Resuscitation 85 (2014) 1127–1128
Contents lists available at ScienceDirect
Resuscitation journal homepage: www.elsevier.com/locate/resuscitation
Editorial
Quality of life after cardiac arrest: How and when to assess outcomes after hospital discharge?
Significant variation in incidence and survival rates for out-ofhospital cardiac arrest (OHCA) patients has been observed between countries, states and cities.1–4 In recent years, there has been substantial investment in the improvement of the emergency medical response to OHCA patients, and reports of impressive survival gains are emerging. For example, results from the Danish Cardiac Arrest Registry show an increase in 30-day survival for OHCA patients of presumed cardiac aetiology from 3.5% (95% CI, 2.5%–4.5%) in 2001 to 10.8% (95% CI, 9.4%–12.2%) in 2010 (p < 0.001).5 Similarly, data from the London Ambulance Service cardiac arrest registry show a notable increase in survival to hospital discharge for bystander witnessed OHCA of presumed cardiac cause with an initial rhythm of ventricular fibrillation/ventricular tachycardia (VF/VT), with survival increasing from 12.0% in 2007/08 to 31.7% in 2011/12.6 In Victoria, Australia, we have seen the relative odds of survival to discharge for VF/VT patients increase two fold from 2003/04 to 2012/13 (AOR 2.1, 95% CI 1.6–2.8).7 Although survival to hospital discharge rates are improving, assessment of the health related quality of life (HRQoL) and neurological status of OHCA survivors is also important. To date the literature on the assessment of quality of life of cardiac arrest survivors has been disparate. A systematic review by Elliot et al.8 highlighted significant heterogeneity in the follow-up periods and HRQoL tools applied to the OHCA population. This review also demonstrated a lack of large scale prospective studies focused on assessing the quality of life of OHCA survivors, with the majority of studies (47/70) being case series. In addition, many studies assessed only neurological injury which may be different to quality of life, and most studies (n = 54) also contained less than 100 survivors.8 In this issue of Resuscitation, a study by Beesems et al.9 addresses many of these limitations. The investigators followed OHCA survivors identified within the ARREST registry in the Netherlands province of North-Holland, and prospectively applied the Short-form Health Survey (SF-12), Modified Rankin Scale (MRS), Telephonic Interview for Cognitive Status (TICS) and the Caregiver Strain Index (CSI) at 6–12 months post arrest. Overall, 21% of 1456 adult OHCA patients who were resuscitated by the emergency medical service survived to hospital discharge. Two-hundred and twenty survivors completed interviews at a median of 9 months post arrest (response rate of approximately 77% after excluding death post hospital discharge and patients aged
Contents lists available at ScienceDirect
Resuscitation journal homepage: www.elsevier.com/locate/resuscitation
Editorial
Quality of life after cardiac arrest: How and when to assess outcomes after hospital discharge?
Significant variation in incidence and survival rates for out-ofhospital cardiac arrest (OHCA) patients has been observed between countries, states and cities.1–4 In recent years, there has been substantial investment in the improvement of the emergency medical response to OHCA patients, and reports of impressive survival gains are emerging. For example, results from the Danish Cardiac Arrest Registry show an increase in 30-day survival for OHCA patients of presumed cardiac aetiology from 3.5% (95% CI, 2.5%–4.5%) in 2001 to 10.8% (95% CI, 9.4%–12.2%) in 2010 (p < 0.001).5 Similarly, data from the London Ambulance Service cardiac arrest registry show a notable increase in survival to hospital discharge for bystander witnessed OHCA of presumed cardiac cause with an initial rhythm of ventricular fibrillation/ventricular tachycardia (VF/VT), with survival increasing from 12.0% in 2007/08 to 31.7% in 2011/12.6 In Victoria, Australia, we have seen the relative odds of survival to discharge for VF/VT patients increase two fold from 2003/04 to 2012/13 (AOR 2.1, 95% CI 1.6–2.8).7 Although survival to hospital discharge rates are improving, assessment of the health related quality of life (HRQoL) and neurological status of OHCA survivors is also important. To date the literature on the assessment of quality of life of cardiac arrest survivors has been disparate. A systematic review by Elliot et al.8 highlighted significant heterogeneity in the follow-up periods and HRQoL tools applied to the OHCA population. This review also demonstrated a lack of large scale prospective studies focused on assessing the quality of life of OHCA survivors, with the majority of studies (47/70) being case series. In addition, many studies assessed only neurological injury which may be different to quality of life, and most studies (n = 54) also contained less than 100 survivors.8 In this issue of Resuscitation, a study by Beesems et al.9 addresses many of these limitations. The investigators followed OHCA survivors identified within the ARREST registry in the Netherlands province of North-Holland, and prospectively applied the Short-form Health Survey (SF-12), Modified Rankin Scale (MRS), Telephonic Interview for Cognitive Status (TICS) and the Caregiver Strain Index (CSI) at 6–12 months post arrest. Overall, 21% of 1456 adult OHCA patients who were resuscitated by the emergency medical service survived to hospital discharge. Two-hundred and twenty survivors completed interviews at a median of 9 months post arrest (response rate of approximately 77% after excluding death post hospital discharge and patients aged
