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Long-term functional recovery and health-related quality of life of elderly out-of-hospital cardiac arrest survivors

  • Emily Andrew
    Correspondence
    Corresponding author at: Ambulance Victoria, 375 Manningham Road, Doncaster, VIC, 3108, Australia.
    Affiliations
    Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Australia

    Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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  • Eric Mercier
    Affiliations
    Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia

    Centre de recherche du CHU de Québec, Québec, Canada

    The Alfred Hospital, Melbourne, Australia
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  • Ziad Nehme
    Affiliations
    Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Australia

    Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia

    Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston, Australia
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  • Stephen Bernard
    Affiliations
    Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Australia

    Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia

    The Alfred Hospital, Melbourne, Australia
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  • Karen Smith
    Affiliations
    Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Australia

    Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia

    Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston, Australia
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      Abstract

      Introduction

      Understanding the prognosis of elderly out-of-hospital cardiac arrest (OHCA) patients is vital to informing resuscitation and advanced care planning decisions. However, short-term outcomes such as survival to hospital discharge do not account for post-arrest quality of life. We describe the 12-month functional recovery and health-related quality of life (HR-QOL) of elderly OHCA survivors, including those arresting in aged care facilities.

      Methods

      We conducted a retrospective analysis of Victorian Ambulance Cardiac Arrest Registry data for all OHCA survivors to hospital discharge aged ≥65 years between 1 January 2010 and 30 June 2016. The influence of age on functional recovery and independent living was assessed using multivariable logistic regression.

      Results

      During the study period, 20,103 elderly OHCAs were attended, 9016 (44.9%) of whom received a resuscitation attempt. In total, 876 (9.7%) patients survived to hospital discharge and 777 were alive 12 months post-arrest. Of these, 651 participated in 12-month follow-up (response rate 83.8%). Most (60.6%) resided at home without additional care and 66.6% reported a good functional recovery, however both measures decreased with increasing age (p < 0.001). Mental HR-QOL increased with increasing age and was significantly better than the age- and sex-matched Australian population. Each 10-year increase in age was associated with a 40.8% (95%CI 25.6–53.0%) reduction in the odds of good functional recovery, and a 65.8% (95%CI 55.8–73.5%) reduction in the odds of living independently. Of the 2575 OHCAs in an aged care facility, 2.2% survived to hospital discharge, however no patient reported a good 12-month functional recovery.

      Conclusions

      Most elderly OHCA survivors resided independently with good functionality 12 months post-arrest. However, increasing age was associated with less favourable outcomes. New strategies are needed with regard to resuscitation in aged care facilities.

      Keywords

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