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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References
- Global incidences of out-of-hospital cardiac arrest and survival rates: systematic review of 67 prospective studies.Resuscitation. 2010; 81: 1479-1487
- Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis.Circ Cardiovasc Qual Outcomes. 2010; 3: 63-81
- Mortality and neurological outcome in the elderly after target temperature management for out-of-hospital cardiac arrest.Resuscitation. 2015; 91: 92-98
- The relationship between age and outcome in out-of-hospital cardiac arrest patients.Resuscitation. 2015; 94: 49-54
- Out-of-hospital cardiac arrests in the older age groups in Melbourne, Australia.Resuscitation. 2011; 82: 398-403
- Survival after out-of-hospital cardiac arrest in relation to age and early identification of patients with minimal chance of long-term survival.Circulation. 2015; 131: 1536-1545
- Out-of-hospital cardiac arrest in the elderly: a large-scale population-based study.Resuscitation. 2015; 94: 28-32
- Pre-arrest predictors of survival after resuscitation from out-of-hospital cardiac arrest in the elderly a systematic review.BMC Geriatr. 2013; 13: 1-10
- Systematic review of quality of life and other patient-centred outcomes after cardiac arrest survival.Resuscitation. 2011; 82: 247-256
- Quality of life and functional outcomes 12 months after out-of-hospital cardiac arrest.Circulation. 2015; 131: 174-181
- Causes and consequences of comorbidity: a review.J Clin Epidemiol. 2001; 54: 661-674
- Predictors of long-term functional outcome and health-related quality of life after out-of-hospital cardiac arrest.Resuscitation. 2017; 113: 77-82
- Post-discharge outcomes after resuscitation from out-of-hospital cardiac arrest: a ROC PRIMED sub-study.Resuscitation. 2015; 93: 74-81
- Improved survival with favorable neurological outcome in elderly individuals with out-of-hospital cardiac arrest in Japan–A nationwide observational cohort study.Circulation. 2016; 80: 1153-1162
- Comorbidity and favorable neurologic outcome after out-of-hospital cardiac arrest in patients of 70 years and older.Resuscitation. 2015; 94: 33-39
- Mortality and neurological outcome in the elderly after target temperature management for out-of-hospital cardiac arrest.Resuscitation. 2015; 91: 92-98
- The influence of age and chronic medical conditions on neurological outcomes in out of hospital cardiac arrest.Resuscitation. 2015; 89: 169-176
Australian Bureau of Statistics. 3101.0 Australian Demographics Statistics, Dec 2016 Canberra: ABS; 2016 [11/08/2017]. Available from: http://www.abs.gov.au/Ausstats/[email protected]/exnote/3101.0.
- Using a cardiac arrest registry to measure the quality of emergency medical service care: decade of findings from the Victorian Ambulance Cardiac Arrest Registry.Circ Cardiovasc Qual Outcomes. 2015; 8: 56-66
- Cardiac Arrest and Cardiopulmonary Resuscitation Outcome Reports: Update of the Utstein Resuscitation Registry Templates for Out-of-Hospital Cardiac Arrest: A Statement for Healthcare Professionals From a Task Force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia); and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation.Resuscitation. 2015; 96: 328-340
- Structured interviews for the Glasgow Outcome Scale and the extended Glasgow Outcome Scale: guidelines for their use.J Neurotrauma. 1998; 15: 573-585
- A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity.Med Care. 1996; 34: 220-233
- A measure of health status from the EuroQol Group.Ann Med. 2001; 33: 337-343
- A wilcoxon-type test for trend.Stat Med. 1985; 4: 87-90
- Quality of Life in South Australia as measured by the SF-12 Health Status Questionnaire: Population norms for 2003.Dept. of Human Services, Australia (SA)2004
- The relationship between age and outcome in out-of-hospital cardiac arrest patients.Resuscitation. 2015; 94: 49-54
- The influence of comorbidity on survival and long-term outcomes after out-of-hospital cardiac arrest.Resuscitation. 2017; 110: 42-47
- Resuscitation of out-of-hospital cardiac arrests in residential aged care facilities in Melbourne, Australia.Resuscitation. 2012; 83: 58-62
- Survival after out-of-hospital cardiac arrest in nursing homes – a nationwide study.Resuscitation. 2018; 125: 90-98
- Age-specific prognostication after out-of-hospital cardiac arrest – the ethical dilemma between ‘life-sustaining treatment’ and ‘the right to die’ in the elderly.Eur Heart J: Acute Cardiovasc Care. 2017; 6: 112-120
Article info
Publication history
Published online: March 12, 2018
Accepted:
March 9,
2018
Received in revised form:
March 5,
2018
Received:
January 4,
2018
Footnotes
☆A Spanish translated version of the abstract of this article appears as Appendix in the final online version at https://doi.org/10.1016/j.resuscitation.2018.03.017.
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
