Clinical paperDoes time heal fatigue, psychological, cognitive and disability problems in people who experience an out-of-hospital cardiac arrest? Results from the DANCAS survey study
Introduction
Successful advances in community resuscitation and acute hospital interventions have led to increasing numbers of out-of-hospital cardiac arrest (OHCA) survivors.1 Yet, survival after OHCA can be complicated by fatigue, psychological, cognitive and disability problems.[2], [3], [4], [5] The growing focus on life after OHCA has led to ‘Recovery’ being included in the Chain of survival6 and international post-resuscitation guidelines now recommend referral to fatigue-, psychosocial- and cognitive-based support/rehabilitation.2 However, these recommendations are primarily based on studies with survivors < 12 months after OHCA26 and it is possible, that with time, the problems described in these short-term studies may improve without the need for specific post-OHCA interventions.
Where surveys have been conducted with survivors > 12-months after the event, studies are generally very small, [7], [8], [9], [10], [11], [12], [13], [14], [15], [16] or include a highly select group of survivors, for example, as part of target temperature management studies,[11], [13], [15] or only investigate global measures of neurological status and/or health-related quality of life[7], [17], [18], [19], [20] (see Supplementary Table 1). These global measures are important outcomes for assessing the effect of prehospital or acute hospital interventions, and providing information on overall survivor status. However, to develop, tailor and deliver effective post-OHCA interventions, we need to know what proportion of survivors have domain-specific problems, for example, fatigue or anxiety, and whether this changes with time.
Hence, we investigated fatigue, symptoms of anxiety and depression, mental recovery and disability in survivors 1–5 years since OHCA and, whether the results are different at different time points post-OHCA.
Section snippets
Study design, setting and population
This study has a cross-sectional study design using a sub-set of data from the DANCAS (DANish Cardiac Arrest Survivorship) survey described in the published protocol21 and is reported according to the STROBE guidelines.22 The Danish Cardiac Arrest Registry was used to identify people, ≥18 years of age and resident in Denmark, who suffered an OHCA from 1 January 2016 to 31 December 2019 and were alive 30-days after OHCA. We chose the 1–5 years timeframe because this provides both a long-term
Results
Total eligible survey population was 2116, of which 1258 survivors (59.5 %) responded (Fig. 1). Survey participant characteristics are described in Table 1. Mean age was 62.4 (SD 12.8) and 80.7 % were male. Compared to non-respondents, survey respondents were significantly older, male, with longer education, receiving a higher income; more were Western-born, had an OHCA in a public place, and received bystander resuscitation, and they had shorter hospital length of stay and less co-morbidities (
Discussion
As far as we know, this is the largest study of OHCA survivors reporting outcomes up to five years after event. Overall, the proportion of survivors reporting fatigue was 29 %, anxiety 20 %, depression 15 %, and 27 % disability. When asked specifically about their recovery after OHCA, 11 % of survivors felt they now needed help with their everyday activities and a third that they had not fully recovered mentally. As time since OHCA does not seem to change these self-reported problems, our
Conclusion
Up to a third of survivors report fatigue, anxiety, depression, reduced mental recovery and disability 1–5 years after OHCA. This proportion is the same regardless of how much time has passed post-OHCA supporting the need for early screening and tailored post-OHCA interventions to help survivors adapt to their new situation.
Sources of funding
This project was supported by infrastructure provided by REHPA, The Danish knowledge center for rehabilitation and palliative care, Odense Univeristy Hospital which receives funding from the Danish Government. This project is part of a PhD partially funded by a PhD faculty scholarship from the University of Denmark and a stipendium from the Region of Southern Denmark (19/15041).
CRediT authorship contribution statement
Vicky L. Joshi: Conceptualization, Methodology, Investigation. Lars Hermann Tang: Conceptualization, Methodology, Writing – review & editing. Tina Broby Mikkelsen: Investigation, Writing – review & editing. Jørgen Feldbæk Nielsen: Conceptualization, Methodology, Writing – review & editing. Line Zinckernagel: Conceptualization, Writing – review & editing. Britt Borregaard: Investigation, Writing – review & editing. Sachin Agarwal: Methodology, Writing – review & editing. Annette Kjær Ersbøll:
Acknowledgements
We would like to thank all the OHCA survivors who took the time to complete the survey. Thank you to Helle Collatz Christensen, Kristian Bundgaard Ringgren and everyone involved in the Danish Cardiac Arrest Registy for their help with this project. Thank you to OPEN (Open Patient Data Explorative Network) and Tanja Gram Petersen for their help with the Danish registires. Finally, thank you to Jahan Shabnam, Jens-Jakob Kjer Møller, Josefine Oredson Krone, Nikolaj Nielsen, Sofie Raahauge
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