Factors predicting quality of life and societal participation after survival of a cardiac arrest: A prognostic longitudinal cohort study

doi:10.1016/j.resuscitation.2017.11.069

Resuscitation

Volume 123, February 2018, Pages 51-57

https://doi.org/10.1016/j.resuscitation.2017.11.069 Get rights and content

Abstract

Aim

For those patients who suffer unfavourable outcome after survival of cardiac arrest, it is important to know whether this can be predicted at an early stage. Support can subsequently be provided. This study aimed to identify early prognostic factors of quality of life (QOL) and societal participation at one year post-cardiac arrest.

Methods

The design was a prospective longitudinal cohort study following cardiac arrest survivors up to one year. Prognostic personal, injury-related, function-related and subjective outcome factors were selected and entered into a hierarchical regression model to assess whether they were predictive of QOL and societal participation at one year post-cardiac arrest.

Results

Hundred and ten cardiac arrest survivors were included. Not having a partner, more functional limitations (at two weeks) and cognitive complaints were significantly predictive of lower physical QOL, while higher levels of anxiety and depression symptoms (at three months) were significant predictors of mental QOL. A neurological history and higher levels of anxiety and depression symptoms were significantly predictive of lower brain injury-specific QOL. Societal participation was only predicted by premorbid functioning.

Conclusion

This study identified prognostic factors of QOL and societal participation one year after survival of cardiac arrest. Screening of these factors in early stages can identify those survivors with possibly unfavourable QOL at one year post cardiac arrest. For those survivors, preventive and targeted interventions may be offered.

Introduction

Surviving a cardiac arrest is not always without consequences, especially for those suffering a hypoxic brain damage. It was recently shown that most patients return to pre-arrest levels of functioning in terms of participation (for instance return to work) and quality of life (QOL) [[1], [2]]. However, a minority of the survivors cannot return to their life as before and for those it is important to know whether this unfavourable outcome can be predicted at an early stage in order to support people.

In a retrospective cohort study, we showed that age and gender were significantly related to societal participation and QOL three years after the cardiac arrest [3]. Physical QOL was significantly related to cognitive complaints, daily activities, post-traumatic stress and fatigue, while mental QOL was explained by emotional problems, cognitive complaints and fatigue [4]. Apparently both personal factors and subjective outcome influence long term outcome.

Prognostic studies on long term participation and QOL after cardiac arrest are however scarce. In a prospective cohort study on moderate to severe traumatic brain injury (TBI), emotional problems next to length of stay, have shown to be independent predictors of long term mental QOL, while physical QOL was explained by time since injury, length of stay and functional outcome [5]. From a TBI perspective, this means that injury-related factors are also important. Forslund et al. [6] additionally showed that better community integration and a positive change in physical QOL over time predicted better physical QOL at two years post TBI. Lower depression scores and positive change in mental QOL over time predicted higher mental QOL scores at two years. In a prospective cohort study on mild stroke patients [7], stable low QOL and a decline in QOL over time were predicted by psychological factors such as less acceptance, self-efficacy, and proactive coping and more neuroticism, pessimism, helplessness, and passive coping.

From these retrospective studies on cardiac arrest and prospective studies on other forms of brain injury it can be concluded that a prediction model for long term societal participation and QOL should incorporate many different prognostic factors related to the person, the injury and the short-term outcome. The aim of the current study was therefore to investigate which factors predict long term outcome in terms of societal participation and QOL after survival of a cardiac arrest. We considered personal (premorbid) factors, injury-related factors, early function-related factors and subjective outcome at three months post cardiac arrest as independent predictors of outcome (QOL and societal participation) at one year.

Section snippets

Design

The current study stems from the project called ‘Activity and Life After Survival of a Cardiac Arrest’ (ALASCA) [ISRCTN74835019] [8] which was a prospective longitudinal cohort study with a nested randomised controlled trial (n = 238). The current study excluded patients who were allocated to the intervention group (n = 97) and therefore the current cohort consists of 141 patients (238 − 97 = 141) who only received the usual care. Their situation seems most reflective for a ‘natural’ course and

Results

A total of 141 patients participated of which 110 (78%) still participated at 12 months post-cardiac arrest (Fig. 1). Table 1 displays characteristics of the included patients. Included patients showed significant higher cognitive functioning than drop-outs (CogLog score 26.6 vs. 23.9, p = 0.01). Differences on other characteristics were non-significant.

With regard to the QOL at one year post-cardiac arrest, included patients showed a mean of 44.2 (SD = 11.0) on the PCS; 50.6 (SD = 10.7) on the

Discussion

In this prospective study, we examined the contribution of four groups of variables (personal factors, characteristics of cardiac arrest, early function-related factors and subjective outcome at three months) on QOL and societal participation one year after survival of a cardiac arrest. Concerning demographic information, we found that having a partner was a positive predictive personal factor on physical QOL and that neurological history had a negative impact on brain injury-specific QOL.

Conclusions

In conclusion, this study has shown that not cardiac-arrest related factors but demographic, early function-related factors and subjective well-being at three months are predictive of QOL at one year post-cardiac arrest. Societal participation showed to be predicted by premorbid functioning. For the minority of survivors who experience unfavourable outcome at one year post-cardiac arrest, screening for these predictive factors at an early stage can help to identify those at risk of poor

Conflicts of interest

None.

Author contributions

DV, VM, CH, and JV were involved in the design of the study. DV was the principle investigator on this project who performed the data analyses. DV mainly wrote the drafts of the manuscript, with assistance of VM, CH and JV. All authors take responsibility for the integrity of the data and the accuracy of the data analysis. All authors read, critically reviewed and approved the final manuscript. JV is the guarantor.

Acknowledgements

This work was supported by the Netherlands Organisation for Health Research and Development (ZonMw 920-03-373); Fonds Nuts Ohra (0602-069) and Stichting Elisabeth Strouven. These funding agencies did not play a role in the study design; collection, analysis and interpretation of the data; writing the manuscript; or decisions in where to submit the manuscript.

We would like to acknowledge all patients who participated in the current study and thank all participating hospitals, their involved

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^☆: 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.2017.11.069.

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Clinical paperFactors predicting quality of life and societal participation after survival of a cardiac arrest: A prognostic longitudinal cohort study☆

Abstract

Aim

Methods

Results

Conclusion

Introduction

Section snippets

Design

Results

Discussion

Conclusions

Conflicts of interest

Author contributions

Acknowledgements

Resuscitation

Arch Phys Med Rehabil

Resuscitation

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Heart Lung

Arch Phys Med Rehabil

Arch Phys Med Rehabil

J Neurol Sci

Resuscitation

Resuscitation

Int J Cardiol

Long-term outcome after survival of a cardiac arrest: a prospective longitudinal cohort study

Neurorehabil Neural Repair

Cognitive function, quality of life and mental health in survivors of our-of-hospital cardiac arrest: a review

Anaesth Intensive Care

Determinants of quality of life in survivors of cardiac arrest

J Rehabil Med

Predicting health-related quality of life 2 years after moderate-to-severe traumatic brain injury

Acta Neurol Scand

Trajectories of health-related quality of life after stroke: results from a one-year prospective cohort study

Disabil Rehabil

Activity and Life After Survival of a Cardiac Arrest (ALASCA) and the effectiveness of an early intervention service: design of a randomised controlled trial

BMC Cardiovasc Disord

Clinical paper
Factors predicting quality of life and societal participation after survival of a cardiac arrest: A prognostic longitudinal cohort study☆