing the HR-QOL of out-of-hospital cardiac arrest (OHCA) survivors has not been developed. We sought to compare the responses of 12-month OHCA survivors to three instruments, and assess instrument validity in OHCA survivors. Methods: The Victorian Ambulance Cardiac Arrest Registry invited 12-month OHCA survivors to participate in telephone follow-up between January 2011 and December 2015. Responders provided answers to the 12 Item Short Form Health Survey (SF-12), Three-Level EuroQol-5D (EQ-5D-3L) and the Glasgow Outcome Scale-Extended (GOSE). The SF-12 was also used to derive the SF-6D. Responses were used to assess the interpretability and construct validity of the instruments. Results: A total of 1,188 patients and proxies responded. Large ceiling effects were observed for the EQ-5D-3L (patients=46%, proxies=23%). Substantial variability was also observed in SF-6D responses for patients who reported full health according to the EQ-5D-3L. For patient responders, the strongest correlations were observed between the EQ-5D-3L index score and SF-6D (ρ=0.65, p<0.001), and between the SF-6D and SF-12 physical component (ρ=0.69, p<0.001). The distribution of the SF-6D and EQ-5D-3L differed significantly for patients reporting a lower or upper moderate GOSE outcome and lower or upper good recovery (p<0.001 for all comparisons). Conclusions: The EQ-5D-3L demonstrated limited interpretability due to the presence of ceiling effects. However, the measurement properties of the SF-12, SF-6D and GOSE suggest that these may be useful measures of HR-QOL and functional recovery in OHCA survivors.
Article
Objectives: To prospectively investigate cognitive recovery from 3 to 12 months after resuscitation from out-of-hospital cardiac arrest (OHCA) and the associations between cognitive performance at 3 months and health-related quality of life (HRQL), psychological distress and work status after 12 months. Methods: At both assessments, neuropsychological tests were used to measure aspects of general mental ability, verbal and visual memory, psychomotor speed and executive function. The Short Form-36 (SF-36) was used to measure mental and physical HRQL, and the Hospital Anxiety and Depression Scale (HADS) to assess psychological distress. Results: 33 survivors completed both exams (31 males, mean age 58.6 years, SD=13). The OHCAs were witnessed and due to cardiac origins. Nine patients were awake at admission to the hospital. Longer coma duration was associated with poorer cognitive results. Memory impairments were the most common symptom. The mean changes and effect sizes indicated minor improvements in cognitive performance from 3-12 months (Hedges g<= .26). Reliable change indices for an individual's results further confirmed the stability of the group statistics. The HADS scores showed increased depressive symptoms, and mental HRQL was reduced from 3 to 12 months. Higher reports of psychological distress were related to worse HRQL. Work participation increased. Better cognitive results at 3 months were correlated with better HRQL and return to work at 12 months. Conclusions: The current data describe stability in results from 3-12 months. A worse cognitive performance at 3 months and higher reports of psychological distress were associated with lower HRQL.
Article
Brain injury affects neurologic function and quality of life in survivors after cardiac arrest. To compare the effects of 2 target temperature regimens on long-term cognitive function and quality of life after cardiac arrest. In this multicenter, international, parallel group, assessor-masked randomized clinical trial performed from November 11, 2010, through January 10, 2013, we enrolled 950 unconscious adults with cardiac arrest of presumed cardiac cause from 36 intensive care units in Europe and Australia. Eleven patients were excluded from analysis for a total sample size of 939. Targeted temperature management at 33°C vs 36°C. Cognitive function was measured by the Mini-Mental State Examination (MMSE) and assessed by observers through the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Patients reported their activities in daily life and mental recovery through Two Simple Questions and their quality of life through the Medical Outcomes Study 36-Item Short Form Health Survey, version 2. In the modified intent-to-treat population, including nonsurvivors, the median MMSE score was 14 in the 33°C group (interquartile range [IQR], 0-28) vs 17 in the 36°C group (IQR, 0-29) (P = .77), and the IQCODE score was 115 (IQR, 79-130) vs 115 (IQR, 80-130) (P = .57) in the 33°C and 36°C groups, respectively. The median MMSE score for survivors was within the reference range and similar (33°C group median, 28; IQR, 26-30; vs 36°C group median, 28; IQR, 25-30; P = .61). The median IQCODE score was within the minor deficit range (33°C group median, 79.5; IQR, 78.0-85.9; vs 36°C group median, 80.7; IQR, 78.0-86.9; P = .04). A total of 18.8% vs 17.5% of survivors reported needing help with everyday activities (P = .71), and 66.5% in the 33°C group vs 61.8% in the 36°C group reported that they thought they had made a complete mental recovery (P = .32). The mean (SD) mental component summary score was 49.1 (12.5) vs 49.0 (12.2) (P = .79), and the mean (SD) physical component summary score was 46.8 (13.8) and 47.5 (13.8) (P = .45), comparable to the population norm. Quality of life was good and similar in patients with cardiac arrest receiving targeted temperature management at 33°C or 36°C. Cognitive function was similar in both intervention groups, but many patients and observers reported impairment not detected previously by standard outcome scales. ClinicalTrials.gov NCT01020916.
Article
-Target temperature management is recommended as a neuro-protective strategy after out-of-hospital cardiac arrest. Potential effects of different target temperatures on cognitive impairment commonly described in survivors are not sufficiently investigated. The primary aim of this study was to evaluate whether a target temperature of 33ºC compared to 36ºC was favourable for cognitive function, and secondary to describe cognitive impairment in cardiac arrest survivors in general. -Study-sites included 652 cardiac arrest survivors originally randomized and stratified for site to temperature control at 33ºC or 36ºC within the Target Temperature Management trial. Survival until 180 days after the arrest was 52% (33ºC n=178/328 36ºC n=164/324). Survivors were invited to a face-to-face follow-up and 287 cardiac arrest survivors (33ºC n=148/36ºC n=139) were assessed with tests for memory (Rivermead Behavioural Memory Test), executive functions (Frontal Assessment Battery) and attention/mental speed (Symbol Digit Modalities Test). A control-group of 119 matched patients hospitalized for acute ST-elevation myocardial infarction (STEMI) without cardiac arrest performed the same assessments. Half of the cardiac arrest survivors had cognitive impairment, which was mostly mild. Cognitive outcome did not differ (p >0.30) between the two temperature groups (33ºC/36ºC). Compared to STEMI-controls attention/mental speed was more affected among cardiac arrest patients, but results for memory and executive functioning were similar. -Cognitive function was comparable in survivors of out-of-hospital cardiac arrest when targeting a temperature of 33ºC and 36ºC. Cognitive impairment detected in cardiac arrest survivors was also common in matched STEMI-controls not having had a cardiac arrest. Clinical Trial Registration Information-ClinicalTrials.gov. Identifier: NCT01946932.
Article
There is a limited guidance for outcome reporting for cardiac arrest trials. This review was conducted to explore the degree of variation and identify trends in outcome reporting. Randomised controlled trials enrolling patients with cardiac arrest (2002-12) were identified by applying a search strategy to four databases. Titles, abstracts and short-listed studies were independently assessed for eligibility. Data on the primary and secondary outcome measures, details of outcome reporting and reproducibility were extracted. 61 studies matched the inclusion criteria. There was wide variation in the focus, method and timing of assessment. Outcomes most commonly reported across studies were: survival (85.2%), activities (52.5%), body structure or function (41.0%), and processes of care (26.2%). Over 160 individual outcomes were reported including 39 different reports of survival measures of which 11 were measurements of ROSC (return of spontaneous circulation). Twenty different assessments of activity limitation were reported; only one was patient-reported. Many assessments were poorly defined or non-reproducible. The majority of outcomes were assessed up to hospital discharge (89.3%). There was no one outcome measure that was assessed across all trials. Outcome reporting in cardiac arrest RCTs lacks consistency and transparency. Guidance for improved outcome reporting is urgently required to reduce this heterogeneity in reporting, improve the quality of assessment in clinical trials, and to support the synthesis of trial data. The results highlight the importance of working towards a core outcome set for cardiac arrest clinical trials to maximise the utility of future research. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Article
Background: Out-of-hospital cardiac arrest (OHCA) is a significant global health problem. There has been considerable investment in improving the emergency medical response to OHCA, with associated improvements in survival. However, concern remains that survivors have a poor quality of life. This study describes the quality of life of OHCA survivors at 1-year postarrest in Victoria, Australia. Methods and results: Adult OHCA patients who arrested between 2010 and 2012 were identified from the Victorian Ambulance Cardiac Arrest Registry. Paramedics attended 15 113 OHCA patients of which 46.3% received an attempted resuscitation. Nine hundred and twenty-seven (13.2%) survived to hospital discharge of which 76 (8.2%) died within 12 months. Interviews were conducted with 697 (80.7%) patients or proxies, who were followed-up via telephone interview, including the Glasgow Outcome Scale-Extended, the 12-item short form health survey, and the EuroQol. The majority (55.6%) of respondents had a good recovery via the Glasgow Outcome Scale-Extended≥7 (41.1% if patients who died postdischarge were included and nonrespondents were assumed to have poor recovery). The mean EuroQol index score for respondents was 0.82 (standard deviation, 0.19), which compared favorably with an adjusted population norm of 0.81 (standard deviation, 0.34). The mean 12-item short form Mental Component Summary score for patients was 53.0 (standard deviation, 10.2), whereas the mean Physical Component Summary score was 46.1 (standard deviation, 11.2). Conclusions: This is the largest published study assessing the quality of life of OHCA survivors. It provides good evidence that many survivors have an acceptable quality of life 12 months postarrest, particularly in comparison with population norms.
Article
Background: Studies on out-of-hospital cardiac arrest (OHCA) use overall performance category (OPC)/cerebral performance category (CPC) as outcome. We studied quality of life, neuro-cognitive functioning and independency in daily life of patients and strain of caregivers 6-12 months after cardiac arrest. Methods: Two hundred and twenty patients (>18 year) who survived 6-12 months after OHCA and relatives were interviewed by telephone with validated questionnaires (Short-form Health Survey) (SF-12), Modified Rankin Scale (MRS), telephonic interview cognitive status (TICS) and Caregiver Strain Index (CSI) and compared with OPC and CPC at discharge. SF-12 of elderly (≥80 years) was compared to an open Dutch population of ≥80 years. Results: Of all patients, 45% had normal physical and 90% had normal mental SF-12. Eighty-one percent had a normal MRS (MRS≤2). Eighty-four percent had normal TICS. Compared to the reference population, elderly scored 40.5 on the mental and 53.2 on the physical SF-12, while the reference population scored 38.1 (θ=0.20) and 54.4 (θ=-0.15), respectively, (n.s.) Of the patients with OPC≤2 and CPC≤2 at discharge 15% scored MRS 3-5 and 15% abnormal TICS at follow-up, respectively. Ninety-two percent of all patients gave their quality of life a value of ≥6 (maximum 10). Patients treated with hypothermia scored on most health outcomes similar to those who did not need such treatment. Sixteen percent of caregivers experienced strain, correlating significantly with TICS of patients. Conclusion: The great majority of survivors have normal functioning and cognition 6-12 months after OHCA. Functional and neuro-cognitive telephonic tests 6-12 months after OHCA are simple and better reflect patients functioning at home than OPC/CPC at discharge.
Article
To investigate whether there were any changes in and correlations between, anxiety, depression and health-related quality of life (HRQoL) over time, between hospital discharge, and one and six months after cardiac arrest (CA), in patients treated with therapeutic hypothermia, (TH). During a 4-year period at three hospitals in Sweden, 26 patients were prospectively included, after CA treated with TH. All patients completed the questionnaires Hospital Anxiety and Depression, Scale (HADS), Euroqol (EQ5D), Euroqol visual analogue scale (EQ-VAS) and Short Form 12 (SF12) at, three occasions, at hospital discharge, and at one and 6 months after CA. There was improvement over time in HRQoL, the EQ5D index (p=0.002) and the SF12 physical, component score (PCS) (p=0.005). Changes over time in anxiety and depression were not found., Seventy-three percent of patients had an EQ-VAS score below 70 (scale 0-100) on overall health status, at discharge from hospital; at 6 months the corresponding figure was 41%. Physical problems were the, most common complaint affecting HRQoL. A correlation was found between depression and HRQoL, and this was strongest at six months (rs= -.44 to -.71, p≤0.001), Conclusion: HRQoL improves over the first 6 months after a CA. Patients reported lower levels of, HRQoL on the physical as compared to mental component. The results indicate that the less anxiety, and depression patients perceive, the better HRQoL they have and that time can be an important factor, in recovery after CA.
Article
Measurement of health-related quality of life (HRQOL) in people with disability can be problematic. Ambiguous or paradoxical findings can occur because of differences among people or changes within people regarding internal standards, values, or conceptualization of HRQOL. These "response shifts" can affect standard psychometric indices, such as reliability and validity. Attending to appraisal processes and response shift theory can inform development of HRQOL measures for people with disability that do not confound function and health and that consider important causal indicators such as environment. By design, most HRQOL measures equate function with health, necessarily leading to a lower measured HRQOL in people with functional impairments regardless of their level of self-perceived health. In this article, we present theoretical and conceptual distinctions building on response shift theory and other current developments in HRQOL research. We then submit a set of suggested directions for future measurement development in populations with disabilities that consider these distinctions and extend their use in future measurement developments.
Article
Although eradicating discrepancies in health is of unquestioned importance, there are few studies examining health-related quality of life (HRQOL) among men and women with coronary artery disease (CAD), a highly prevalent and morbid condition among industrialized nations. This study compares the HRQOL outcomes of men and women in Alberta, Canada, 1 year after the documentation of coronary artery disease by cardiac catheterization. Patients' disease-specific HRQOL was assessed 1 year after angiography using the Seattle Angina Questionnaire, whereas their generic health status, burden of depressive symptoms, and social support were respectively quantified with the EuroQol EQ-5D, the Center for Epidemiological Studies Depression Scale (short form), and the Medical Outcomes Study social support scale. The latter 2 instruments were used to adjust Seattle Angina Questionnaire outcomes for potential confounding characteristics hypothesized to be associated with sex and gender. General linear modeling and a change in Seattle Angina Questionnaire scores from baseline to 1 year were used to compare the HRQOL outcomes of men and women, after adjusting for demographics, clinical factors, depressive symptoms, and social support differences between groups. A total of 2394 (60% of those eligible) patients responded to the baseline and the 1-year follow-up survey. The adjusted mean 1-year Seattle Angina Questionnaire scores were significantly higher in men when compared with women, even after adjustment for all clinical factors, social support, depressive symptoms, and baseline HRQOL scales. Not only were women noted to have worse health status at the time of angiography, but despite adjusting for these differences, residual discrepancies in 1-year health status persisted. Women with coronary artery disease report worse HRQOL 1 year after coronary angiography when compared with men, and the discrepancies observed are only partially accounted for by sex differences in depression and social support. As a result, the measurement of gender roles and perceptions may be the best place to persist on the quest to identifying and understanding the noted discrepancies in cardiac recovery and HRQOL outcomes.
Article
To describe the current evidence on the frequency and nature of cognitive impairments in survivors of out-of-hospital cardiac arrest. Systematic review. Pubmed, Embase, PsychInfo and Cinahl (1980-2006). No language restriction was imposed. The following inclusion criteria were used: participants had to be survivors of out-of-hospital cardiac arrest, 18 years or older, and there had to be least one cognitive outcome measure with a follow-up of 3 months or more. Case reports and qualitative studies were excluded. The articles were screened on title, abstract and full text by two reviewers. All selected articles were reviewed and assessed by two reviewers independently using a quality criteria list. Out of the 286 articles initially identified, 28 were selected for final evaluation. There was a high heterogeneity between the studies with regard to study design, number of participants, outcome measures and duration of follow-up. In general, the quality of the articles appeared low, with a few positive exceptions. The reported frequency of cognitive impairments in survivors of out-of-hospital cardiac arrest ranged from 6% to 100%. Memory problems were the most common cognitive impairment, followed by impairments in attention and executive functioning. Three high-quality prospective studies found that cognitive problems occurred in about half of the survivors of out-of-hospital cardiac arrest. There are few good studies on the frequency of cognitive impairments after out-of-hospital cardiac arrest. However, cognitive problems, in particular memory problems, seem common in survivors of out-of-hospital cardiac arrest.
Article
To assess the impact of therapeutic hypothermia on cognitive function and quality of life in comatose survivors of out of Hospital Cardiac arrest (OHCA). We prospectively studied comatose survivors of OHCA consecutively admitted in a 4-year period. Therapeutic hypothermia was implemented in the last 2-year period, intervention period (n=79), and this group was compared to patients admitted the 2 previous years, control period (n=77). We assessed Cerebral Performance Category (CPC), survival, Mini Mental State Examination (MMSE) and self-rated quality of life (SF-36) 6 months after OHCA in the subgroup with VF/VT as initial rhythm. CPC in patients alive at hospital discharge was significantly better in the intervention period with a CPC of 1-2 in 97% vs. 71% in the control period, p=0.003, corresponding to an adjusted odds ratio of a favourable cerebral outcome of 17, p=0.01. No significant differences were found in long-term survival (57% vs. 56% alive at 30 months), MMSE, or SF-36. Therapeutic hypothermia (hazard ratio: 0.15, p=0.007) and bystander CPR (hazard ratio 0.19, p=0.002) were significantly related to survival in the intervention period. CPC at discharge from hospital was significantly improved following implementation of therapeutic hypothermia in comatose patients resuscitated from OCHA with VF/VT. However, significant improvement in survival, cognitive status or quality of life could not be detected at long-term follow-up.
Article
To assess the long-term outcome of bystander-witnessed out-of-hospital cardiac arrest victims in Estonia by using the survival rate and quality of life assay. All resuscitation attempts made from 01.01.1999 to 31.12.2002 in Estonia were retrospectively screened for bystander-witnessed adult out-of-hospital cardiac arrests of cardiac origin. The patients who survived hospital discharge were included in the study. Their long-term survival data were retrieved from Estonian Population Registry on March 15, 2004. Quality of life was assessed by RAND-36 questionnaire. Comparisons were made with population norms, and patients suffering from myocardial infarction or angina pectoris. 854 bystander-witnessed resuscitation attempts were made in four years. 91 patients (10.7%) survived to hospital discharge. Their one-year survival rate was 77.0% and five-year survival rate 64.3%. 44 patients responded to quality of life questionnaire, sent 16-62 months after out-of-hospital cardiac arrest (response rate 77.2%). Respondents rated their quality of life significantly worse than general population in five out of eight categories. The out-of-hospital cardiac arrest survivors with known cardiovascular disease in history (n=30) had quality of life similar to patients suffering from myocardial infarction or angina pectoris who had not required resuscitation. In Estonia majority of bystander-witnessed out-of-hospital cardiac arrest victims who survive hospital discharge are alive one and also more than three years after resuscitation. Their quality of life is worse than that of general population.
Article
The aim of this study was to assess the acceptability, validity and reliability of the Short Form 36 quality of life questionnaire in 166 adult patients following discharge from a general intensive care unit. Reliability was quantified by measuring internal consistency using correlation among items and Cronbach's alpha coefficient. Reliability coefficients were calculated from two-way analysis of variance. Construct validity was tested by examining differences in scores between sex and age groups. Content validity was reflected by the spread of dimension scores. Acceptability to patients appeared reasonable, although considerable nursing time was required to administer the questionnaire. The measures of reliability exceeded recognised statistical standards in all but two instances. Construct validity was confirmed by lower scores being reported by women and older age groups. The scores of six of the eight dimensions were spread throughout the entire range of possible scores suggesting acceptable content validity.
Article
To study whether the Short Form-36 questionnaire can be used to assess the patient's quality of life on admission to the ICU by use of proxies in both scheduled and emergency admissions. Prospective study involving direct interviews of patients and relatives before or during ICU stay in a 10-bed mixed intensive care unit in a 654-bed university affiliated hospital. Patients before major elective surgery ( n=55) or following emergency admissions ( n=57). Patients and proxies completed a health questionnaire in the first 72 h following emergency admission or the day before a scheduled admission to the ICU. Internal consistency was evaluated by measurement of Cronbach's alpha. All dimensions of the SF-36 had adequate internal consistency. On all eight dimensions a significant correlation was found between the patient and their proxy. In general, proxies underestimated the patient's quality of life although differences were small (less than 5%). On most items a good to very good agreement was found (alpha>0.6). Quality of life assessment was not affected by the admission status of the patient (acute or elective admission and surgical or medical diagnosis). The SF-36 questionnaire completed by a proxy can reliable assesses the quality of life of the critically ill patient on admission to the ICU. Proxies underestimated the patient's quality of life, although the differences were small.
Article
Mortality after out-of-hospital cardiac arrest from ventricular fibrillation is high. Programs focusing on early defibrillation have improved the rate of survival to hospital discharge. We conducted a population-based analysis of the long-term outcome and quality of life of survivors. All patients who had an out-of-hospital cardiac arrest between November 1990 and January 2001 who received early defibrillation for ventricular fibrillation in Olmsted County, Minnesota, were included. The survival rate was compared with that of an age-, sex-, and disease-matched (2:1) control population of residents who had not had an out-of-hospital cardiac arrest and with that of age- and sex-matched controls from the general U.S. population. The quality of life was assessed with use of the Medical Outcomes Study 36-item Short-Form General Health Survey (SF-36) and compared with U.S. population norms. Of 200 patients who presented with an out-of-hospital cardiac arrest with ventricular fibrillation, 145 (72 percent) survived to hospital admission (7 died in the emergency department) and 79 (40 percent) were neurologically intact (good overall capability or moderate overall disability) at discharge. The mean (+/-SD) length of follow-up was 4.8+/-3.0 years. Nineteen patients died after discharge from the hospital. The expected five-year survival rate (79 percent) was identical to that among age-, sex-, and disease-matched controls (P=0.68) but lower than that among the age- and sex-matched U.S. population (86 percent, P=0.02). Fifty patients completed SF-36 surveys at the end of follow-up, and the majority had a nearly normal quality of life, with the exception of reduced vitality. Long-term survival among patients who have undergone rapid defibrillation after out-of-hospital cardiac arrest is similar to that among age-, sex-, and disease-matched patients who did not have out-of-hospital cardiac arrest. The quality of life among the majority of survivors is similar to that of the general population.
Article
To investigate the effect of social class and gender on self perceived health status for those recovering from an acute myocardial infarction. A longitudinal survey design was used, collecting both qualitative and quantitative data. Quantitative data are reported in this article, obtained by questionnaire over the first year after the event. SF-36 and EQ-5D (EuroQol) were used to measure self perceived health status. Community based study in a city in the north of England. A consecutive sample of 229 people discharged from hospital after acute myocardial infarction. Main results: Overall gain in health status was found to be statistically significant over the year. Improvements were greatest in domains relating to role fulfillment and pursuit of normal and social activities. When analysed by gender, women showed poorer improvement than men, particularly in the domains relating to physical and social functioning. Analysed by social class, those without educational qualifications showed poorer improvement in pain experience and vitality. Access to a car was significant in avoiding physical limitations and promoting general health. Existing gradients between the health of women and men, and between the social classes, are maintained and probably exacerbated by the experience of acute illness, and health professionals need to be made aware of social groups who are at risk of poor rehabilitation.
Article
Early defibrillation programs have improved long-term outcomes following out-of-hospital cardiac arrest from ventricular fibrillation. Although long-term collective quality of life and survival are favorable, there are subsets of these patients who may be predisposed to worse outcomes. In particular, elderly patients may present with more comorbid medical conditions affecting their outcome. However, the impact of age on mortality rate and quality of life after rapid defibrillation is unknown. Observational study. Hospital. All patients with an out-of-hospital cardiac arrest between November 1990 and January 2001 who received rapid defibrillation for ventricular fibrillation in Olmsted County, Minnesota. All patients received treatment at one hospital. Long-term outcome and quality of life were followed. Survival was estimated using the Kaplan-Meier method. The quality of life was established by an SF-36 survey. Two hundred patients presented in ventricular fibrillation out-of-hospital cardiac arrest; of these, 138 (69%) survived to hospital admission, seven (4%) died in the emergency department, and 79 (39%) were discharged neurologically intact. The average age was 62+/-16 yrs, with 51% (n = 40) of the population > or =65. The average length of follow-up was 4.8+/-3.0 yrs. The 5-yr survival in patients <65 was 94% (confidence interval, 86-100%) and 66% (confidence interval, 52-84%) in patients > or =65 (p <.001). The observed survival in the younger group was not different from that expected in a U.S. age- and gender-matched population. However, in the older group, the expected survival was significantly lower compared with an age- and gender-matched U.S. population (p =.01) but similar to an age-, gender-, and disease-matched cohort of patients from Olmsted County not experiencing an arrest. In both age-dependent cohort populations, the quality of life scores crossed the norm in all categories with exception of vitality in patients >65 yrs old (42.6+/-7.2). In direct comparison between the two patient groups, the older cohort reported lower levels of physical functioning (p =.002), role-emotional score (p =.03), and role-physical score (p =.007). Other SF-36 scores were not different between the groups. Sixty-five percent of patients <65 yrs returned to work compared with 56% of older patients. The survival rate for ventricular fibrillation out-of-hospital cardiac arrest is significantly improved by the presence of a rapid defibrillation program. In patients <65 yrs old, long-term survival is equal to that of normal individuals and quality of life is similar to the general population. The survival, although high, in older patients is less than that in age-matched healthy controls, and physical and emotional quality of life scores are decreased.
Article
Previous studies have shown that early defibrillation programs improve survival after an out-of-hospital cardiac arrest (OHCA). Reports also suggest that women fare worse than men do after cardiovascular events, but there is no population-based study of sex differences after an OHCA with early defibrillation. We, therefore, compared the short- and long-term survival and quality-of-life (QOL) in women and men after an OHCA. All patients with a ventricular fibrillation (VF) OHCA who received early defibrillation in Olmstead County, Minnesota between November 1990 and December 2000 were included. Using medical records and the cardiac arrest database, the short- and long-term survival and QOL based on a SF-36 survey of each sex were compared. Adjusted QOL scores were obtained by using age- and sex-specific norms from a sample of the general U.S. population; an adjusted score of 50 (normalized mean) was considered normal. Thirty-seven female and 163 male patients presented with a VF OHCA and early defibrillation. Survival to hospital admission was significantly better for women than men [30 female survivors to admission (81%), 112 male (69%), p = 0.04]. Paradoxically, survival to discharge among those admitted was worse for women [13 female survivors to discharge (43%), 66 male (61%), p = 0.04]. The average length of follow-up was 4.8+/-3.0 years. The 5-year expected survival was 83% in women and 78% in men (p = 0.48). There was no difference in call-to-shock time (6+/-2, 6+/-2 min, p = 0.6) or whether the arrest was witnessed (86, 82%, p = 0.64). There was no statistical difference between women and men in age (64+/-17, 65+/-14 years), ejection fraction (40+/-17, 40+/-18%), diabetes (17, 29%, p = 0.16), hypertension (23, 28%, p = 0.58) or known CAD (27, 48%, p = 0.06). Adjusted QOL scores were similar between women and men in terms of pain (52+/-9, 52+/-10) vitality (47+/-11, 40+/-9), general health (49+/-9, 44+/-7), social function (51+/-10, 51+/-8), and mental health (50+/-10, 49+/-6). Women are more likely to survive to hospital admission following an OHCA. However, admitted women less likely to survive their hospital stay. Long-term survival and QOL are equally favorable in both sexes.
User's manual for the SF-36v2 Health Survey
  • M E Maruish
Maruish ME. User's manual for the SF-36v2 Health Survey 3rd ed. Lincoln, QualityMetric Incorporated, 2011
COSCA (Core Outcome Set for Cardiac Arrest) in Adults: An Advisory Statement From the International Liaison Committee on Resuscitation
COSCA (Core Outcome Set for Cardiac Arrest) in Adults: An Advisory Statement From the International Liaison Committee on Resuscitation. Resuscitation 2018;127:147-63.
Pensions at a Glance 2017: OECD and G20 Indicators
  • Oecd
OECD. Pensions at a Glance 2017: OECD and G20 Indicators. OECD Publishing, Paris;
Early neurologically-focused follow-up after cardiac arrest improves quality of life at one year: A randomised controlled trial
Early neurologically-focused follow-up after cardiac arrest improves quality of life at one year: A randomised controlled trial. Int J Cardiol 2015;193:8-16.