Survivors who report a poorer health-related quality of life (HRQOL) several months after cardiac arrest experience significantly reduced long-term survival, according to a large study, underscoring the potential prognostic value of patient-reported outcomes.

The study, published in JAMA Network Open, used linked Swedish national registers to examine whether HRQOL measured three to six months after in-hospital cardiac arrest (IHCA) or out-of-hospital cardiac arrest (OHCA) was associated with long-term survival of up to seven years.

The registry cohort included adult patients who experienced IHCA or emergency service-treated OHCA between 2014 and 2019 and survived at least 90 days.

HRQOL was assessed using the EuroQoL 5-dimension 5-level (EQ-5D-5L) questionnaire level sum score (LSS) and the EQ visual analogue scale.

The final cohort comprised 2,000 IHCA survivors (median age 73 years; 66% male) and 1,108 OHCA survivors (median age 69 years; 77% male), with follow-up extending to June 2021.

More pronounced survival effects after in-hospital cardiac arrest

Among IHCA survivors, 20% reported no cognitive, emotional or physical problems (LSS 5), 52% reported mild problems (LSS 6–10) and 29% reported moderate to extreme problems (LSS 11–25).

In the OHCA cohort, 27% reported no problems, 58% mild problems and 15% moderate to extreme problems.

During a median follow-up of five years, 475 deaths occurred among IHCA survivors (24%) and 132 among OHCA survivors (12%). After adjustment for age, sex, comorbidities and arrest characteristics, IHCA survivors with the poorest HRQOL (LSS 11–25) had more than twice the risk of death compared with those reporting no problems (adjusted hazard ratio 2.50; 95% CI 1.82–3.43).

No statistically significant increase in mortality risk was observed among IHCA survivors with mild HRQOL impairment.

Among OHCA survivors, long-term survival did not differ significantly when HRQOL was analysed using categorical groups. However, when HRQOL was examined as a continuous measure, the results suggested a gradual increase in mortality risk with worsening HRQOL. These estimates showed greater uncertainty and should be interpreted with caution, the authors said.

Domain-specific analyses showed that reporting problems in any EQ-5D-5L domain – including mobility, self-care, usual activities, pain or discomfort, and anxiety or depression – was independently associated with higher mortality among IHCA survivors.

Symptoms of depression, as measured by the Hospital Anxiety and Depression Scale (HADS), were also associated with reduced long-term survival in the IHCA cohort, whereas anxiety symptoms were not. No clear associations between HADS scores and mortality were observed among OHCA survivors.

Interventions targeting impaired HRQOL

The data suggest that patient-reported outcomes may provide important prognostic information beyond early neurological status and short-term survival although certain limitations were apparent.

HRQOL data were missing for a substantial proportion of eligible patients, particularly after OHCA, raising the possibility of selection bias. HRQOL was assessed at a single time point, and pre-arrest data were unavailable. Furthermore, as an observational study, causal relationships cannot be inferred, the authors said.

Despite these limitations, they concluded that poorer HRQOL reported three to six months after OHCA or IHCA was associated with reduced long-term survival.

The authors also noted that assessment may support more individualised follow-up and rehabilitation for these patients but also highlighted the need for prospective studies to determine whether interventions targeting impaired HRQOL can improve long-term outcomes.

Reference
Dillenbeck E et al. Health-Related Quality of Life and Long-Term Survival After Cardiac Arrest. JAMA Netw Open 2026;9(1):e2552832.