Cardiac Arrest Survivorship Research Hub

AIMS: The Modified Caregiver Strain Index (M-CSI) is a 13-item instrument that measures caregiver strain among various populations. A Danish version is lacking, and the psychometric properties among relatives of out-of-hospital cardiac arrest (OHCA) survivors are unknown. This study aimed to translate, cross-culturally adapt, and evaluate the psychometric properties of the Danish version of the M-CSI in relatives of OHCA survivors. METHODS AND RESULTS: The study used data from the national cross-sectional DANCAS (DANish Cardiac Arrest Survivorship) survey, where relatives of OHCA survivors completed the Danish versions of M-CSI, the Hospital Anxiety and Depression Scale (HADS), and the World Health Organisation's Five Well-being Index (WHO-5). The M-CSI was forward- and back-translated, pre-tested, and culturally adapted. Structural validity was examined with exploratory factor analysis (EFA) and construct validity was investigated using a priori hypothesis testing (known-groups validity) and correlations with the other instruments (convergent validity/overlapping constructs). The internal consistency reliability was assessed using Cronbach's α. In total, 561 relatives responded (response rate 45%), of which 88% were women, the median age was 64, and 24% reported caregiver strain (M-CSI ≥7). The EFA supported a one-factor structure. Based on the a priori hypotheses, it was confirmed that younger caregivers (<55 years) described more caregiver strain (effect size δ = 0.13; small). Correlations between M-CSI, HADS-A, HADS-D, and WHO-5 were moderate. Internal consistency was α = 0.90. CONCLUSION: The Danish version of the M-CSI demonstrated good structural validity, good internal consistency reliability, and good construct validity in relatives of OHCA survivors.

No abstract provided.

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.