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Health-related quality of life after cardiac arrest
Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health.
2020 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Cardiac arrest is a major health problem worldwide. For many of the afflicted, cardiac arrest is the natural end of life. For others, it is an unexpected event suddenly striking in the middle of life. During the last decades, major efforts in treatment have contributed to more people surviving their cardiac arrest. However, previous research has mainly focused on survival, while the knowledge about health-related quality of life in survivors is sparse. Hence, there is a need for more research in order to extend the knowledge about the living situations among survivors and their spouses. For example, factors associated with health-related quality of life are not sufficiently investigated. Knowledge about such factors is important in order to develop interventions and to be able to improve post cardiac arrest care. In addition, existing research shows incongruent results concerning differences in characteristics and survival between men and women. In order to provide equitable care between sexes, further studies are warranted.

Aim: The overall aim of this thesis was to increase the knowledge of survival and health-related quality of life among people suffering cardiac arrest with focus on sex and other related factors. The specific aims were: to describe in-hospital cardiac arrest events with regard to sex and investigate if sex is associated with survival after controlling for known predictors and interaction effects (study I), to describe health status and psychological distress among in-hospital cardiac arrest survivors in relation to sex (study II), to investigate factors associated with health-related quality of life among cardiac arrest survivors treated with an implantable cardioverter defibrillator in relation to sex, and to compare their health-related quality of life with a general population, (study III) and to investigate if type D personality and perceived control among cardiac arrest survivors and their spouses were associated with their own and their partners’ health-related quality of life (study IV).

Methods: The general design in all studies (I-IV) was quantitative, cross-sectional and correlational. This thesis is based on four different data collections. Data was systematically collected using national quality registries (I and II) or by sending questionnaires to survivors (III and IV) and their spouses (IV), treated at several different hospitals in Sweden. The sample size varied between 126 and 990 across the studies. The outcomes and explanatory study variables were chosen with respect to Wilson and Cleary’s conceptual model of health-related quality of life. The main outcome variables were survival after resuscitation, survival at hospital discharge, survival at 30 days post cardiac arrest (I), and health-related quality of life measured by the Hospital Anxiety and Depression Scale (II and III) and the EuroQol-5 dimensions (II-IV). In this thesis descriptive and inferential statistics were applied. The main statistics consisted of logistic and linear regression analyses, and structural equation modelling.

Results: Male sex was associated with a better chance of survival to hospital discharge, but no associations between sex and survival after resuscitation or at 30 days were identified. More men than women received resuscitation attempts when suffering an in-hospital cardiac arrest (study I). Health-related quality of life among most cardiac arrest survivors was good (II-IV), even when compared to a general population (III). However, a significant proportion reported low health status and symptoms of anxiety and depression (II and III). Women reported worse health-related quality of life compared to men, and female sex was associated with poorer health-related quality of life in the multiple regression models (II and III). Several additional factors were identified to be associated with poorer health-related quality of life: being unemployed, having a type D personality, perceiving less control, suffering from more comorbidities and suffering from more ICD-related concerns (III). In addition, older age was associated with poorer (EQ VAS) or better (HADS Anxiety) health-related quality of life, depending of outcome measure (II). Moreover, perceived control and type D personality among the survivors were associated with health-related quality of life among their spouses, but not vice versa.

Conclusions: Although, sex does not appear to be an important predictor for survival, the difference between men and women regarding the proportion of resuscitation attempts should be further investigated. The majority of survivors and their spouses report good health-related quality of life similar to general populations. However, a substantial proportion suffer from health problems. Since women in general report worse health-related quality of life compared to men a higher proportion of women may be in need of support. Several factors associated with worse health-related quality of life were identified and might be used during follow-up and rehabilitation. For example, identifying type D personality might be important when screening patients at risk for health problems. Perceiving more control could be targeted by health-supportive interventions, for example person-centered care. Healthcare professionals should make efforts to identify survivors at risk of poor health-related quality of life and offer individualized support when needed. Characteristics among survivors were associated with health-related quality of life in their spouses. Including spouses in follow-up care is therefore important. Wilson and Cleary’s conceptual model for health-related quality of life appears to be applicable for choosing outcomes in cardiac arrest research and might be helpful when designing interventions to improve post cardiac arrest care.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2020. , p. 59
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1721
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:liu:diva-163602DOI: 10.3384/diss.diva-163602ISBN: 9789179299439 (print)OAI: oai:DiVA.org:liu-163602DiVA, id: diva2:1393574
Public defence
2020-03-13, Hasselquistsalen, Building 511, Campus US, Linköping, 09:00 (English)
Opponent
Supervisors
Funder
Swedish Heart Lung FoundationMedical Research Council of Southeast Sweden (FORSS)
Note

Fel ISBN i tryckt version, korrigerat i den elektroniska utgåvan.

Ytterligare forskningsfinansiär: Region Kalmar County

Available from: 2020-02-17 Created: 2020-02-17 Last updated: 2020-02-24Bibliographically approved
List of papers
1. Is there a difference in survival between men and women suffering in-hospital cardiac arrest?
Open this publication in new window or tab >>Is there a difference in survival between men and women suffering in-hospital cardiac arrest?
2014 (English)In: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 43, no 6, p. 510-515Article in journal (Refereed) Published
Abstract [en]

Objectives: To describe in-hospital cardiac arrest (CA) events with regard to sex and to investigate if sex is associated with survival. Background: Previous studies exploring differences between sexes are incongruent with regard to clinical outcomes. In order to provide equality and improve care, further investigations into these aspects are warranted. Methods: This registry study included 286 CAs. To investigate if sex was associated with survival, logistic regression analyses were performed. Results: The proportion of CA with a resuscitation attempt compared to CA without resuscitation was higher among men. There were no associations between sex and survival when controlling for previously known predictors and interaction effects. Conclusions: Sex does not appear to be a predictor for survival among patients suffering CA where resuscitation is attempted. The difference regarding proportion of resuscitation attempts requires more attention. It is important to consider possible interaction effects when studying the sex perspective.

Place, publisher, year, edition, pages
Elsevier, 2014
Keywords
Heart arrest; Hospital; Sex; Survival; Predictor
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-112817 (URN)10.1016/j.hrtlng.2014.05.012 (DOI)000344837600007 ()25005828 (PubMedID)
Note

Funding Agencies|county council of Kalmar

Available from: 2015-01-08 Created: 2014-12-17 Last updated: 2020-02-17Bibliographically approved
2. Health status and psychological distress among in-hospital cardiac arrest survivors in relation to gender
Open this publication in new window or tab >>Health status and psychological distress among in-hospital cardiac arrest survivors in relation to gender
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2017 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 114, p. 27-33Article in journal (Refereed) Published
Abstract [en]

Aim: To describe health status and psychological distress among in -hospital cardiac arrest (IHCA) survivors in relation to gender. Methods: This national register study consists of data from follow-up registration of IHCA survivors 3-6 months post cardiac arrest (CA) in Sweden. A questionnaire was sent to the survivors, including measurements of health status (EQ-5D-5L) and psychological distress (HADS). Results: Between 2013 and 2015, 594 IHCA survivors were included in the study. The median values for EQ-5D-5L index and EQVAS among survivors were 0.78 (ql-q3 = 0.67-0.86) and 70 (ql -q3 = 50-80) respectively. The values were significantly lower (p amp;lt; 0.001) in women compared to men. In addition, women reported more problems than men in all dimensions of EQ-5D-5L, except self -care. A majority of the respondents reported no problems with anxiety (85.4%) and/or symptoms of depression (87.0%). Women reported significantly more problems with anxiety (p amp;lt; 0.001) and symptoms of depression (p amp;lt; 0.001) compared to men. Gender was significantly associated with poorer health status and more psychological distress. No interaction effects for gender and age were found. Conclusions: Although the majority of survivors reported acceptable health status and no psychological distress, a substantial proportion reported severe problems. Women reported worse health status and more psychological distress compared to men. Therefore, a higher proportion of women may be in need of support. Health care professionals should make efforts to identify health problems among survivors and offer individualised support when needed. (C) 2017 Elsevier B.V. All rights reserved.

Place, publisher, year, edition, pages
ELSEVIER IRELAND LTD, 2017
Keywords
Anxiety; Depression; Health status; Heart arrest; Hospitals; Gender
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-138921 (URN)10.1016/j.resuscitation.2017.02.006 (DOI)000402487800021 ()28216089 (PubMedID)
Note

Funding Agencies|Swedish Heart and Lung Association; Medical Research Council of Southeast Sweden

Available from: 2017-06-27 Created: 2017-06-27 Last updated: 2020-02-17
3. Factors associated with health-related quality of life among cardiac arrest survivors treated with an implantable cardioverter-defibrillator
Open this publication in new window or tab >>Factors associated with health-related quality of life among cardiac arrest survivors treated with an implantable cardioverter-defibrillator
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2018 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 132, p. 78-84Article in journal (Refereed) Published
Abstract [en]

Aim: To explore factors associated with health-related quality of life (HRQoL) among cardiac arrest (CA) survivors treated with an implantable cardioverter-defibrillator (ICD) in relation to gender, and to compare their HRQoL with a general population. Methods: This cross-sectional study included 990 adults treated with an ICD after suffering CA. All participants received a questionnaire including demographics, comorbidities and instruments to measure HRQoL (EQ-5D-3L and HADS), ICD-related concerns (ICDC), perceived control (CAS), and type D personally (DS-14). HRQoL (EQ-5D-3L) was compared to a general Swedish population, matched for age and gender. Linear regression analyses were used to explore factors associated with HRQoL. Results: The CA survivors reported better HRQoL in EQ index and less pain/discomfort compared to the general population (p amp;lt; 0.001). In contrast, they reported more problems in mobility and usual activities (p amp;lt; 0.01). Problems with anxiety and depression were reported by 15.5% and 7.4% respectively. The following factors were independently associated with all aspects of worse HRQoL: being unemployed, suffering more comorbidity, perceiving less control, and having a type D personally. Further, being female and suffering ICD-related concerns were independently associated with worse HRQoL in three of the four final regression models. Conclusions: This extensive population-based study showed that most CA survivors living with an ICD rate their HRQoL as acceptable. In addition, their HRQoL is similar to a general population. Women reported worse HRQoL compared to men. Several factors associated with HRQoL were identified, and might be used when screening patients for health problems and when developing health promoting interventions.

Place, publisher, year, edition, pages
ELSEVIER IRELAND LTD, 2018
Keywords
Health-related quality of life; Health status; Psychological distress; Cardiac arrest; Implantable cardioverter-defibrillator; Gender
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-152373 (URN)10.1016/j.resuscitation.2018.09.002 (DOI)000446854900019 ()30201535 (PubMedID)
Note

Funding Agencies|Medical Research Council of Southeast Sweden; Swedish Heart and Lung Association

Available from: 2018-11-05 Created: 2018-11-05 Last updated: 2020-02-17
4. Dyadic effects of type D personality and perceived control on health-related quality of life in cardiac arrest survivors and their spouses using the actor-partner interdependence model
Open this publication in new window or tab >>Dyadic effects of type D personality and perceived control on health-related quality of life in cardiac arrest survivors and their spouses using the actor-partner interdependence model
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2020 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 19, no 4, p. 351-358Article in journal (Refereed) Published
Abstract [en]

Background: There is a lack of knowledge about factors associated with health-related quality of life in cardiac arrest survivors and their spouses. In addition, survivors and spouses are likely to affect each others health-related quality of life. Aims: The aim was to investigate if a distressed personality and perceived control among cardiac arrest survivors and their spouses were associated with their own and their partners health-related quality of life. Methods: This dyadic cross-sectional study used the actor-partner interdependence model to analyse associations between a distressed personality (type D personality), perceived control (control attitudes scale), and health-related quality of life (EQ index and EQ visual analogue scale). Results: In total, 126 dyads were included in the study. Type D personality and perceived control in cardiac arrest survivors were associated with their own health-related quality of life. In their spouses, a significant association was found for type D personality but not for perceived control. In addition, type D personality and perceived control in survivors were associated with health-related quality of life in their spouses. Conclusions: Type D personality and perceived control are factors that might be considered during post cardiac arrest, because of the associations with health-related quality of life in survivors and spouses. More research is needed to test psychosocial interventions in the cardiac arrest population in order to improve health-related quality of life.

Place, publisher, year, edition, pages
SAGE PUBLICATIONS LTD, 2020
Keywords
Heart arrest; survivor; partner; health; quality of life; dyads
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-162500 (URN)10.1177/1474515119890466 (DOI)000498130000001 ()31752502 (PubMedID)
Note

Funding Agencies|Swedish Heart and Lung AssociationSwedish Heart-Lung Foundation; Medical Research Council of Southeast Sweden

Available from: 2019-12-16 Created: 2019-12-16 Last updated: 2020-04-09

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