Health-related quality of life in young Norwegian survivors of out-of-hospital cardiac arrest related to pre-arrest exercise habits.

Aim: To compare health-related quality of life (HRQoL) in young survivors of out-of-hospital cardiac arrest (OHCA) in Norway with an age and sex-matched reference population and to assess the associations between exercise volume prior to OHCA and HRQoL after. Methods: We present data from survivors aged 18-50 years registered with OHCA in the Norwegian Cardiac Arrest Registry between January 1st 2015 and December 31st 2017. Survivors were invited to answer two questionnaires; (1) the Short Form 36 (SF-36) Health Survey Version 1, and (2) about exercise habits prior to OHCA. Respondents were randomly matched 1:1 for age and sex with a reference population (data were available from the Norwegian Centre for Research Data). Results: Of the 175 survivors invited, 95 (54%) responded, median age was 44 (range 35-48) years, 26 (27%) females. Valid results for SF-36 were available for 91 survivors, of whom 87 reported pre-OHCA exercise-volume. Prior to OHCA, 21 did no regular exercise, 44 exercised 1-4 hours/week and 22 exercised ≥5 hours/week. Compared to the reference population survivors had significantly (p < 0.01) poorer SF-36 scores for scales relating to physical- and mental health. SF-36 scale scores were similar in survivors who did and did not exercise regularly. Within the regular exercisers, survivors reporting ≥5 hours of exercise/week had better SF-36 scores than those exercising less. Conclusion: Poorer HRQoL in survivors compared to the reference population should prompt us to explore how treatment and rehabilitation could be improved and adapted. More exercise before OHCA favoured better HRQoL after, which aligns well with the recognised positive association between HRQoL and physical activity in general.

A 3-year population-based study of exercise-related sudden cardiac arrest among 12- to 50-year-old Norwegians.

INTRODUCTION: Regular exercise is associated with reduced risk of cardiovascular disease. Paradoxically, an increased risk of sudden cardiac arrest (SCA) is documented during or immediately after exercise and in athletes compared to the nonathletic population. Our objective was to identify, through multiple sources, the total number of exercise-related versus non-exercise-related SCA in the young population in Norway. METHODS: We collected primary data from the prospective Norwegian Cardiac Arrest Registry (NorCAR) for all patients aged 12-50 suffering SCA of presumed cardiac cause from 2015 to 2017. We collected secondary data about prior physical activity and the SCA, through questionnaires. We searched media reports for SCA incidents in sports. Exercise-related SCA is defined as SCA during or <1 h after exercise. RESULTS: Overall, 624 patients, median age 43 years, were included from NorCAR. Two thirds (393) replied to the study invitation, of whom 236 answered the questionnaires: 95 survivors and 141 next of kin. The media search resulted in 18 relevant hits. With a multiple source approach, we identified 63 cases of exercise-related SCA, equivalent to an incidence of 0.8/100 000 person-years, versus 7.8/100 000 person-years of non-exercise-related SCA. Among those who answered (n = 236), almost two thirds (59%) exercised regularly, most commonly (45%) 1-4 h/week. Endurance exercise (38%) was the most prevalent type of regular exercise and the most common activity during exercise-related SCA (53%). CONCLUSION: The burden of exercise-related SCA was low (0.8 per 100 000 person-years) and ten times lower than non-exercise-related SCA in the young population in Norway.

The aftermath of surviving a sudden cardiac arrest for young exercisers - a qualitative study in Norway.

BACKGROUND: When surviving a sudden cardiac arrest (SCA), physical, cognitive, and emotional effects of surviving may be present for months or years. The survivors' family and colleagues are also highly affected by the incident. There is little knowledge about experiences of surviving SCA in individuals who prior to the incident were young and reported to exercise regularly. Consequently, the aim of this study was to explore the aftermath of surviving a SCA in young, regular exercisers. METHODS: The study had a qualitative design, conducting in-depth individual interviews with SCA survivors < 50 years of age reporting to exercise ≥ 5 h/week and/or who suffered SCA during or less than 60 min after exercise. The data were analysed using systematic text condensation in-line with recommendations from Malterud. RESULTS: 18 of 31 eligible participants were included in the study. Through analysis we identified 'Establishing a new everyday life' as superordinate category, with subordinate categories a) being part of my surroundings, b) expecting normality but facing a new reality and c) lucky to be alive! CONCLUSION: This study adds knowledge about young and regular exercisers' experiences after surviving a SCA. The obligations of everyday life in young survivors of SCA often imply a high work load and complex tasks, e.g. due to being in the beginning of their career or even still studying. Healthcare personnel, as well as the society, need to acknowledge that although lucky to be alive and apparently well-functioning, young survivors of SCA may have persistent challenges that cause frustration and reduced quality of life.

Experiences of cardiac arrest survivors among young exercisers in Norway: A qualitative study.

Aim: To explore how young exercisers experience surviving sudden cardiac arrest (SCA), focusing on interpretation of warning signs and experiences with the healthcare system. Methods: The study had a qualitative design, and data was collected using individual, semi-structured interviews. Inclusion criteria were SCA survivors aged 18-50 years old who reported at least five hours of exercise/week prior to SCA, or who suffered SCA during or ≤60 min after exercise. Results: 18 interviews were performed (4 females), age range 19-49 years old. Analysis identified the themes [1] neglected warning signs, [2] fluctuating between gratitude and criticism and [3] one size does not fit all. When young exercisers experienced symptoms such as fainting, chest pain, arrythmia, shortness of breath and fatigue, these were often ignored by either the participants, healthcare personnel or both. SCA survivors were grateful to the healthcare system and for the efforts made by healthcare personnel, but experienced a mismatch between what patients needed and could utilize, and what they actually received regarding both information and individualised services. Being young exercisers, the participants reported to have individual needs, but treatment and rehabilitation were not adapted and were mainly targeted to rehabilitation of older patients. Conclusion: Patients and healthcare personnel should be aware of cardiac related symptoms and warning signs for SCA, and these should be properly assessed in the population of young exercisers. SCA survivors need useful and repeated information. The needs of SCA survivors among young exercisers require individualisation of services.

Importance of reporting survival as incidence: a cross-sectional comparative study on out-of-hospital cardiac arrest registry data from Germany and Norway.

OBJECTIVES: Health registries are a unique source of information about current practice and can describe disease burden in a population. We aimed to understand similarities and differences in the German Resuscitation Registry (GRR) and the Norwegian Cardiac Arrest Registry (NorCAR) and compare incidence and survival for patients resuscitated after out-of-hospital cardiac arrest. DESIGN: A cross-sectional comparative analysis reporting incidence and outcome on a population level. SETTING: We included data from the cardiac arrest registries in Germany and Norway. PARTICIPANTS: Patients resuscitated between 1 January 2015 and 31 December 2019 were included, resulting in 29 222 cases from GRR and 16 406 cases from NorCAR. From GRR, only emergency medical services (EMS) reporting survival information for patients admitted to the hospital were included. PRIMARY AND SECONDARY OUTCOME MEASURES: This study focused on the EMS systems, the registries and the patients included in both registries. The results compare the total incidence, incidence of patients resuscitated by EMS, and the incidence of survival. RESULTS: We found an incidence of 68 per 100 000 inhabitants in GRR and 63 in NorCAR. The incidence of patients treated by EMS was 67 in GRR and 53 in NorCAR. The incidence of patients arriving at a hospital was higher in GRR (24.3) than in NorCAR (15.1), but survival was similar (8 in GRR and 7.8 in NorCAR). CONCLUSION: GRR is a voluntary registry, and in-hospital information is not reported for all cases. NorCAR has mandatory reporting from all EMS and hospitals. EMS in Germany starts treatment on more patients and bring a higher number to hospital, but we found no difference in the incidence of survival. This study has improved our knowledge of both registries and highlighted the importance of reporting survival as incidence when comparing registries.