OHCA survivors report restricted socialization, increased cognitive impairment post-arrest

Nearly half of all out-of-hospital cardiac arrest (OHCA) survivors struggle to rejoin the workforce and participate in society post-heart attack, a study published in Circulation: Cardiovascular Quality and Outcomes suggests.

“Out-of-hospital cardiac arrest trials have historically focused on survival, and substantial knowledge gaps still exist on long-term outcomes and the quality of life after OHCA,” corresponding author Gisela Lilja, OT, PhD, and colleagues wrote in the paper.

Lilja et al.’s previous work has established that more than 50 percent of OHCA survivors in a large sample cohort face mild-to-moderate cognitive impairment after their cardiac arrest, implying an unfavorable long-term outcome in those patients.

“It seems likely that even mild cognitive disability may impose important limitation on more demanding everyday activities such as work,” the authors wrote. “On the other hand, we recognize that cognitive impairment identified by objective assessments without consequences for everyday life may be of less importance for the patients’ long-term outcome.”

To expand their research, Lilja’s team focused on 287 OHCA survivors included in the TTM (Target Temperature Management) trial, alongside 119 controls with ST-segment-elevation myocardial infarction (STEMI). All controls were matched for age and sex.

Over a follow-up period of 180 days, the researchers assessed participants for their level of participation in society, judging the patients based on their ability to return to work, emotional issues and cognitive impairment.

Compared with the control cohort, OHCA survivors were more likely to struggle to participate in everyday life and society six months post-arrest, reaching a 30 percent participation rate compared to the control’s 47 percent. OHCA patients who’d been working before their cardiac arrest were also more prone to take sick leave, according to the study—27 percent of the pool took off work compared to just 7 percent of the working control group with STEMI.

The fifty-five OHCA survivors with cognitive impairment who were expected to return to work were also three times more likely to be on sick leave compared to those without cognitive disabilities, Lilja and co-authors reported. Survivors who were the least active in their communities after their cardiac events also saw higher rates of depression, restricted mobility, memory impairment, novel problem-solving difficulties, fatigue and slower processing speed.

Cliften W. Callaway, MD, wrote in an accompanying editorial that while Lilja and colleagues’ work shines a light on an often-overlooked aspect of OHCA, its limitations—for, example, the trial’s reliance on the Cerebral Performance Category (CPC) score to measure brain performance—could be “imprecise and unreliable.”

“As survival from cardiac arrest increases, it is critical to optimize the quality of outcomes that are important to patients,” Callaway wrote. “Quality of recovery is influenced not just by physical impairments, but also by the resilience of the patient, by the resources provided to them, by the environment in which they reside and by the available adaptive strategies. Clinical care and research trials should pay attention to all of these factors.”

Lilja and co-authors recommended in the study that clinicians address social symptoms more frequently in OHCA survivors, so they can identify patients who need additional support and rehabilitation.