Aim: To investigate whether the aetiology of in-hospital cardiac arrest (IHCA) is associated with long-term survival after 30-day survival.

Methods: A nationwide registry-based cohort study was conducted using the Swedish Registry for Cardiopulmonary Resuscitation. Adult IHCA patients in Sweden between 2018 and 2023 who survived ≥30 days were included. Aetiologies were merged into six categories (myocardial ischemia [reference], other cardiac, pulmonary, infectious, haemorrhagic and other non-cardiac). Cox (proportional hazards) regression models were used to estimate crude and multivariable adjusted (demographics, comorbidities, arrest characteristics) hazard ratios (HRs) with 95% CIs for all-cause mortality.

Results: Among 2692 30-day survivors (median age 71 years; 67% male), 886 deaths (33%) occurred over a median 3.7-year follow-up; overall one‑year survival was 86%. In the fully adjusted model, higher hazards of death were observed for infectious (HR 1.79, 95% CI 1.30–2.47), haemorrhagic (1.71, 1.20–2.43), and pulmonary aetiologies (1.61, 1.24–2.11), compared to myocardial ischemia. No difference was observed for cardiac and other non‑cardiac aetiologies.

Conclusions: Aetiology of in-hospital cardiac arrest is independently associated with long‑term prognosis after 30‑day survival. Compared with myocardial ischemia, infectious, haemorrhagic and pulmonary causes are associated with higher long‑term mortality. These findings support aetiology‑informed follow‑up after IHCA.

Background: Surviving sudden cardiac arrest often lead to long-term cognitive, emotional, and physical consequences. Although clinical guidelines recommend structured post-cardiac arrest follow-up, such follow-up is often lacking or inconsistent. Tailored digital interventions are scarce but may help address gaps in follow-up resources. The CARDIS trial evaluates the effects on patient-reported outcome measures of a co-created, web-based support programme designed to improve wellbeing, self management, and reintegration into everyday life for cardiac arrest survivors.

Methods: CARDIS is a multicentre, parallel-group, randomised controlled trial enrolling cardiac arrest survivors aged >18 years. Participants will be randomised 1:1 to intervention or control. Both groups will receive standard post-cardiac arrest care, including a routine followup visit with screening and management of cognitive, physical and emotional health, as well as a printed booklet. The intervention group will additionally receive access to a webbased selfguided support programme for 3 months. After study completion, control participants will be offered the programme.

Outcomes: Primary outcome is overall wellbeing and health (QWB) at 3 months. Secondary outcomes include self-reported cognitive problems, HRQoL, life satisfaction, symptoms of depre ssion and anxiety, post-traumatic stress, fatigue, and sleep disturbances. A process evaluation will evaluate social selection bias, adherence and participants experiences.

Discussion: The CARDIS trial will investigate the use of more accessible and standardised follow-up pathways by complementing existing care structures, thereby enhancing equity in long-term recovery and quality-of-life without requiring additional healthcare resources. The process evaluation will provide data on adherence, social selection, and engagement, essential for future implementation.

Trial registration: The trial is registered at clinicaltrials.gov (NCT07240714).

Importance  

Health-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.

Objective  

To investigate whether HRQOL 3 to 6 months after cardiac arrest is associated with long-term survival.

Design, Setting, and Participants  

This 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.

Exposures

 EQ-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 Measures  

Long-term survival up to a maximum of 7 years among patients surviving IHCA and OHCA.

Results  

In 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 Relevance  

In 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.