To determine the association of depressive and PTSD symptoms with cardiac arrest survivors’ long-term recovery perceptions—after accounting for cognitive status, functional independence, and medical comorbidities—Sachin Agarwal, MD, MPH, Alex Presciutti, MA, and colleagues assessed cardiac arrest survivors using the question, “Do you feel that you have made a complete recovery from your arrest?”

“Despite improved survivability, cardiac arrest (CA) survivors face significant ‘extra-cardiac’ sequelae (neurologic, psychiatric, functional) secondary to lack of blood flow to the brain,” says Dr. Agarwal. “Understanding what impacts survivors’ subjective perception, months after discharge, is critical in developing quality, patient-centered care.”

For the study, published in the Journal of Critical Care, the research team measured psychological symptoms using the Center for Epidemiological Studies-Depression scale (CES-D) and the PTSD Checklist-Specific (PCLS). At 6 months post-cardiac arrest, 53% of patients had negative recovery perceptions. About one-third screened positively for depression and 28% for PTSD. Patients with higher CES-D scores were significantly more likely to have negative recovery perceptions in both unadjusted and adjusted analyses. PCL-S scores were significantly associated with negative recovery perceptions in an unadjusted model, but not after adjustment for covariates.

“We hypothesized that once survivors enter the real world and do not have the safety of the hospital room and resources, cognitive and physical impairments can become more apparent,” says Presciutti. “Based on this notion, we reran the analysis done at discharge and found that, despite the presence and persistence of marked neurologic and functional impairments after cardiac arrest, psychological distress is still the guiding factor when it comes to patient’s perceived recovery at 6 months.”

Dr. Agarwal stresses the need for a strong focus on patient-centered care. “Cardiac arrest survivors need to be informed, at least by hospital discharge, that they will be confronted with these issues post-discharge, which seems to be a limitation of current care paradigms,” he adds. He aims to continue examining the utility of hospital-based programs, such as his first-of-its-kind NeuroCardiac Clinic, as part of discharge planning to address psychological distress.

References

Presciutti A, Sobczak E, Sumner J, et al. The impact of psychological distress on long-term recovery perceptions in survivors of cardiac arrest. J Crit Care. 2019;50:227-233. Available at
www.sciencedirect.com/science/article/pii/S0883944118313844#.

Presciutti A, Verma J, Pavol M, et al. Posttraumatic stress and depressive symptoms characterize cardiac arrest survivors’ perceived recovery at hospital discharge. Gen Hosp Psychiatry. 2018;53:108-113.