title: Early neurologically-focused follow-up after cardiac arrest improves quality of life at one year: A randomised controlled trial.
abstract: BACKGROUND
  Survivors of a cardiac arrest frequently have cognitive and emotional problems and their quality of life is at risk. We developed a brief nursing intervention to detect cognitive and emotional problems, provide information and support, promote self-management, and refer them to specialised care if necessary. This study examined its effectiveness.
  
  
  METHODS
  Multicentre randomised controlled trial with measurements at two weeks, three months and twelve months after cardiac arrest. 185 adult cardiac arrest survivors and 155 caregivers participated. Primary outcome measures were societal participation and quality of life of the survivors at one year. Secondary outcomes were the patient's cognitive functioning, emotional state, extended daily activities and return to work, and the caregiver's well-being. Data were analysed using 'intention to treat' linear mixed model analyses.
  
  
  RESULTS
  After one year, patients in the intervention group had a significantly better quality of life on SF-36 domains Role Emotional (estimated mean differences (EMD)=16.38, p=0.006), Mental Health (EMD=6.87, p=0.003) and General Health (EMD=8.07, p=0.010), but there was no significant difference with regard to societal participation. On the secondary outcome measures, survivors scored significantly better on overall emotional state (HADS total, EMD=-3.25, p=0.002) and anxiety (HADS anxiety, EMD=-1.79, p=0.001) at one year. Furthermore, at three months more people were back at work (50% versus 21%, p=0.006). No significant differences were found for caregiver outcomes.
  
  
  CONCLUSIONS
  The outcomes of cardiac arrest survivors can be improved by an intervention focused on detecting and managing the cognitive and emotional consequences of a cardiac arrest.
  
  
  BACKGROUND
  Current controlled trials, ISRCTN74835019.
authors.affiliation: Adelante, Centre of Expertise in Rehabilitation and Audiology, Zandbergsweg 111, 6432 CC Hoensbroek, The Netherlands; CAPHRI School for Public Health and Primary Care, Department of Rehabilitation Medicine, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands. Electronic address: v.moulaert@adelante-zorggroep.nl.
authors.forename: Véronique R M
authors.initials: VR
authors.lastname: Moulaert
authors.affiliation: School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands.
authors.forename: Caroline M
authors.initials: CM
authors.lastname: van Heugten
authors.affiliation: CAPHRI School for Public Health and Primary Care, Department of Methodology and Statistics, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands.
authors.forename: Bjorn
authors.initials: B
authors.lastname: Winkens
authors.affiliation: Adelante, Centre of Expertise in Rehabilitation and Audiology, Zandbergsweg 111, 6432 CC Hoensbroek, The Netherlands.
authors.forename: Wilbert G M
authors.initials: WG
authors.lastname: Bakx
authors.affiliation: Maastricht University Medical Centre, Department of Neurology, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
authors.forename: Marc C F T M
authors.initials: MC
authors.lastname: de Krom
authors.affiliation: CAPHRI School for Public Health and Primary Care, Department of Cardiology, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
authors.forename: Ton P M
authors.initials: TP
authors.lastname: Gorgels
authors.affiliation: Oxford Centre for Enablement, Neurological Rehabilitation, Windmill Road, OX3 7HE Oxford, United Kingdom.
authors.forename: Derick T
authors.initials: DT
authors.lastname: Wade
authors.affiliation: Adelante, Centre of Expertise in Rehabilitation and Audiology, Zandbergsweg 111, 6432 CC Hoensbroek, The Netherlands; CAPHRI School for Public Health and Primary Care, Department of Rehabilitation Medicine, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands.
authors.forename: Jeanine A
authors.initials: JA
authors.lastname: Verbunt
mesh_terms: D000328:Adult; D000368:Aged; D003072:Cognition Disorders / Q000209:etiology / Q000523:psychology*; D004644:Emotions; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000150:complications* / Q000523:psychology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012151:Resuscitation; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: Cardiac arrest; Cognitive impairments; Psychosocial intervention; Quality of life; Rehabilitation; Resuscitation