院外心脏骤停后的重返工作与社会参与
Return to Work and Participation in Society After Out-of-Hospital Cardiac Arrest.
作者信息
Lilja Gisela, Nielsen Niklas, Bro-Jeppesen John, Dunford Hannah, Friberg Hans, Hofgren Caisa, Horn Janneke, Insorsi Angelo, Kjaergaard Jesper, Nilsson Fredrik, Pelosi Paolo, Winters Tineke, Wise Matt P, Cronberg Tobias
机构信息
From the Department of Clinical Sciences (G.L., T.C.) and Department of Clinical Sciences, Anesthesiology and Intensive Care Medicine (N.N., H.F.), Skane University Hospital, Lund University, Sweden; Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Denmark (J.B.-J., J.K.); Adult Critical Care, University Hospital of Wales, Cardiff, United Kingdom (H.D., M.P.W.); Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Sahlgrenska Academy, University of Gothenburg, Sweden (C.H.); Intensive Care, Academic Medical Center, Amsterdam, The Netherlands (J.H., T.W.); Anesthesia and Intensive Care, IRCCS AOU San Martino IST, Genova, Italy (A.I.); Research and Development Centre Skane, Medical Statistics and Epidemiology, Lund, Sweden (F.N.); and Department of Surgical Sciences and Integrated Diagnostics, Ospedale Policlinico San Martino - IRCCS per l'Oncologia, University of Genova, Italy (P.P.).
出版信息
Circ Cardiovasc Qual Outcomes. 2018 Jan;11(1):e003566. doi: 10.1161/CIRCOUTCOMES.117.003566.
BACKGROUND
The aim of this study was to describe out-of-hospital cardiac arrest (OHCA) survivors' ability to participate in activities of everyday life and society, including return to work. The specific aim was to evaluate potential effects of cognitive impairment.
METHODS AND RESULTS
Two hundred eighty-seven OHCA survivors included in the TTM trial (Target Temperature Management) and 119 matched control patients with ST-segment-elevation myocardial infarction participated in a follow-up 180 days post-event that included assessments of participation, return to work, emotional problems, and cognitive impairment. On the Mayo-Portland Adaptability Inventory-4 Participation Index, OHCA survivors (n=270) reported more restricted participation In everyday life and in society (47% versus 30%; <0.001) compared with ST-segment-elevation myocardial infarction controls (n=118). Furthermore, 27% (n=36) of pre-event working OHCA survivors (n=135) compared with 7% (n=3) of pre-event working ST-segment-elevation myocardial infarction controls (n=45) were on sick leave (odds ratio, 4.9; 95% confidence interval, 1.4-16.8; =0.01). Among the OHCA survivors assumed to return to work (n=135), those with cognitive impairment (n=55) were 3× more likely (odds ratio, 3.3; 95% confidence interval, 1.2-9.3; =0.02) to be on sick leave compared with those without cognitive impairment (n=40; 36%, n=20, versus 15%, n=6). For OHCA survivors, the variables that were found most predictive for a lower participation were depression, restricted mobility, memory impairment, novel problem-solving difficulties, fatigue, and slower processing speed.
CONCLUSIONS
OHCA survivors reported a more restricted societal participation 6 months post-arrest, and their return to work was lower compared with ST-segment-elevation myocardial infarction controls. Cognitive impairment was significantly associated with lower participation, together with the closely related symptoms of fatigue, depression, and restricted mobility. These predictive variables may be used during follow-up to identify OHCA survivors at risk of a less successful recovery that may benefit from further support and rehabilitation.
CLINICAL TRIAL REGISTRATION
URL: https://www.clinicaltrials.gov. Unique identifier: NCT01946932.
背景
本研究的目的是描述院外心脏骤停（OHCA）幸存者参与日常生活和社会活动的能力，包括重返工作岗位。具体目标是评估认知障碍的潜在影响。
方法与结果
纳入TTM试验（目标温度管理）的287名OHCA幸存者和119名匹配的ST段抬高型心肌梗死对照患者在事件发生后180天参与了随访，随访内容包括对参与度、重返工作岗位、情绪问题和认知障碍的评估。在梅奥-波特兰适应性量表-4参与指数上，与ST段抬高型心肌梗死对照组（n = 118）相比，OHCA幸存者（n = 270）报告在日常生活和社会中的参与度受限更多（47%对30%；<0.001）。此外，事件前工作的OHCA幸存者（n = 135）中有27%（n = 36）休病假，而事件前工作的ST段抬高型心肌梗死对照组（n = 45）中这一比例为7%（n = 3）（比值比，4.9；95%置信区间，1.4 - 16.8；P = 0.01）。在假定会重返工作岗位的OHCA幸存者（n = 135）中，有认知障碍的幸存者（n = 55）休病假的可能性是无认知障碍者（n = 40）的3倍（比值比，3.3；95%置信区间，1.2 - 9.3；P = 0.02）（分别为36%，n = 20，对15%，n = 6）。对于OHCA幸存者，发现对较低参与度预测性最强的变量是抑郁、行动受限、记忆障碍、解决新问题困难、疲劳和处理速度较慢。
结论
OHCA幸存者在心脏骤停后6个月报告社会参与度受限更多，与ST段抬高型心肌梗死对照组相比，他们重返工作岗位的比例更低。认知障碍与较低的参与度显著相关，同时还与疲劳、抑郁和行动受限等密切相关症状有关。这些预测变量可在随访期间用于识别可能恢复不佳、可能从进一步支持和康复中受益的OHCA幸存者。
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