Very long-term survivors of in-hospital and out-of-hospital cardiac arrest show considerable impairment of daily life

Abstract

Background: Reliable data on long-term outcomes after cardiac arrest (CA) remain scarce. Identifying factors persistently impacting the quality of life after CA is crucial to improve long-term outcomes. Methods: Adult in-and out-of-hospital CA patients surviving to hospital discharge between 1996 and 2015 were retrospectively included. We classified survivors in stages of survival time and assessed long-term survival and quality of life by contacting patients via a standardized telephone questionnaire including the modified Rankin Scale (mRS). Results: Of 4,234 patients, 1,573 (37.2%) survived to hospital discharge. Among those, 693(44.1%) were alive at the time of the interview. We obtained interviews in 178 patients at a survival time of 7.8 (4.2-12.6) years. Younger age, female gender, and shorter duration of initial hospitalization and coma were associated with long-term survival. Conversely, higher median age at time of CA predicted poor outcome (mRS 3) and impaired quality of daily life. Around 25% declared being impaired in mobility, with female gender and higher age being predictors. Impairment in personal care and hygiene was stated in 11.8%, and activities of daily life such as shopping troubled 33.1%. Chronic pain impairing daily life was reported in 47.2% of cases, and lower socioeconomic status was suggestive of unfavourable outcome. Conclusion: Very long-term survivors showed considerable impairment of quality of life in terms of reduced mobility, self-care, or chronic pain. Higher age at time of CA and lower socioeconomic status showed worse outcomes. A more personalized screening of survivors for risk factors and long-term support are suggested.

Return to Work After Refractory Out‐of‐Hospital Cardiac Arrest in Patients Managed With or Without Extracorporeal Cardiopulmonary Resuscitation: A Nationwide Register‐Based Study

“… 20 The importance of selection is highlighted by results of a study on cardiac arrest survivors that found considerably impaired quality of life, with higher age associated with worse outcome. 21 The contrary results likely reflect the strict selection process characterizing ECPR cohorts, which is even more pronounced in our study where only patients employed before the OHCA and aged <65 years were included. The strict selection occurring in our study is also reflected in the higher 30‐day survival in patients managed with ECPR compared with patients managed with sACLS (24% versus 7%).…”

Is frailty associated with long-term survival, neurological function and patient-reported outcomes after in-hospital cardiac arrest? – A Swedish cohort study

“…Regarding long-term survival, our cohort may suggest poorer outcomes than other recent studies, 16,[43][44] , but those studies include both out-of-hospital and in-hospital cardiac arrest as well as adults in all age groups, while our cohort is restricted to those aged at least 65 years. When comparing our cohort to frail patients after intensive care, [17][18] survival figures are more similar, indicating a general association between frailty and long-term survival after hospitalisation and severe illness.…”

Association of Socioeconomic Status With Long-Term Outcome in Survivors After Out-of-Hospital Cardiac Arrest: Nationwide Population-Based Longitudinal Study

“…In addition to the interest in short-term clinical outcomes, the long-term clinical outcomes and recovery of OHCA survivors have drawn attention [ 39 ]. The recovery from cardiac arrest continues long after the patient is discharged from the hospital [ 40 , 41 ]. As the importance of long-term prognosis has become apparent, “recovery” has been added as a new link in the chain of survival in the 2020 American Heart Association guidelines [ 7 ].…”