Abstract 302: NeuroCardiac Comprehensive Care Clinic Seeks to Define and Detect Neurological, Psychiatric, and Functional Sequelae in Cardiac Arrest Survivors

Abstract

Introduction: Despite improved survivability, cardiac arrest (CA) survivors face significant “extracardiac” (i.e. functional, cognitive and psychosocial) sequelae. More so, survivors and their caregivers are seemingly unaware that they will be confronted with these issues post-discharge. As a response, we have created a multidisciplinary, follow-up clinic to provide comprehensive and well-coordinated care to CA survivors. The team includes a neurointensivist, neuropsychologist, neuropsychiatrist and a chaplain. Hypothesis: CA survivors attending a follow-up clinic will have improved outcomes compared to historical controls. Methods: Fisher’s exact and Wilcoxon Rank-sum tests were used to assess differences in 1-year outcomes between survivors who had at least one follow-up visit in the NeuroCardiac clinic (2/2017-1/2018), with historical controls (9/2015 - 1/2017) who had no clinic visits. Results: Clinic patients (n= 34; median visit per patient=2), were slightly younger (49 vs 57 years, p=0.03) than historic controls (n=47), but otherwise there were no significant differences in demographic, psychosocial or functional status at hospital discharge. At 1-year, clinic patients, compared to historic controls, had significantly greater independence on the Lawton Physical Self-Maintenance Scale (mean score 7.6 vs 8.9, p=0.03) and Instrumental Activities of Daily Living scale (4.9 vs 8.8, p =.01). In clinic patients, there was a trend towards return to work (38.2% vs 23.4%), having a less negative impact on their marital status (5.9% vs 21.3%) and reduced complaints of sleep issues (29% vs 52%). Clinic patients had lower rates of depression symptoms on the Center for Epidemiological Studies-Depression scale (9.8 vs 13.4), were less fearful about the possibility of arrest recurrence (23.5% vs 31.9%), had more positive recovery perceptions (55.9% vs 38.3%), and had higher self-reported overall health ratings on a 100-point scale (84.7 vs 75.4) at one year. Conclusions: We have taken an important step in early detection of extracardiac symptoms in a systematic manner after CA. This paradigm shift could potentially be utilized to develop and implement novel interventions responsible for improving clinical outcomes and quality of life.