Association between bystander cardiopulmonary resuscitation and redeemed prescriptions for antidepressants and anxiolytics in out-of-hospital cardiac arrest survivors

Use of healthcare services before and after out-of-hospital cardiac arrest

INTRODUCTION

Knowledge about the use of healthcare services in patients experiencing out-of-hospital cardiac arrest (OHCA) is limited. We aimed to describe and compare the use of healthcare by OHCA survivors two years before and one year after cardiac arrest.

METHODS

Adult patients with OHCA of medical cause, who survived >30 days, were identified in the Norwegian Cardiac Arrest Registry. The Norwegian Patient Registry, The Cause of Death Registry, and The Norwegian Registry for Primary Healthcare provided data on survival and the use of healthcare services. We investigated the use of primary, specialist and mental healthcare, as well as rehabilitation services.

RESULTS

In 2015-2018, 13,112 OHCA cases were identified; 1435 (14%) patients survived >30 days (6.8/100,000 patients/year). The proportion of patients in the cohort that used primary healthcare each month increased form 43% before to 69% after OHCAto (p<0.001). We found a doubling of monthly healthcare contacts in both specialist healthcare (from 26% to 57%, p<0.001) and mental healthcare (from 3% to 8%, p>0.001). The observed increases in primary, specialist and mental healthcare use started two weeks, six months, and eight months before OHCA, respectively. Half of the patients had contact with primary healthcare services on the same day as the cardiac arrest. Two out of five patients were registered for rehabilitation after OHCA.

CONCLUSION

The use of primary, specialist and mental healthcare services increased before OHCA and remained significantly higher the year after OHCA. Less than half of the patients surviving cardiac arrest were registered for rehabilitation.

Evaluation of Neurologic and Psychiatric Outcomes After Hospital Discharge Among Adult Survivors of Cardiac Arrest

IMPORTANCE

Long-term risks of neurologic and psychiatric disease after cardiac arrest are largely unknown.

OBJECTIVE

To examine the short-term and long-term risks of common neurologic outcomes (stroke, epilepsy, Parkinson disease, and dementia) and psychiatric outcomes (depression and anxiety) in patients after hospitalization for cardiac arrest.

DESIGN, SETTING, AND PARTICIPANTS

This nationwide population-based cohort study with 21 years of follow-up included data on 250 838 adults from all Danish hospitals between January 1, 1996, and December 31, 2016. Danish medical registries were used to identify all patients with a first-time diagnosis of cardiac arrest and 2 matched comparison cohorts. The first comparison cohort included patients with a first-time diagnosis of myocardial infarction; the second comprised people from the general population. Data analysis was performed from November 1, 2020, to June 30, 2021.

EXPOSURES

In-hospital or out-of-hospital cardiac arrest.

MAIN OUTCOMES AND MEASURES

Neurologic and psychiatric outcomes after hospital discharge were ascertained using medical registries. Twenty-one-year hazard ratios (HRs) and 95% CIs were computed based on Cox regression analysis, controlled for matching factors, and adjusted for comorbidity and socioeconomic status.

RESULTS

Among the 250 838 individuals included in this study (median age, 67 years [IQR, 57-76 years]; 173 946 [69.3%] male), 3 groups were identified: 12 046 patients with cardiac arrest, 118 332 patients with myocardial infarction, and 120 460 people from the general population. Compared with patients with myocardial infarction, patients with cardiac arrest had an increased rate of ischemic stroke (10 per 1000 persons; HR, 1.30; 95% CI, 1.02-1.64) and hemorrhagic stroke (2 per 1000 persons; HR, 2.03; 95% CI, 1.12-3.67) in the first year after discharge. During the full follow-up period, rates were as follows: for epilepsy, 28 per 1000 persons (HR, 2.01; 95% CI, 1.66-2.44); for dementia, 73 per 1000 persons (HR, 1.23; 95% CI, 1.09-1.38); for mood disorders including depression, 270 per 1000 persons (HR, 1.78; 95% CI, 1.68-1.89); and for anxiety, 187 per 1000 persons (HR, 1.98; 95% CI, 1.85-2.12). The rate of Parkinson disease was similar in the 2 cohorts (8 per 1000 persons; HR, 0.96; 95% CI, 0.65-1.42). The rates of the aforementioned outcomes were highest during the first year after cardiac arrest and then declined over time. Comparisons between the cohort of patients with cardiac arrest and the general population cohort showed higher rates of epilepsy, dementia, depression, and anxiety in the cardiac arrest group.

CONCLUSIONS AND RELEVANCE

In this cohort study, patients discharged after cardiac arrest had an increased rate of subsequent stroke, epilepsy, dementia, depression, and anxiety compared with patients with myocardial infarction and people from the general population, with declining rates over time. These findings suggest the need for preventive strategies and close follow-up of cardiac arrest survivors.

Long-term outcomes after out-of-hospital cardiac arrest in relation to socioeconomic status

AIMS

This study aimed to examine whether socioeconomic differences exist in long-term outcomes after out-of-hospital cardiac arrest (OHCA).

METHODS

We included 2309 30-day OHCA survivors ≥ 30 years of age from the Danish Cardiac Arrest Registry, 2001-2014, divided in tertiles of household income (low, medium, high). Absolute probabilities were estimated using logistic regression for 1-year outcomes and cause-specific Cox regression for 5-year outcomes. Differences between income-groups were standardized with respect to age, sex, education and comorbidities.

RESULTS

High-income compared to low-income patients had highest 1-year (96.4% vs. 84.2%) and 5-year (87.6% vs. 64.1%) survival, and lowest 1-year (11.3% vs. 7.4%) and 5-year (13.7% vs. 8.6%) risk of anoxic brain damage/nursing home admission. The corresponding standardized probability differences were 8.2% (95%CI 4.7-11.6%) and 13.9% (95%CI 8.2-19.7%) for 1- and 5-year survival, respectively; and -4.5% (95%CI -8.2 to -1.2%) and -5.1% (95%CI -9.3 to -0.9%) for 1- and 5-year risk of anoxic brain damage/nursing home admission, respectively. Among 831 patients < 66 years working prior to OHCA, 72.1% returned to work within 1 year and 80.8% within 5 years. High-income compared to low-income patients had the highest chance of 1-year (76.4% vs. 58.8%) and 5-year (85.3% vs. 70.6%) return to work with the corresponding absolute probability difference of 18.0% (95%CI 3.8-32.7%) for 1-year and 9.4% (95%CI -3.4 to 22.3%) for 5-year.

CONCLUSION

Patients of high socioeconomic status had higher probability of long-term survival and return to work, and lower risk of anoxic brain damage/nursing home admission after OHCA compared to patients of low socioeconomic status.

Bystander interventions and survival following out-of-hospital cardiac arrest at Copenhagen International Airport

AIM

To examine incidence and outcome following out-of-hospital cardiac (OHCA) arrest in a high-risk area characterised by high density of potential bystanders and easy access to nearby automated external defibrillators (AEDs).

METHODS

This retrospective observational study investigated pre-hospital and in-hospital treatment, as well as survival amongst persons with OHCA at Copenhagen International Airport between May 25, 2015 and May 25, 2019. OHCA data from pre- and in-hospital medical records were obtained and compared with public bystander witnessed OHCAs in Denmark.

RESULTS

Of the 23 identified non-traumatic OHCAs, 91.3% were witnessed by bystanders, 73.9% received bystander cardiopulmonary resuscitation (CPR), and 43.5% were defibrillated by a bystander. Survival to hospital discharge was 56.5%, with 100% survival among persons with an initial shockable heart rhythm. Compared with nationwide bystander witnessed OHCAs, persons with OHCA at the airport were less likely to receive bystander CPR (73.9% vs. 89.4%, OR 0.33; 95% CI, 0.13-0.86), more likely to receive bystander defibrillation (43.5% vs. 24.8%, OR 2.32; 95% CI, 1.01-5.31), to achieve return of spontaneous circulation (78.2% vs. 50.6%, OR 3.51; 95% CI, 1.30-9.49), and survive to hospital discharge (56.5% vs. 45.2%, OR 1.58; 95% CI, 0.69-3.62).

CONCLUSION

We found a high proportion of bystander defibrillation indicating that bystanders will quickly apply an AED, when accessible. Importantly, 56% of all persons, and all persons with a shockable heart rhythm survived. These findings suggest increased potential for survival following OHCA and support current guidelines to strategically deploy accessible AEDs in high-risk OHCA areas.

Exposure to selective serotonin reuptake inhibitors in utero and early elementary school outcomes

OBJECTIVE

Data on special education in offspring exposed to selective serotonin reuptake inhibitors (SSRIs) in utero are lacking. We examined associations of in utero SSRI exposure with special education needs and delayed elementary school start.

METHODS

A population-based case-cohort study using Danish nationwide birth and prescription registry data from 2005 to 2008. Follow-up ends during 2011-2015 to capture special education needs during and delayed entry to the first elementary school year. Cases were in utero SSRI-exposed offspring. Cohort-controls were SSRI-unexposed offspring of mothers previously on SSRIs. We reported odds ratios (ORs) and 95% confidence intervals (CIs), adjusted for relevant potential confounders.

RESULTS

Of 117 475 first-incident non-multiple pregnancy births, 3314 were SSRI-exposed, and 3536 were unexposed. Among SSRI-exposed offspring, 3.2% (n = 98) had special school needs vs. 2.4% (n = 77) in unexposed offspring, P-value=0.048. Correspondingly, 12.3% (n = 383) among SSRI-exposed children had delayed school entry vs. 9.4% (n = 308) in unexposed offspring, P-value < 0.001. Adjusted OR for the association with special school needs was 1.12 (95% CI 0.82-1.55; P-value = 0.48) and 1.38 (95% CI 0.90-2.13; P-value = 0.14) for exposure in all three trimesters. The corresponding adjusted ORs for delayed school entry were 1.17 (95% CI 0.99-1.38; P-value = 0.073) and 1.40 (95% CI 1.11-1.76; P-value = 0.004).

CONCLUSION

In utero SSRI exposure in all three trimesters was associated with delayed elementary school start but not special education needs.