Advertisement

Does time heal fatigue, psychological, cognitive and disability problems in people who experience an out-of-hospital cardiac arrest? Results from the DANCAS survey study

      Abstract

      Aims

      Out-of-hospital cardiac arrest (OHCA) survivors may suffer short-term fatigue, psychological, cognitive and disability problems, but we lack information on the proportion of survivors with these problems in the long-term. Hence, we investigated these problems in survivors 1–5 years post-OHCA and whether the results are different at different time points post-OHCA.

      Methods

      All adults who survived an OHCA in Denmark from 2016 to 2019 were identified using the Danish Cardiac Arrest Registry and invited to participate in a survey between October 2020 and March 2021. The survey included the Modified Fatigue Impact Scale, Hospital Anxiety and Depression Scale, “Two simple questions” (everyday activities and mental recovery), and the 12-item World Health Organisation Disability Assessment Schedule 2.0. To investigate results at different time points, survivors were divided into four time-groups (12–24, 25–36, 37–48 and 49–56 months post-OHCA). Differences between time-groups were determined using the Kruskall-Wallis test for the mean scores and Chi-square test for the proportion of survivors with symptoms.

      Results

      Total eligible survey population was 2116, of which 1258 survivors (60 %) responded. Overall, 29 % of survivors reported fatigue, 20 % anxiety, 15 % depression, and 27 % disability. When survivors were sub-divided by time since OHCA, no significant difference was found on either means scores or proportion between time groups (p = 0.28 to 0.88).

      Conclusion

      Up to a third of survivors report fatigue, anxiety, depression, reduced mental function and disability 1–5 years after OHCA. This proportion is the same regardless of how much time has passed supporting early screening and tailored post-OHCA interventions to help survivors adapt to their new situation.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Resuscitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Ringgren K.B.
        • Schønau L.
        • Thomsen K.L.
        2019 Årsrapport Dansk hjertestopregister [Annual report Danish Cardiac Arrest Registry].
        Dansk Råd for Genoplivning, Denmark2020
        • Nolan J.P.
        • Sandroni C.
        • Bottiger B.W.
        • et al.
        European Resuscitation Council and European Society of Intensive Care Medicine Guidelines 2021: post-resuscitation care.
        Resuscitation. 2021; 161 (published Online First: 2021/03/29): 220-269https://doi.org/10.1016/j.resuscitation.2021.02.012
        • Cronberg T.
        • Greer D.M.
        • Lilja G.
        • et al.
        Brain injury after cardiac arrest: from prognostication of comatose patients to rehabilitation.
        Lancet Neurol. 2020; 19: 611-622https://doi.org/10.1016/s1474-4422(20)30117-4
        • Orbo M.
        • Aslaksen P.M.
        • Larsby K.
        • et al.
        Alterations in cognitive outcome between 3 and 12 months in survivors of out-of-hospital cardiac arrest.
        Resuscitation. 2016; 105: 92-99https://doi.org/10.1016/j.resuscitation.2016.05.017
        • Kearney J.
        • Dyson K.
        • Andrew E.
        • et al.
        Factors associated with return to work among survivors of out-of-hospital cardiac arrest.
        Resuscitation. 2020; 146 (published Online First: 2019/09/21): 203-212https://doi.org/10.1016/j.resuscitation.2019.09.006
        • Sawyer K.N.
        • Camp-Rogers T.R.
        • Kotini-Shah P.
        • et al.
        Sudden cardiac arrest survivorship: a scientific statement from the American Heart Association.
        Circulation. 2020; 141 (published Online First: 2020/02/23): e654-e685https://doi.org/10.1161/CIR.0000000000000747
        • Schnaubelt S.
        • Mayr F.B.
        • Losert H.
        • et al.
        Very long-term survivors of in-hospital and out-of-hospital cardiac arrest show considerable impairment of daily life.
        Resuscitation. 2022; (published Online First: 2022/02/09)https://doi.org/10.1016/j.resuscitation.2022.01.023
        • Steinbusch C.V.M.
        • van Heugten C.M.
        • Rasquin S.M.C.
        • et al.
        Cognitive impairments and subjective cognitive complaints after survival of cardiac arrest: a prospective longitudinal cohort study.
        Resuscitation. 2017; 120: 132-137https://doi.org/10.1016/j.resuscitation.2017.08.007
        • Moulaert V.R.M.
        • van Heugten C.M.
        • Gorgels T.P.M.
        • et al.
        Long-term outcome after survival of a cardiac arrest: a prospective longitudinal cohort study.
        Neurorehabilitation Neural Repair. 2017; 31: 530-539https://doi.org/10.1177/1545968317697032
        • Wimmer H.
        • Lundqvist C.
        • Saltyte Benth J.
        • et al.
        Health-related quality of life after out-of-hospital cardiac arrest - a five-year follow-up study.
        Resuscitation. 2021; 162 (published Online First: 2021/02/12): 372-380https://doi.org/10.1016/j.resuscitation.2021.01.036
        • Caro-Codon J.
        • Rey J.R.
        • Lopez-de-Sa E.
        • et al.
        Long-term neurological outcomes in out-of-hospital cardiac arrest patients treated with targeted-temperature management.
        Resuscitation. 2018; 133 (published Online First: 2018/09/27): 33-39https://doi.org/10.1016/j.resuscitation.2018.09.015
        • Andersson A.-E.
        • Rosén H.
        • Sunnerhagen K.S.
        Life after cardiac arrest: a very long term follow up.
        Resuscitation. 2015; 91: 99-103https://doi.org/10.1016/j.resuscitation.2015.01.009
        • Kowalik R.
        • Szczerba E.
        • Kołtowski Ł.
        • et al.
        Cardiac arrest survivors treated with or without mild therapeutic hypothermia: performance status and quality of life assessment.
        Scandinavian J Trauma Resuscitation Emergency Med. 2014; 22: 75-78https://doi.org/10.1186/s13049-014-0076-9
        • Saarinen S.
        • Kamarainen A.
        • Silfvast T.
        • et al.
        Pulseless electrical activity and successful out-of-hospital resuscitation - long-term survival and quality of life: an observational cohort study.
        Scandinavian J Trauma Resuscitation Emergency Med. 2012; 20: 74https://doi.org/10.1186/1757-7241-20-74
        • Flickinger K.L.
        • Jaramillo S.
        • Repine M.J.
        • et al.
        One-year outcomes in individual domains of the cerebral performance category extended.
        Resusc Plus. 2021; 8 (published Online First: 2021/12/23): 100184https://doi.org/10.1016/j.resplu.2021.100184
        • Viktorisson A.
        • Sunnerhagen K.S.
        • Johansson D.
        • et al.
        One-year longitudinal study of psychological distress and self-assessed health in survivors of out-of-hospital cardiac arrest.
        BMJ Open. 2019; 9 (published Online First: 2019/07/06): e029756https://doi.org/10.1136/bmjopen-2019-029756
        • Spangenberg T.
        • Schewel J.
        • Dreher A.
        • et al.
        Health related quality of life after extracorporeal cardiopulmonary resuscitation in refractory cardiac arrest.
        Resuscitation. 2018; 127 (published Online First: 2018/04/08): 73-78https://doi.org/10.1016/j.resuscitation.2018.03.036
        • Viktorisson A.
        • Sunnerhagen K.S.
        • Pöder U.
        • et al.
        Well-being among survivors of out-of-hospital cardiac arrest: a cross-sectional retrospective study in Sweden.
        BMJ Open. 2018; 8: e021729
        • Nehme Z.
        • Andrew E.
        • Bernard S.
        • et al.
        Comparison of out-of-hospital cardiac arrest occurring before and after paramedic arrival: epidemiology, survival to hospital discharge and 12-month functional recovery.
        Resuscitation. 2015; 89 (published Online First: 2015/01/27): 50-57https://doi.org/10.1016/j.resuscitation.2015.01.012
        • Nehme Z.
        • Andrew E.
        • Bernard S.
        • et al.
        Sex differences in the quality-of-life and functional outcome of cardiac arrest survivors.
        Resuscitation. 2019; 137 (published Online First: 2019/02/09): 21-28https://doi.org/10.1016/j.resuscitation.2019.01.034
        • Joshi V.L.
        • Tang L.H.
        • Borregaard B.
        • et al.
        Long-term physical and psychological outcomes after out-of-hospital cardiac arrest-protocol for a national cross-sectional survey of survivors and their relatives (the DANCAS survey).
        BMJ Open. 2021; 11 (published Online First: 2021/04/04): e045668https://doi.org/10.1136/bmjopen-2020-045668
        • Vandenbroucke J.P.
        • von Elm E.
        • Altman D.G.
        • et al.
        Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration.
        PLOS Medicine. 2007; 4: e297
        • Soar J.
        • Bottiger B.W.
        • Carli P.
        • et al.
        European Resuscitation Council Guidelines 2021: adult advanced life support.
        Resuscitation. 2021; 161 (published Online First: 2021/03/29): 115-151https://doi.org/10.1016/j.resuscitation.2021.02.010
        • Maciel C.B.
        • Barden M.M.
        • Greer D.M.
        Neurologic recovery after cardiac arrest: a multifaceted puzzle requiring comprehensive coordinated care.
        Curr Treatment Options Cardiovasc Med. 2017; 19: 52https://doi.org/10.1007/s11936-017-0548-0
        • Fisk J.D.
        • Ritvo P.G.
        • Ross L.
        • et al.
        Measuring the functional impact of fatigue: initial validation of the fatigue impact scale.
        Clin Infect Dis. 1994; 18 (published Online First: 1994/01/01): S79-S83https://doi.org/10.1093/clinids/18.supplement_1.s79
        • Fisk J.D.
        • Pontefract A.
        • Ritvo P.G.
        • et al.
        The impact of fatigue on patients with multiple sclerosis.
        Can J Neurol Sci. 1994; 21 (published Online First: 1994/02/01): 9-14
        • Schiehser D.M.
        • Delano-Wood L.
        • Jak A.J.
        • et al.
        Validation of the Modified Fatigue Impact Scale in mild to moderate traumatic brain injury.
        J Head Trauma Rehabil. 2015; 30 (published Online First: 2014/01/15): 116-121https://doi.org/10.1097/HTR.0000000000000019
        • Amtmann D.
        • Bamer A.M.
        • Noonan V.
        • et al.
        Comparison of the psychometric properties of two fatigue scales in multiple sclerosis.
        Rehabil Psychol. 2012; 57 (published Online First: 2012/06/13): 159-166https://doi.org/10.1037/a0027890
        • Christensen A.V.
        • Dixon J.K.
        • Juel K.
        • et al.
        Psychometric properties of the Danish Hospital Anxiety and Depression Scale in patients with cardiac disease: results from the DenHeart survey.
        Health Qual Life Outcomes. 2020; 18 (published Online First: 2020/01/09): 9https://doi.org/10.1186/s12955-019-1264-0
        • Snaith R.P.
        The hospital anxiety and depression scale.
        Health Quality of Life Outcomes. 2003; 1: 29https://doi.org/10.1186/1477-7525-1-29
        • Longstreth Jr., W.T.
        • Nichol G.
        • Van Ottingham L.
        • et al.
        Two simple questions to assess neurologic outcomes at 3 months after out-of-hospital cardiac arrest: experience from the public access defibrillation trial.
        Resuscitation. 2010; 81 (published Online First: 2010/02/23): 530-533https://doi.org/10.1016/j.resuscitation.2010.01.011
        • Cronberg T.
        • Lilja G.
        • Horn J.
        • et al.
        Neurologic function and health-related quality of life in patients following targeted temperature management at 33 degrees C vs 36 degrees C after out-of-hospital cardiac arrest: a randomized clinical trial.
        JAMA Neurol. 2015; 72 (published Online First: 2015/04/07): 634-641https://doi.org/10.1001/jamaneurol.2015.0169
        • Ustun T.B.
        • Chatterji S.
        • Kostanjsek N.
        • et al.
        Developing the World Health Organization Disability Assessment Schedule 2.0.
        Bull World Health Organ. 2010; 88 (published Online First: 2010/11/16): 815-823https://doi.org/10.2471/BLT.09.067231
        • Federici S.
        • Bracalenti M.
        • Meloni F.
        • et al.
        World Health Organization disability assessment schedule 2.0: an international systematic review.
        Disability Rehabilitation. 2017; 39 (published Online First: 2): 2347-2380https://doi.org/10.1080/09638288.2016.1223177
        • Andrews G.
        • Kemp A.
        • Sunderland M.
        • et al.
        Normative data for the 12 item WHO Disability Assessment Schedule 2.0.
        PLoS One. 2009; 4https://doi.org/10.1371/journal.pone.0008343
        • Jensen V.M.
        • Rasmussen A.W.
        Danish Education Registers.
        Scand J Public Health. 2011; 39 (published Online First: 2011/08/04): 91-94https://doi.org/10.1177/1403494810394715
        • Baadsgaard M.
        • Quitzau J.
        Danish registers on personal income and transfer payments.
        Scand J Public Health. 2011; 39 (published Online First: 2011/08/04): 103-105https://doi.org/10.1177/1403494811405098
        • Lynge E.
        • Sandegaard J.L.
        • Rebolj M.
        The Danish National Patient Register.
        Scand J Public Health. 2011; 39 (published Online First: 2011/08/04): 30-33https://doi.org/10.1177/1403494811401482
        • Sundboll J.
        • Adelborg K.
        • Munch T.
        • et al.
        Positive predictive value of cardiovascular diagnoses in the Danish National Patient Registry: a validation study.
        BMJ Open. 2016; 6 (published Online First: 2016/11/20): e012832https://doi.org/10.1136/bmjopen-2016-012832
        • Quan H.
        • Li B.
        • Couris C.M.
        • et al.
        Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries.
        Am J Epidemiol. 2011; 173 (published Online First: 2011/02/19): 676-682https://doi.org/10.1093/aje/kwq433
        • Thygesen S.K.
        • Christiansen C.F.
        • Christensen S.
        • et al.
        The predictive value of ICD-10 diagnostic coding used to assess Charlson comorbidity index conditions in the population-based Danish National Registry of Patients.
        BMC Medical Res Methodol. 2011; 11: 83https://doi.org/10.1186/1471-2288-11-83
        • Strober L.B.
        • Bruce J.M.
        • Arnett P.A.
        • et al.
        Tired of not knowing what that fatigue score means? Normative data of the Modified Fatigue Impact Scale (MFIS).
        Mult Scler Relat Disord. 2020; 46 (published Online First: 2020/12/11)102576https://doi.org/10.1016/j.msard.2020.102576
        • Kocalevent R.D.
        • Hinz A.
        • Brähler E.
        • et al.
        Determinants of fatigue and stress.
        BMC Res Notes. 2011; 4: 1-5
        • Peskine A.
        • Cariou A.
        • Hajage D.
        • et al.
        Long-term disabilities of survivors of out-of-hospital cardiac arrest: the Hanox study.
        Chest. 2021; 159: 699-711
        • Haywood K.L.
        • Ji C.
        • Quinn T.
        • et al.
        Long term outcomes of participants in the PARAMEDIC2 randomised trial of adrenaline in out-of-hospital cardiac arrest.
        Resuscitation. 2021; 160 (published Online First: 2021/02/02): 84-93https://doi.org/10.1016/j.resuscitation.2021.01.019
        • Sawyer K.N.
        Surviving cardiac arrest - what do we know about recovery & survivorship?.
        Curr Opin Crit Care. 2022; 28 (published Online First: 2022/06/03): 256-261https://doi.org/10.1097/MCC.0000000000000935
        • Tiainen M.
        • Vaahersalo J.
        • Skrifvars M.B.
        • et al.
        Surviving out-of-hospital cardiac arrest: the neurological and functional outcome and health-related quality of life one year later.
        Resuscitation. 2018; 129: 19-23https://doi.org/10.1016/j.resuscitation.2018.05.011
        • Kirchberger I.
        • Braitmayer K.
        • Coenen M.
        • et al.
        Feasibility and psychometric properties of the German 12-item WHO Disability Assessment Schedule (WHODAS 2.0) in a population-based sample of patients with myocardial infarction from the MONICA/KORA myocardial infarction registry.
        Population Health Metrics. 2014; 12: 1-13
        • Johnston S.
        • Eckhardt A.L.
        Fatigue and acute coronary syndrome: a systematic review of contributing factors.
        Heart Lung. 2018; 47 (published Online First: 2018/04/10): 192-204https://doi.org/10.1016/j.hrtlng.2018.03.005
        • Beaulieu-Bonneau S.
        • Ouellet M.-C.
        Fatigue in the first year after traumatic brain injury: course, relationship with injury severity, and correlates.
        Neuropsychol Rehabilitat. 2017; 27: 983-1001https://doi.org/10.1080/09602011.2016.1162176
        • Eckhardt A.L.
        • Devon H.A.
        • Piano M.R.
        • et al.
        Fatigue in the presence of coronary heart disease.
        Nursing Res. 2014; 63: 83-93https://doi.org/10.1097/NNR.0000000000000019
        • Maughan D.
        • Toth M.
        Discerning primary and secondary factors responsible for clinical fatigue in multisystem diseases.
        Biology. 2014; 3: 606-622https://doi.org/10.3390/biology3030606
      1. Aali G, Drummond A, das Nair R, et al. Post-stroke fatigue: a scoping review. F1000Res 2020;9:242. doi: 10.12688/f1000research.22880.2 [published Online First: 2020/09/18].

        • Presciutti A.
        • Newman M.M.
        • Sawyer K.N.
        • et al.
        Gaps in the provision of cognitive and psychological resources in cardiac arrest survivors with good neurologic recovery.
        Ther Hypothermia Temp Manag. 2021; (published Online First: 2021/05/13)https://doi.org/10.1089/ther.2021.0003
        • Haywood K.L.
        • Southern C.
        • Tutton E.
        • et al.
        An international collaborative study to co-produce a patient-reported outcome measure of cardiac arrest survivorship and health-related quality of life (CASHQoL): a protocol for developing the long-form measure.
        Resuscitation Plus. 2022; : 11https://doi.org/10.1016/j.resplu.2022.100288