Elsevier

Resuscitation

Volume 128, July 2018, Pages 198-203
Resuscitation

Clinical paper
Long-term quality of life of caregivers of cardiac arrest survivors and the impact of witnessing a cardiac event of a close relative

https://doi.org/10.1016/j.resuscitation.2018.03.016Get rights and content

Abstract

Background

The incidence of cardiac arrest is high, with a poor survival rate of 8–14%. Currently, only limited evidence is available about long-term consequences of cardiac arrest on quality of life of caregivers.

Aims

First, to determine the level of daily functioning and quality of life in caregivers of cardiac arrest survivors two years after the cardiac arrest. Second, to study the long-term impact of witnessing the event of a cardiac arrest.

Methods

A longitudinal cohort study including caregivers of cardiac arrest survivors. Participants received a questionnaire at home. Outcome variables were instrumental daily activities(FAI), emotional functioning(HADS), fatigue(FSS), caregiver strain(CSI), impact of event(IES), and quality of life(SF36).

Results

57 caregivers (89% female, age 56,9 ± 12 years) participated. Two years after the cardiac arrest, quality of life of caregivers equals that of the general population, although almost 30% still scored high on the Impact of Events Scale. Mean IES-, FSS-, CSI and FAI-scores were increased as compared to the general population (P < 0.001). Two years after the cardiac arrest, caregivers that witnessed the resuscitation (IES = 23.6 ± 14.9) still experienced significantly more trauma related stress than caregivers that did not witness the resuscitation (11.9 ± 12.5; p < 0.01).

Conclusions

Two years after the cardiac arrest, quality of life of caregivers is quite good, but almost one third of the caregivers still experience a high level of trauma-related stress, especially in those that witnessed the resuscitation. Future research will have to focus on the effectiveness of support programs for caregivers of survivors of cardiac arrest.

Introduction

The incidence of cardiac arrest in the Netherlands is estimated 60–92 per 100.000 persons per year [1], [2]. Just a small minority (8–14%) survives and can be discharged from the hospital [2], [3]. At the time of discharge from the hospital, 47–50% of the survivors rated their level of functioning moderate to severe [2], [3]. These limitations in daily functioning and quality of life after cardiac arrest may be due to cardiac and neurological residual symptoms. Sixteen to fifty percent of the survivors had neurocognitive deficits [4], [5] such as memory problems, attention problems and difficulties in executive functioning [7] due to post-hypoxic encephalopathy [6] which can impact physical and psychosocial functioning [8]. The level of functioning after a cardiac arrest improves over time. Although six months after cardiac arrest, 23% percent of the survivors still needed help in daily functioning [9], returned 96% to their pre-arrest level of daily functioning one year after the arrest [10].

Given the impact on functioning of the patient, caregivers may also experience consequences of the cardiac arrest, such as reported in caregivers of patients with brain injury [11]. One year post cardiac arrest, both patients and caregivers reported an improve in wellbeing [12]. However, after one year, 40% of the caregivers still experienced a high impact of the event. Partners of survivors of cardiac arrest can experience long-term symptoms such as mood disturbances, posttraumatic stress and strain as well [13]. Partners often experience even more stress and feelings of anxiety than patients themselves. A variety of 15–64% of the partners showed a higher level of strain [12], [13], [14]. Even 25 months after the cardiac arrest, relatives were still coping with major changes in their living conditions [9]. Sixty percent experienced psychosomatic problems, such as lack of interest, sleep disturbances, restlessness, decreased libido, reduction of impulse, weight loss and loss of appetite. Fifty percent reported lack of social support [9]. A systematic review on psychological distress in partners of patients with implantable cardioverter defibrillator (ICD) showed that the level of psychological distress was at least as high among partners of patients, as it was among the patients themselves [15]. Furthermore, most of the included studies suggested a decrease in the experienced amount of stress during the first year post-implantation. The ICD-implantation indication, comorbidity, and the partner’s age and psychological status were related to the level of distress and quality of life [15].

However, despite all information retrieved during the past years, only restricted information is available about the long-term consequences of cardiac arrest on the caregivers. The aim of this study was therefore to determine the impact of a cardiac arrest on long-term daily functioning and quality of life in caregivers of survivors two years after their cardiac arrest. The second aim was to study a potential relationship between the attendance and possible participation of the caregivers during cardiopulmonary resuscitation (CPR) and long-term functioning.

Section snippets

Study population

For the current study, caregivers of patients who participated in the ALASCA study (Activity and Life After Survival of a Cardiac Arrest) were approached 2 years after cardiac arrest to fill in a questionnaire. (ALASCA) [16]. Inclusion of participants in the original ALASCA study lasted from April 2007 till November 2010. Only those patients included before March 2009 were invited to participate in this two year follow-up. Two years post cardiac arrest, caregivers received a self-report

Results

As shown in Fig. 1, a total number of 153 caregivers of patients, who survived a cardiac arrest between April 2007 and March 2009, gave consent at the start of the ALASCA study. One year after the cardiac arrest, 131 caregivers still participated in the study and received a questionnaire of whom 84% completed it. As shown in Fig. 1, Two years after the cardiac arrest 107 caregivers still participated in the study and were sent a questionnaire. Of the 107 questionnaires sent, 57 (53%) were

Discussion

The aim of this study was to examine the long-term (two years) level of daily functioning and quality of life in caregivers of cardiac arrest survivors. Two years after the cardiac arrest, caregivers of cardiac arrest survivors perceive their quality of life as the general population. However, almost one third of the caregivers of cardiac survivors still experienced a higher level of trauma related stress. Caregivers who witnessed the resuscitation experienced more stress than those that did

Conclusion

The results of this study show that quality of life of caregivers of survivors of a cardiac arrest is quite well. But almost one third of caregivers still experience a high level of trauma related stress which seems to be even higher in caregivers that witnessed the resuscitation, than in caregivers that did not witness CPR. Future research will have to focus on screening for stress related to attending a cardiac arrest of a close relative and the effectiveness of support programs for

Conflict of interest statement

All authors hereby declare that they do not have any conflicts of interest

Jeanine Verbunt

Corresponding author

Acknowledgements

The study is funded by the Netherlands Organisation for Health Research and Development (ZON/MW) and Fonds Nuts Ohra.

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