Long-term health-related quality of life, healthcare utilisation and back-to-work activities in intensive care unit survivors: Prospective confirmatory study from the Frisian aftercare cohort

Abstract

Purpose More substantial information on recovery after Intensive Care Unit (ICU) admission is urgently needed. In a previous retrospective study, the proportion of non-recovery patients was 44%. The aim of this prospective follow-up study was to evaluate changes in Health-Related Quality of Life (HRQoL) in the first year after ICU-admission. Methods Long-stay adult ICU-patients (≥ 48 hours) were included. HRQoL was evaluated with the Dutch translation of the RAND-36 item Health Survey (RAND-36) at baseline via proxy measurement, and at three, six, and twelve months after ICU admission. Subsequently, the relation between physical functioning, healthcare utilisation, and work activities was explored. Results A total of 81 patients were included in this study. Fifty-five percent of patients did not meet criteria for full recovery and were allocated to the Non Recovery (NR)-group (Physical Functioning domain-score: 35 [15–55]). Baseline physical HRQoL differed significantly between the Recovery (R) and NR-group. Patients in the NR-group received home care more often and had higher healthcare utilisation (44 versus 17% in the first three months post-ICU, p = 0.013). Only fourteen percent of NR-patients were able to participate in work activities. Moreover, NR-patients persistently showed impaired overall HRQoL throughout the year after critical illness. Conclusions Limited recovery in ICU survivors is reflected in overall impaired HRQoL, as well as in far-reaching consequences for patients’ healthcare needs and their ability to reintegrate into society. In our study, baseline HRQoL appeared to be an important predictor of long-term outcomes, but not Clinical Frailty Scale (CFS) score. And, (proxy-derived) HRQoL may help to identify patients at risk of long-term non-recovery.

Psychological symptoms and health-related quality of life in intubated and non-intubated intensive care survivors: A multicentre, prospective observational cohort study

“…pre-existing health) may be more important than the presence or absence of invasive ventilation. 41 In particular, pre-existing co-morbidities and frailty can influence HRQOL outcomes in ICU survivors, [42] , [43] , [44] although we did not evaluate pre-existing frailty in our study. We did find that the EQ-5D utility score was significantly worse in intubated versus non-intubated survivors in the short-term (3-months), although any difference had disappeared by 12-months.…”

Protein and energy intake in intensive care unit survivors during the first year of recovery: A descriptive cohort study

“…[2][3][4] These health problems are described as the post-intensive care syndrome and can have various consequences, including increased healthcare utilization and reduced societal participation. [5][6][7] Recovery after critical illness can be tedious or even fail to occur. The consequences of critical illness include, but are not limited to, severe catabolism, loss of muscle mass and function, overall weakness, and multiple organ dysfunction.…”

“…Still, many survivors of critical illness suffer from long‐term health deficits and a reduced quality of life 2–4 . These health problems are described as the post–intensive care syndrome and can have various consequences, including increased healthcare utilization and reduced societal participation 5–7 …”

The prevalence of mental frailty in ICU survivors and informal caregiver strain: A 1-year retrospective study of the Frisian aftercare cohort

“…Long-term non-recovery in ICU survivors is common 6 and results in higher healthcare utilization and the inability to participate in society. 7,8 In addition, long-term impairments pose a high burden on the patient’s informal caregivers, as they often provide informal care. Although the impact of critical illness on relatives and informal caregivers is yet to be fully understood, a large proportion of caregivers experience depressive symptoms, trauma-related problems, and restrictions in daily living over a longer period of time.…”