Benefits of cardiac rehabilitation on patients who have experienced out of hospital cardiac - PowerPoint Presentation

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Benefits of cardiac rehabilitation on patients who have experienced out of hospital cardiac arrests (OOHCA) – a retrospective cohort study.

Robert Zecchin*, Cuynet Ada, Jim Pouliopoulos, Saurabh Kumar, A. Robert Denniss. Westmead Hospital, Sydney NSW.Slide2
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Global

incidences of out-of-hospital cardiac arrest and survival rates: Systematic review of 67 prospective studies.Jocelyn Berdowskia et al.

Resuscitation

81 (2010) 1479–1487

Results: Sixty-seven studies from Europe, North America, Asia or Australia met inclusion criteria.

The weighted

incidence estimate was significantly higher in studies including adults than in those

including adults

and paediatrics for treated OHCAs (62.3 vs 34.7; P < 0.001); and for treated OHCAs with a

cardiac cause

(54.6 vs 40.8; P = 0.004). Neither survival to discharge rates nor VF survival to discharge

rates differed

statistically significant among studies. The incidence of treated OHCAs was higher in

North America

(54.6) than in Europe (35.0), Asia (28.3), and Australia (44.0) (P < 0.001). In Asia,

the

percentage of

VF and survival to discharge rates

were lower (11% and 2%, respectively) than those in Europe (

35% and

9%, respectively), North America (28% and 6%, respectively), or

Australia (40% and 11%, respectively

)

(

P < 0.001, P < 0.001).Slide6
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Chain Of SurvivalSlide11
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OUT-OF-HOSPITAL CARDIAC ARREST

A STRATEGY FOR SCOTLAND Review 2015/2016Slide15

Cardiac and general rehabilitation

Recovering patients should also be assessed by a cardiac rehabilitation team and offered a cardiac rehabilitation programme suited to their needs in line with NICE and professional society guidance.Slide16

Cardiac rehabilitation: The missing link to close the chain of survival?

González-Salvado V, et al. Resuscitation. 2017 Apr;113:e7-e8Slide17

Long-Term Post-Discharge Risks in

Older Survivors of Myocardial Infarction With and Without Out-of-Hospital Cardiac Arrest. Christopher B. Fordyce et al

. J Am Coll Cardiol 2016;67:1981–90Slide18
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Background

Survival to hospital discharge of patients who have had an out of hospital cardiac arrest (OOHCA) is estimated at 10%. A recent recommendation to enable cardiac rehabilitation (CR) be part of the “chain of survival” concept was made. However, there is a lack of knowledge of the effects of (CR) on these surviving patients, especially in Australia.Slide20

Methodology

All patients identified has having an OOHCA who attended a single CR program in Western Sydney from 2008 to 2017 were included. CR outcome data in relation to diagnoses, complications, socio-demographics, functional capacity, risk factors, medications and quality of life (QOL), including depression and anxiety, were used for analysis.Slide21

Results: Study Population

Period2008 - 2017N=

102

Age

(mean+/-SD; years)

57 +/-

13

Gender

90% male

Cause

91% ischaemic

LVEF (%)

45 +/-

13

Wait

Times (mean; day of event to first assessment at CR)

30 +/- 22

Median = 23 daysSlide22

Complications/Interventions post OOHCA

%Intubation45

Cardiogenic shock

31

- Positive Inotropes

31

- IABP

20

ICD

23

Emergent CTSx

3

Hypoxic Brain Injury

6

Psychological Support

8Slide23

Risk Factors

%Diabetes13

Smoking

34

Hypertension

44

Depression

18

Obesity (> 30kg/m2)

21

Hyperlipidaemia

95Slide24

Medications

%Digoxin4

Beta-Blockers

87

ACE-I/ARB

74

Anti-Arrhythmics

8

Ca Channel Blockers

7

Anti-Depressants

10Slide25

Outcomes (1)

PrePostP-value

Functional Capacity

- METs (EST)

8.2 +/- 3

10.9 +/- 3

<0.001

-

Metres (6MWT)

385 +/- 124

453 +/- 109

<0.001

Risk

Factors

- Smoking

-

75%

cessation

- Total Cholesterol (mmol/L)

4.7 +/- 1.2

3.6 +/-

0.8

<0.001

- Triglycerides (mmol/L)

1.8 +/-

0.9

1.4 +/- 0.8

0.01Slide26

Outcomes (2)

PrePostP-value

QOL (SF-36)

- Total

109 +/- 16

125 +/-

15

<0.001

- Physical Functioning

57 +/- 23

81 +/- 17

<0.001

- Bodily Pain

64 +/- 26

80 +/- 24

<0.001

-

Vitality

55 +/- 21

71 +/- 18

<0.001

- Role-Emotional

49 +/- 46

78 +/- 35

<0.001

- Mental Health

74 +/- 18

82 +/- 15

<0.001

DASS

- Depression

6.8 +/- 9.6

3.5 +/- 4.8

0.01

- Anxiety

6.4 +/- 6.9

4.0 +/- 4.5

0.02

- Total

21

+/- 24

13 +/- 13

0.005

CR Completion

-

69%

-Slide27

Man

who was clinically dead at Baulkham Hills meets doctor who saved his life. Hills Shire Times April 10, 2018 7:54am

“I

honestly didn’t think he was going to make it

.

“Honestly I was so upset in a happy way. I want people to be aware of CPR.”

Someone already helped him out of his vehicle and I introduced myself and said ‘I’m an orthopaedic surgeon’ and took over and did CPR

.

“It’s a chain of things that happened to help him survive and I helped him survive

.

“A few minutes later the ambulance arrived and took over.”

FIJI Indian Bimal Deo was due to be home this week. Instead, he was reunited with the hero doctor who brought him back from the dead after he suffered a heart attack behind the wheel at Baulkham Hills

.Slide28

Pre

PostBMI

(kg/m2)

20.2

20.3

Waist Circ. (cm)

84.5

82

METs

8

11

Smoking

(CO ppm)

1

3

Depression (DASS)

4 (normal)

0 (normal)

No. of sessions

-

10

Completed

-

Yes

Cardiac Rehabilitation for BDSlide29

Conclusion

Patients who survived an OOHCA and attended CR benefitted greatly in regards to both physical and psychosocial constructs. CR should be included in the “chain of survival” and be an integral part of post-resuscitative care.Slide30