This cohort study examines whether health-related quality of life 3 to 6 months after cardiac arrest is associated with long-term survival among adults who survived in-hospital or out-of-hospital cardiac arrest.,QuestionIs health-related quality of life (HRQOL) 3 to 6 months after cardiac arrest associated with long-term survival?FindingsIn this cohort study including 2000 survivors of in-hospital cardiac arrest and 1108 survivors of out-of-hospital cardiac arrest (OHCA), poorer HRQOL reported with the EuroQoL 5-dimension 5-level (EQ-5D-5L) tool questionnaire was associated with reduced long-term survival (assessed up to 7 years) in both cohorts, although uncertainty was higher among OHCA survivors.MeaningFindings suggest that HRQOL measured after cardiac arrest with the EQ-5D-5L may help identify survivors at risk of reduced long-term survival and inform follow-up care and rehabilitation; further research should confirm clinical utility.,ImportanceHealth-related quality of life (HRQOL) follow-up can increase knowledge of cardiac arrest outcomes from the patient's perspective. Whether HRQOL affects long-term survival is unknown.ObjectiveTo investigate whether HRQOL 3 to 6 months after cardiac arrest is associated with long-term survival.Design, Setting, and ParticipantsThis cohort study linked 5 national registers with nationwide coverage in Sweden across a 7-year period and included survivors of in-hospital cardiac arrest (IHCA) or out-of-hospital cardiac arrest (OHCA) between January 1, 2014, and December 31, 2019, with follow-up through June 30, 2021. Participants were adults surviving at least 90 days after IHCA or OHCA who completed follow-up EuroQoL 5-dimension 5-level (EQ-5D-5L) tool questionnaires. Analyses were performed December 2 to 20, 2024.ExposuresEQ-5D-5L level sum score (LSS; sum of EQ-5D-5L dimensions, ranging from 5 [no problems] to 25 [extreme problems in all dimensions]), and the visual analog scale EQ VAS, 3 to 6 months after cardiac arrest.Main Outcome and MeasuresLong-term survival up to a maximum of 7 years among patients surviving IHCA and OHCA.ResultsIn total, 2000 survivors of IHCA (median [IQR] age, 73 [65-80] years, 66% male) and 1108 survivors of OHCA (median [IQR] age, 69 [59-75] years, 77% male) were included. There were 475 deaths among patients with IHCA and 132 deaths among patients with OHCA. For patients with IHCA, the LSS distribution was 394 (20%) for LSS 5, 1034 (52%) for LSS 6 to 10, and 572 (29%) for LSS 11 to 25. For patients with OHCA, the LSS distribution was 299 (27%) for LSS 5, 637 (58%) for LSS 6 to 10, and 168 (15%) for LSS 11 to 25. In the IHCA population, LSS 11 to 25 had higher hazard of death compared with LSS 5 (adjusted hazard ratio [AHR], 2.50 [95% CI, 1.82-3.43]), whereas LSS 6 to 10 did not (AHR, 1.21 [95% CI, 0.88-1.65]). In OHCA, no associations were found between LSS categories and long-term survival (LSS 11-25 vs LSS 5: AHR, 1.41 [95% CI, 0.83-2.42]; LSS 6-10 vs LSS 5: AHR, 0.88 [95% CI, 0.56-1.39]). In both IHCA and OHCA, spline modeling using LSS and EQ VAS as continuous variables showed significant increases in hazards of death with poorer HRQOL, although the estimates in the OHCA population showed greater uncertainty.Conclusions and RelevanceIn this cohort study of patients who survived beyond 90 days after IHCA or OHCA, poorer HRQOL reported with EQ-5D-5L scores 3 to 6 months after cardiac arrest was associated with reduced long-term survival in both groups, with greater uncertainty for OHCA estimates. HRQOL assessment may help guide follow-up care.

Aim: Self-reported cognitive function has been described as an important complement to performance-based measurements but has seldom been investigated in cardiac arrest (CA) survivors. Therefore, the aim was to describe self-reported cognitive function and its association with health status, psychological distress, and life satisfaction.

Methods: This study utilised data from the Swedish Register of Cardiopulmonary Resuscitation (2018–2021), registered 3–6 months post-CA. Cognitive function was assessed by a single question: “How do you experience your memory, concentration, and/or planning abilities today compared to before the cardiac arrest?”. Health status was measured using the EQ VAS, psychological distress with the Hospital Anxiety and Depression Scale, and overall life satisfaction with the Life Satisfaction checklist. Data were analysed using binary logistic regression.

Results: Among 4026 identified survivors, 1254 fulfilled the inclusion criteria. The mean age was 65.9 years (SD = 13.4) and 31.7% were female. Self-reported cognitive function among survivors was reported as: ‘Much worse’ by 3.1%, ‘Worse’ by 23.8%, ‘Unchanged’ by 68.3%, ‘Better’ by 3.3%, and ‘Much better’ by 1.5%. Declined cognitive function was associated with lower health status (OR = 2.76, 95% CI = 2.09–3.64), symptoms of anxiety (OR = 3.84, 95% CI = 2.80–5.24) and depression (OR = 4.52, 95% CI = 3.22–6.32), and being dissatisfied with overall life (OR = 2.74, 95% CI = 2.11–3.54). These associations remained significant after age, sex, place of CA, aetiology, initial rhythm, initial witnessed status, and cerebral performance were controlled.

Conclusions: Survivors experiencing declined cognitive function post-CA are at a higher risk of poorer health status, increased psychological distress, and reduced life satisfaction, and these risks should be acknowledged by healthcare professionals.

Having an infant requiring care in a neonatal intensive care unit (NICU) is challenging for parents. The aim was to investigate the effects of the Family Health Conversation (FamHC) model on self-reported mental health, family wellbeing, and family functioning in parents of infants requiring mechanical respiratory support during NICU care. This interventional study included 147 parents (72, intervention group; 75, control group). All participants received a study-specific questionnaire at three time points. The intervention trended toward positive effects on mental health, family wellbeing, and family functioning. However, all measurements showed considerable variation, and the estimated effects were not statistically significant at the 0.05 level. Regardless of the intervention, mental health symptoms decreased over time, whereas family wellbeing and functioning remained stable. To conclude, although the intervention trended favorable for all outcomes, no significant differences were observed between groups. Potential effects might be better identified using qualitative methodology or self-reporting measures in a larger sample.

Introduction: Cardiac arrest (CA) survivors often face significant health challenges, including insomnia, which can adversely affect their healthrelated quality of life. The Minimal Insomnia Symptom Scale (MISS) is a brief, self-reported instrument designed to screen for insomnia. This study aimed to identify the measurement properties of the MISS in CA survivors and to explore a relevant cut-off score. Methods: Data were collected from two studies: a health survey of CA survivors and a sub-study of a randomized controlled trial (RCT) on targeted temperature management (TTM2). A total of 269 CA survivors participated, with 212 from the survey and 57 from the RCT, the data was collected 6- 7 months after CA. The MISS was evaluated using the polytomous Rasch model, focusing on model fit, local independence, response category functioning, targeting, reliability, and differential item functioning (DIF). Results: In total, 212 participants were males and 57 females, with a mean age of 66 years. Overall, 51% had survived in-hospital CA and 49% outof-hospital CA. The MISS exhibited acceptable model fit and targeting, with no disordered thresholds or DIF for age, sex, or place of arrest. The reliability was acceptable. The suggested optimal cut-off score for identifying insomnia was >6 points. Conclusions: The findings indicate that MISS is a valid and reliable screening instrument for insomnia in CA survivors. These results support the use of MISS for screening insomnia in CA survivors.

Background 

In Sweden, most out-of-hospital cardiac arrests (OHCAs) occur in private residences and nursing homes. Although studies suggest that nursing home staff appear hesitant to start cardiopulmonary resuscitation (CPR) before ambulance staff arrive, it is unknown whether treatment and outcomes among those who suffer OHCA in nursing homes differ from private residences. The aim of the study was to describe OHCA occurrence, treatment, and 30-day survival in people aged 65 years or older in Swedish nursing homes, in comparison with private residences.

Methods 

This retrospective registry study utilized data from the Swedish Register of Cardiopulmonary Resuscitation from 1992 to 2022. The study included 59 459 OHCAs. Data were analyzed using descriptive and inferential statistics, complemented with generalized linear models.

Results 

The number of OHCAs was 56 379 in private residences and 3 080 in nursing homes. While the occurrence of OHCA increased in private residences it remained stable in nursing homes. The overall survival rate in people suffering OHCA in living facilities was 4.4% during the 31-year study period. There was an advantage of 1.0% in 30-days survival for private residences in the unadjusted analyses (p < 0.001), while the adjusted longitudinal model displayed a positive trend in annual survival odds in both private residences (5.6%) and in nursing homes (3.5%), with no difference between the groups (p = 0.207).

Conclusions 

In this registry study, 30-day survival in nursing homes and private residences was similar and improved in both settings. These findings suggest that the location of OHCA is not the primary determinant of survival. Resuscitation decisions should be guided by careful consideration of the patient’s medical condition, frailty, andpersonal preferences. Future initiatives might include strengthening emergency preparedness in nursing homes while supporting ethically justified and patient-centred shared decision-making.

BackgroundResearch on ethnic and socioeconomic treatment differences following in-hospital cardiac arrest (IHCA) largely draws on register data. Due to the correlational nature of such data, it cannot be concluded whether detected differences reflect treatment bias/discrimination – whereby otherwise identical patients are treated differently solely due to sociodemographic factors. To be able to establish discrimination, experimental research is needed.ObjectiveThe primary aim of this experimental study was to examine whether simulated IHCA patients receive different treatment recommendations based on ethnicity and socioeconomic status (SES), holding all other factors (e.g., health status) constant. Another aim was to examine health care professionals’ (HCP) stereotypical beliefs about these groups.MethodsHCP (N = 235) working in acute care made anonymous treatment recommendations while reading IHCA clinical vignettes wherein the patient's ethnicity (Swedish vs. Middle Eastern) and SES had been manipulated. Afterwards they estimated to what extent hospital staff associate these patient groups with certain traits (stereotypes).ResultsNo significant differences in treatment recommendations for Swedish versus Middle Eastern or high versus low SES patients were found. Reported stereotypes about Middle Eastern patients were uniformly negative. SES-related stereotypes, however, were mixed. High SES patients were believed to be more competent (e.g., respected), but less warm (e.g., friendly) than low SES patients.ConclusionsSwedish HCP do not seem to discriminate against patients with Middle Eastern or low SES backgrounds when recommending treatment for simulated IHCA cases, despite the existence of negative stereotypes about these groups. Implications for health care equality and quality are discussed.

Background: Non-shockable initial rhythm is a known risk factor for high mortality at cardiac arrest (CA). However, knowledge on its association with self-reported health in CA survivors is still incomplete.

Aim: To examine the associations between initial rhythm and self-reported health in CA survivors.

Methods: This nationwide study used data from the Swedish Register for Cardiopulmonary Resuscitation 3–6 months post CA. Health status was measured using EQ-5D-5L and psychological distress by the Hospital Anxiety and Depression Scale (HADS). Kruskal-Wallis test was used to examine differences in self-reported health between groups of different initial rhythms. To control for potential confounders, age, sex, place of CA, aetiology, witnessed status, time to CPR, time to defibrillation, and neurological function were included as covariates in multiple regression analyses for continuous and categorical outcomes.

Results: The study included 1783 adult CA survivors. Overall, the CA survivors reported good health status and symptoms of anxiety or depression were uncommon (13.7% and 13.9% respectively). Survivors with PEA and asystole reported significantly more problems in all dimensions of health status (p = 0.037 to p < 0.001), anxiety (p = 0.034), and depression (p = 0.017) compared to VT/VF. Overall, these differences did not remain in the adjusted regression analyses.

Conclusions: Initial rhythm is not associated with self-reported health when potential confounders are controlled. Initial rhythm seems to be an indicator of unfavourable factors causing the arrest, or factors related to characteristics and treatment. Therefore, initial rhythm may be used as a proxy for identifying patients at risk for poor outcomes such as worse health status and psychological distress.

Aim: To increase survival in out-of-hospital cardiac arrests (OHCA), great efforts are made to improve the number of voluntary first responders (VFR). However, evidence of the potential utility of such efforts is sparse, especially in rural areas. Therefore, the aim was to describe and compare response times for emergency medical services (EMS), fire and rescue services (FRS), and VFR during OHCA in relation to population density.

Methods: This observational and comparative study was based on data including positions and time stamps for VFR and response times for EMS and FRS in a region in southern Sweden.ResultsIn total, 285 OHCAs between 1 July 2020 and 31 December 2021 were analysed. VFR had the shortest median response time in comparison to EMS and FRS in all studied population densities. The overall median (Q1–Q3) time gain for VFR was 03:07 (01:39–05:41) minutes. A small proportion (19.2%) of alerted VFR accepted the assignments. This is most problematic in rural and sub-rural areas, where there were low numbers of alerted VFR. Also, FRS had shorter response time than EMS in all studied population densities except in urban areas.

Conclusion: The differences found in median response times between rural and urban areas are worrisome from an equality perspective. More focus should be placed on recruiting VFR, especially in rural areas since VFR can potentially contribute to saving more lives. Also, since FRS has a shorter response time than EMS in rural, sub-rural, and sub-urban areas, FRS should be dispatched more frequently.

Introduction/aim: Out-of-hospital cardiac arrest (OHCA) with shockable pulseless ventricular tachycardia or fibrillation not responding to defibrillation is a medical challenge. Novel treatment strategies have emerged for so-called refractory ventricular fibrillation not responding to three or more defibrillations but the evidence for optimal timing for these strategies is sparse. The primary aim of this observational study was to assess survival in relation to total numbers of defibrillations in OHCA. Methods: This is a registry-based retrospective cohort study based on data reported by the emergency medical services to the Swedish Registry of Cardiopulmonary Resuscitation and the National Patient Registry. All OHCA patients aged 18 years or older with an initial shockable rhythm in Sweden from January 1, 2010 and December 31, 2020 were included. Exposure was total number of defibrillations, and primary outcome was survival to 30 days. Logistic regression was used to adjust for patient and resuscitation characteristics. Results: Over the study period a total of 10,549 patients were included. Among them, 3,006 (28.5%) received only one shock, 1,665 (15.8%) two shocks, 1,336 (12.9%) three shocks, 1,064 (10.1%) four shocks and 3,478 (33.0%) five or more shocks. In the adjusted analysis an exponential decrease in the 30-day survival was found for each additional defibrillation. For patients receiving one, two, three and four defibrillations, the adjusted probability of survival was 42%, 36%, 30% and 25% respectively. Conclusions: In this registry-based retrospective cohort study, additional defibrillations were associated with a lower survival. This association persisted after adjustments for patient and resuscitation characteristics.

Background: Studies investigating sex disparities related to treatment and outcome of in-hospital cardiac arrest (IHCA) have produced divergent findings and have typically been unable to adjust for outstanding confounding variables.

Objectives: The aim was to examine sex differences in treatment and survival following IHCA, using a comprehensive set of control variables including e.g., age, comorbidity, and patient-level socioeconomic status. Methods: This retrospective study was based on data from the Swedish Register of Cardiopulmonary Resuscitation and Statistics Sweden. In the primary analyses, logistic regression models and ordinary least square regressions were estimated.

Results: The study included 24,217 patients and the majority (70.4%) were men. In the unadjusted analyses, women had a lower chance of survival after cardiopulmonary resuscitation (CPR) attempt, at hospital discharge (with good neurological function) and at 30 days (p<0.01). In the adjusted regression models, female sex was associated with a higher chance of survival after the CPR attempt (B = 1.09, p<0.01) and at 30-days (B = 1.09, p<0.05). In contrast, there was no significant association between sex and survival to discharge with good neurological outcome. Except for treatment duration (B=-0.07, p<0.01), no significant associations between sex and treatment were identified.

Conclusions: No signs of treatment disparities or discrimination related to sex were identified. However, women had a better chance of surviving IHCA compared to men. The finding that women went from having a survival disadvantage (unadjusted analysis) to a survival advantage (adjusted analysis) attests to the importance of including a comprehensive set of control variables, when examining sex differences.