Return to Work and Participation in Society After Out-of-Hospital Cardiac Arrest

Gisela Lilja; Niklas Nielsen; John Bro-Jeppesen; Hannah Dunford; Hans Friberg; Caisa Hofgren; Janneke Horn; Angelo Insorsi; Jesper Kjaergaard; Fredrik Nilsson; Paolo Pelosi; Tineke Winters; Matt P Wise; Tobias Cronberg

doi:10.1161/CIRCOUTCOMES.117.003566

Return to Work and Participation in Society After Out-of-Hospital Cardiac Arrest

Circ Cardiovasc Qual Outcomes. 2018 Jan;11(1):e003566. doi: 10.1161/CIRCOUTCOMES.117.003566.

Affiliations

¹ From the Department of Clinical Sciences (G.L., T.C.) and Department of Clinical Sciences, Anesthesiology and Intensive Care Medicine (N.N., H.F.), Skane University Hospital, Lund University, Sweden; Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Denmark (J.B.-J., J.K.); Adult Critical Care, University Hospital of Wales, Cardiff, United Kingdom (H.D., M.P.W.); Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Sahlgrenska Academy, University of Gothenburg, Sweden (C.H.); Intensive Care, Academic Medical Center, Amsterdam, The Netherlands (J.H., T.W.); Anesthesia and Intensive Care, IRCCS AOU San Martino IST, Genova, Italy (A.I.); Research and Development Centre Skane, Medical Statistics and Epidemiology, Lund, Sweden (F.N.); and Department of Surgical Sciences and Integrated Diagnostics, Ospedale Policlinico San Martino - IRCCS per l'Oncologia, University of Genova, Italy (P.P.). gisela.lilja@med.lu.se.
² From the Department of Clinical Sciences (G.L., T.C.) and Department of Clinical Sciences, Anesthesiology and Intensive Care Medicine (N.N., H.F.), Skane University Hospital, Lund University, Sweden; Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Denmark (J.B.-J., J.K.); Adult Critical Care, University Hospital of Wales, Cardiff, United Kingdom (H.D., M.P.W.); Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Sahlgrenska Academy, University of Gothenburg, Sweden (C.H.); Intensive Care, Academic Medical Center, Amsterdam, The Netherlands (J.H., T.W.); Anesthesia and Intensive Care, IRCCS AOU San Martino IST, Genova, Italy (A.I.); Research and Development Centre Skane, Medical Statistics and Epidemiology, Lund, Sweden (F.N.); and Department of Surgical Sciences and Integrated Diagnostics, Ospedale Policlinico San Martino - IRCCS per l'Oncologia, University of Genova, Italy (P.P.).

PMID: 29326145
DOI: 10.1161/CIRCOUTCOMES.117.003566

Abstract

Background: The aim of this study was to describe out-of-hospital cardiac arrest (OHCA) survivors' ability to participate in activities of everyday life and society, including return to work. The specific aim was to evaluate potential effects of cognitive impairment.

Methods and results: Two hundred eighty-seven OHCA survivors included in the TTM trial (Target Temperature Management) and 119 matched control patients with ST-segment-elevation myocardial infarction participated in a follow-up 180 days post-event that included assessments of participation, return to work, emotional problems, and cognitive impairment. On the Mayo-Portland Adaptability Inventory-4 Participation Index, OHCA survivors (n=270) reported more restricted participation In everyday life and in society (47% versus 30%; P<0.001) compared with ST-segment-elevation myocardial infarction controls (n=118). Furthermore, 27% (n=36) of pre-event working OHCA survivors (n=135) compared with 7% (n=3) of pre-event working ST-segment-elevation myocardial infarction controls (n=45) were on sick leave (odds ratio, 4.9; 95% confidence interval, 1.4-16.8; P=0.01). Among the OHCA survivors assumed to return to work (n=135), those with cognitive impairment (n=55) were 3× more likely (odds ratio, 3.3; 95% confidence interval, 1.2-9.3; P=0.02) to be on sick leave compared with those without cognitive impairment (n=40; 36%, n=20, versus 15%, n=6). For OHCA survivors, the variables that were found most predictive for a lower participation were depression, restricted mobility, memory impairment, novel problem-solving difficulties, fatigue, and slower processing speed.

Conclusions: OHCA survivors reported a more restricted societal participation 6 months post-arrest, and their return to work was lower compared with ST-segment-elevation myocardial infarction controls. Cognitive impairment was significantly associated with lower participation, together with the closely related symptoms of fatigue, depression, and restricted mobility. These predictive variables may be used during follow-up to identify OHCA survivors at risk of a less successful recovery that may benefit from further support and rehabilitation.

Clinical trial registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01946932.

Keywords: cognitive dysfunction; depression; fatigue; heart arrest; sick leave; temperature.

Publication types

Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Activities of Daily Living
Aged
Cardiopulmonary Resuscitation*
Case-Control Studies
Cognition Disorders / diagnosis
Cognition Disorders / psychology*
Cognition*
Emotions
Europe
Female
Humans
Male
Middle Aged
Out-of-Hospital Cardiac Arrest / diagnosis
Out-of-Hospital Cardiac Arrest / physiopathology
Out-of-Hospital Cardiac Arrest / psychology
Out-of-Hospital Cardiac Arrest / rehabilitation*
Recovery of Function
Return to Work*
Sick Leave
Social Participation*
Survivors / psychology*
Time Factors
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT01946932