Analysis of Anxiety or Depression and Long-term Mortality Among Survivors of Out-of-Hospital Cardiac Arrest

Abstract

ImportanceThe recent American Heart Association guidelines added a sixth link in the chain of survival highlighting recovery and emphasized the importance of psychiatric outcome and recovery for survivors of out-of-hospital cardiac arrest (OHCA). The prevalence of psychiatric disorders among this population was higher than that in the general population.ObjectiveTo examine the prevalence of depression or anxiety and the association of these conditions with long-term mortality among individuals who survive OHCA.Design, Setting, and ParticipantsA longitudinal population-based cohort study was conducted to analyze long-term prognosis in patients hospitalized for OHCA between January 1, 2005, and December 31, 2015, who survived for 1 year or longer. Patients with cardiac arrest due to traumatic or nonmedical causes, such as injuries, poisoning, asphyxiation, burns, or anaphylaxis, were excluded. Data were extracted on depression or anxiety diagnoses in this population within 1 year from the database of the Korean National Health Insurance Service and analyzed April 7, 2022, and reanalyzed January 19 to 20, 2023.Main Outcomes and MeasuresFollow-up data were obtained for up to 14 years, and the primary outcome was long-term cumulative mortality. Long-term mortality among patients with and without a diagnosis of depression or anxiety were evaluated.ResultsThe analysis included 2373 patients; 1860 (78.4%) were male, and the median age was 53.0 (IQR, 44.0-62.0) years . A total of 397 (16.7%) patients were diagnosed with depression or anxiety, 251 (10.6%) were diagnosed with depression, and 227 (9.6%) were diagnosed with anxiety. The incidence of long-term mortality was significantly higher in the group diagnosed with depression or anxiety than in the group without depression or anxiety (141 of 397 [35.5%] vs 534 of 1976 [27.0%]; P = .001). With multivariate Cox proportional hazards regression analysis, the adjusted hazard ratio of long-term mortality for total patients with depression or anxiety was 1.41 (95% CI, 1.17-1.70); depression, 1.44 (95% CI, 1.16-1.79); and anxiety, 1.20 (95% CI, 0.94-1.53).Conclusions and RelevanceIn this study, among the patients who experienced OHCA, those diagnosed with depression or anxiety had higher long-term mortality rates than those without depression or anxiety. These findings suggest that psychological and neurologic rehabilitation intervention for survivors of OHCA may be needed to improve long-term survival.

Post-intensive care syndrome and health-related quality of life in long-term survivors of cardiac arrest: a prospective cohort study

“…When looking at psychological sequelae, our results are very similar to a recent Dutch study including 2′345 ICU 1-year survivors, wherein approximately 18% of unselected medical ICU patients had evidence of new depressive symptoms, 14% had evidence of new symptoms of anxiety, and 6% of patients had evidence of new symptoms of PTSD 59 . This is of great clinical relevance, as cardiac arrest survivors with symptoms of anxiety and/or depression seem to have higher long-term mortality compared to those patients without psychological problems 19 . When comparing the health-related quality of life after cardiac arrest in the 5 dimensions of the EQ-5D-3L with the reference results of the Swiss general population, the biggest differences could be observed in the ‘mobility’ and ‘usual activities’ domain, whereas in the ‘pain/discomfort’, ‘anxiety/depression’ and self-care the results were very similar to the reference results from the Swiss general population 54 .…”

“…PICS is an important driver of premature mortality and can have substantial financial implications for patients and their families 16 – 18 . Physical, psychological, and cognitive long-term disabilities are well-known in cardiac arrest survivors 4 , 19 – 25 . In a previous study, our research group found evidence of PICS in 50% of survivors at 12 months of follow-up, with most impairments experienced in the physical domain 4 .…”

Uncovering Methods and Outcomes of Palliative Care for Geriatric Patients: A Scoping Review

“…[57][58][59] Anxiety and depression are common emotional experiences for individuals navigating the complexities of serious illness and mortality. 60,61 Spiritual care interventions, such as utilizing spiritual pain assessment sheets, animal-assisted therapy, spiritual counseling, and cognitive-behavioral therapy, have demonstrated their effectiveness in alleviating these psychological burdens. These interventions help geriatric patients find solace, make sense of their circumstances, and develop inner strength and resilience.…”