Early ADL ability assessment and cognitive screening as markers of post-discharge outcomes after surviving an out-of-hospital cardiac arrest. A prospective cohort study.

Abstract

Background Assessment of activities of daily living (ADL) and cognitive screening are widely used in the care of out-of-hospital cardiac arrest (OHCA) survivors. Evidence linking them to post-discharge outcomes is limited, but could support targeted rehabilitation efforts. Aim To assess whether ADL ability measures and cognitive screening at hospital discharge were associated with post-discharge ADL ability, health-related quality of life (HRQoL) and return to work. Methods This prospective cohort study included 200 OHCA survivors admitted to Aarhus University Hospital. Self-reported ADL ability was measured using the Activities of Daily Living Interview (ADL-I). Observed ADL ability was measured with the Assessment of Motor and Process Skills (AMPS), dichotomised into age-matched or below-ability. Cognitive function was assessed with Montreal Cognitive Assessment (MoCA). Multivariable regressions, with multiple imputation, analysed associations between variables and outcomes, adjusting for age, sex, and comorbidities. Results Adjusted analyses showed significant associations between personal ADL-I (βadjusted = 0.3, 95%CI: 0.2;0.5) and AMPS (βadjusted = -0.6, 95%CI:-1.2;-0.03) at discharge and self-reported ADL ability six months after cardiac arrest. Baseline AMPS was statistically significantly associated with age-matched ADL ability six months after cardiac arrest (ORadjusted 5.5, 95%CI: 1.5;10.0), and personal ADL-I (VAS: βadjusted = 3.00, 95%CI: 1.3;4.6/index score: βadjusted = 0.03, 95%CI 0.01;0.05) and MoCA (index: βadjusted = -0.09, 95%CI: -0.2;-0.02) with HRQoL. The association between MoCA and return to work one-year after cardiac arrest showed an OR of 3.0 (95%CI: 0.5;9.0), although not statistically significant (p = 0.06). Conclusions Decreased ADL ability at hospital discharge was associated with poorer post-discharge outcomes in OHCA survivors, while cognitive screening was also associated with certain aspects of recovery.