Early prediction of long-term cognitive function, emotional distress, and health-related quality of life in cardiac arrest survivors.

Abstract

BACKGROUND: Cardiac arrest survivors are at risk of long-term disturbances in cognition, emotional distress, and health-related quality of life (QoL). Early prediction can guide tailored treatment. We evaluated whether early clinical measures predict long-term outcomes. METHODS: In a longitudinal multicenter cohort study, we prospectively included patients who regained consciousness after cardiac arrest. Potential predictors during hospitalization were scores on the Hospital Anxiety and Depression Scale (HADS), Montreal Cognitive Assessment (MoCA), and Barthel Index, and presence of delirium and transient coma >24 h. These were related to cognitive function (MoCA), emotional distress (HADS), and health-related QoL (EQ-5D-5L) at twelve months using multivariate mixed-effects models, with age and sex as covariates. Likelihood ratios were calculated for cognitive impairment (MoCA < 26). RESULTS: We included 100 patients; 20 % showed cognitive impairment at twelve months and 8 % and 10 % showed signs of anxiety and depression, respectively. Early MoCA showed a borderline significant positive relation with twelve-month MoCA (β = 0.21, p = 0.05). The likelihood ratio for early MoCA < 26 predicting cognitive impairment at twelve months was LR+ 1.29 (95 % CI: 0.40-4.20) and LR- 0.60 (95 % CI: 0.18-1.94). Early HADS was associated with twelve-month HADS (β = 0.47, 95 % CI: 0.33-0.60, p < 0.001), with age negatively associated (β = -0.10, 95 % CI: -0.18 to -0.02, p = 0.019). No other significant relations were found. CONCLUSION: MoCA and HADS scores during hospitalization relate to long-term cognitive and emotional outcomes after cardiac arrest. These measures may help identify patients who could benefit from cognitive rehabilitation or psychosocial support.