Evaluating novel methods of outcome assessment following cardiac arrest



      We compared novel methods of long-term follow-up after resuscitation from cardiac arrest to a query of the National Death Index (NDI). We hypothesized use of the electronic health record (EHR), and internet-based sources would have high sensitivity for identifying decedents identified by the NDI.


      We performed a retrospective study including patients treated after cardiac arrest at a single academic center from 2010 to 2018. We evaluated two novel methods to ascertain long-term survival and modified Rankin Scale (mRS): 1) a structured chart review of our health system’s EHR; and 2) an internet-based search of: a) local newspapers, b), c) Facebook, d) Twitter, e) Instagram, and f) Google. If a patient was not reported deceased by any source, we considered them to be alive. We compared results of these novel methods to the NDI to calculate sensitivity. We queried the NDI for 200 in-hospital decedents to evaluate sensitivity against a true criterion standard.


      We included 1,097 patients, 897 (82%) alive at discharge and 200 known decedents (18%). NDI identified 197/200 (99%) of known decedents. The EHR and local newspapers had highest sensitivity compared to the NDI (87% and 86% sensitivity, respectively). Online sources identified 10 likely decedents not identified by the NDI. Functional status estimated from EHR, and internet sources at follow up agreed in 38% of alive patients.


      Novel methods of outcome assessment are an alternative to NDI for determining patients’ vital status. These methods are less reliable for estimating functional status.


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        • Benjamin E.J.
        • Muntner P.
        • Alonso A.
        • et al.
        Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association.
        Circulation. 2019; 139: e56-e528
        • Haywood K.
        • Whitehead L.
        • Nadkarni V.M.
        • et al.
        COSCA (Core Outcome Set for Cardiac Arrest) in Adults: An Advisory Statement From the International Liaison Committee on Resuscitation.
        Resuscitation. 2018; 127: 147-163
        • 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: e654-e685
        • 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;
        • Toledano M.B.
        • Smith R.B.
        • Brook J.P.
        • Douglass M.
        • Elliott P.
        How to Establish and Follow up a Large Prospective Cohort Study in the 21st Century-Lessons from UK COSMOS.
        PLoS One. 2015; 10: e0131521
        • Wilcox M.E.
        • Ely E.W.
        Challenges in conducting long-term outcomes studies in critical care.
        Curr Opin Crit Care. 2019; 25: 473-488
        • Hermansen S.W.
        • Leitzmann M.F.
        • Schatzkin A.
        The impact on National Death Index ascertainment of limiting submissions to Social Security Administration Death Master File matches in epidemiologic studies of mortality.
        Am J Epidemiol. 2009; 169: 901-908
        • Wojcik N.C.
        • Huebner W.W.
        • Jorgensen G.
        Strategies for Using the National Death Index and the Social Security Administration for Death Ascertainment in Large Occupational Cohort Mortality Studies.
        Am J Epidemiol. 2010; 172: 469-477
        • Hanna D.B.
        • Pfeiffer M.R.
        • Sackoff J.E.
        • Selik R.M.
        • Begier E.M.
        • Torian L.V.
        Comparing the National Death Index and the Social Security Administration's Death Master File to ascertain death in HIV surveillance.
        Public Health Rep. 2009; 124: 850-860
        • Navar A.M.
        • Peterson E.D.
        • Steen D.L.
        • et al.
        Evaluation of Mortality Data From the Social Security Administration Death Master File for Clinical Research.
        JAMA Cardiol. 2019; 4: 375-379
        • Sesso H.D.
        • Paffenbarger R.S.
        • Lee I.M.
        Comparison of National Death Index and World Wide Web death searches.
        Am J Epidemiol. 2000; 152: 107-111
        • Conway R.B.N.
        • Armistead M.G.
        • Denney M.J.
        • Smith G.S.
        Validating the Matching of Patients in the Linkage of a Large Hospital System's EHR with State and National Death Databases.
        Appl Clin Inform. 2021; 12: 82-89
        • Farmer R.
        • Mathur R.
        • Bhaskaran K.
        • Eastwood S.V.
        • Chaturvedi N.
        • Smeeth L.
        Promises and pitfalls of electronic health record analysis.
        Diabetologia. 2018; 61: 1241-1248
        • Elmer J.
        • Callaway C.W.
        • Chang C.H.
        • et al.
        Long-Term Outcomes of Out-of-Hospital Cardiac Arrest Care at Regionalized Centers.
        Ann Emerg Med. 2019; 73: 29-39
        • Elmer J.
        • Rittenberger J.C.
        • Coppler P.J.
        • et al.
        Long-term survival benefit from treatment at a specialty center after cardiac arrest.
        Resuscitation. 2016; 108: 48-53
        • Broderick J.P.
        • Adeoye O.
        • Elm J.
        Evolution of the Modified Rankin Scale and Its Use in Future Stroke Trials.
        Stroke. 2017; 48: 2007-2012
        • Madden K.
        • Scott T.
        • McKay P.
        • et al.
        Predicting and Preventing Loss to Follow-up of Adult Trauma Patients in Randomized Controlled Trials: An Example from the FLOW Trial.
        J Bone Joint Surg Am. 2017; 99: 1086-1092
        • Dettori J.R.
        Loss to follow-up.
        Evid Based Spine Care J. 2011; 2: 7-10
        • Jaramillo S.
        • Flickinger K.L.
        • Repine M.
        • et al.
        Cardiac arrest survivors lost to follow-up after 3-Months, 6-Months and 1-Year.
        Resuscitation. 2020; 150: 8-16
        • Brunner M.
        • Palmer S.
        • Togher L.
        • Hemsley B.
        'I kind of figured it out': the views and experiences of people with traumatic brain injury (TBI) in using social media-self-determination for participation and inclusion online.
        Int J Lang Commun Disord. 2019; 54: 221-233
        • Verberne D.
        • Moulaert V.
        • Verbunt J.
        • van Heugten C.
        Factors predicting quality of life and societal participation after survival of a cardiac arrest: A prognostic longitudinal cohort study.
        Resuscitation. 2018; 123: 51-57
        • Denecke K.
        • Bamidis P.
        • Bond C.
        • et al.
        Ethical Issues of Social Media Usage in Healthcare.
        Yearb Med Inform. 2015; 10: 137-147
      1. Independent Researcher Access to Social Media Data: Comparing Legislative Proposals. Center for Democracy and Technology, 2022. (Accessed November 7, 2022, at