Inadequate follow-up for many cardiac arrest patients
A major international study shows that if cardiac arrest patients are treated like heart attack patients only, this will potentially have negative consequences on their rehabilitation and return to working life. These patients often lack follow-up of the injuries they may have suffered to the brain in connection with their cardiac arrest, the researchers found.
It can happen anywhere, at any time – a heart stops beating.
In Europe, around 350,000 people are affected by out-of-hospital cardiac arrest (OHCA) every year.
Researchers at Lund University in Sweden and Skåne University Hospital led a study in collaboration with colleagues in four other European countries to investigate outcomes for patients who survive cardiac arrest in Sweden, Denmark, the UK, the Netherlands and Italy. Almost half of the 270 patients who took part in one of the largest studies ever conducted in this field found it hard to go back to their previous lives, regardless of whether they were of working age or retired.
“It is a surprisingly high proportion, we didn’t believe there would be so many”, says Gisela Lilja, researcher at Lund University, occupational therapist at Skåne University Hospital and lead author of the article in the scientific journal Circulation Cardiovascular Quality and Outcomes.
In the study, patients pointed out that they experienced cognitive problems such as impaired memory, difficulties with concentration and problem solving, and restricted mobility for at least six months after their cardiac arrest. Many of them also felt tired and depressed.
“In the study, when we also compared cardiac arrest patients with those who had suffered a heart attack, the control group, the cardiac arrest patients found it harder to return to their previous lives. In one of our previous studies we showed that the cardiac arrest survivors had particularly difficult with a slower mental processing speed compared to the control subjects. Now, we have also observed that this particular difficulty does not help them in their return to working life. These patients may be able to work for short periods of time, such as a couple of hours, but they cannot manage an eight-hour working day.”
Gisela Lilja considers that European healthcare is good at rehabilitating patients with brain injuries, but has missed the fact that a number of cardiac arrest patients also need rehabilitation for impaired brain function.
“Doctors on cardiology wards should be on the look-out for cognitive problems among these patients, and ensure that they get help for these impairments where necessary. They must see these patients as both heart and brain patients”, explains Gisela Lilja.
“It is not so easy for the patients themselves to understand what is wrong. Some of them probably believe that it is completely normal to experience memory impairment and fatigue and that there is no support or help available to enable them to return to a higher level of participation in their everyday lives”, Gisela Lilja concludes.
Publication: Return to Work and Participation in Society After Out-of-Hospital Cardiac Arrest
Gisela Lilja, researcher and occupational therapist at the Department of Clinical Sciences, Lund University, and the Centre for Cardiac Arrest at Skåne University Hospital.
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Facts on cardiac arrest/heart attack:
Sudden cardiac arrest means that the heart suddenly stops pumping blood. The person affected will collapse and lose consciousness after only a few seconds, as the brain is affected by lack of oxygen. Cardiac arrest leads to death unless treated immediately.
A heart attack is a blood clot in the coronary artery which causes an oxygen deficiency in a certain part of the heart. How much of the heart is affected and how long it takes before the clot can be dissolved determines the extent of lasting damage. A massive heart attack can lead to cardiac arrest and the death of the patient.
Source: Swedish Resuscitation Council
Facts on sudden cardiac arrest:
Every year, around 10 000 people in Sweden suffer a sudden cardiac arrest. For many of them, it happens unexpectedly in their everyday life – at work, while exercising or at home. Those who suffer sudden out-of-hospital cardiac arrest are often apparently healthy people of working age. The average age of these patients is just over 60 years and three out of four of them are men.
In half of cases, cardio-pulmonary resuscitation is started and one out of ten survives. Survival rates have increased in recent years with better knowledge of CPR among the general public and the development of new and improved treatment methods within public healthcare. However, many cardiac arrest patients suffer subsequent memory impairment and depression.
The cause of a sudden cardiac arrest is often cardiovascular disease, such as constricted blood-vessels. In that case, a subsequent operation can remove the cause of the cardiac arrest. A heart can also stop for other reasons, such as suffocation, drowning, poisoning, drug overdose or a powerful electric shock.
Source: Hans Friberg, consultant physician at Skåne University Hospital