The role of in-hospital traumatic distress after out-of-hospital cardiac arrest in later fatigue, sleep quality, and health-related quality of life

Vicky L Joshi; Frederik Dornonville de la Cour; Dea Siggaard Stenbæk; Britt Borregaard; Christian Hassager; Mette Kirstine Wagner

doi:10.1016/j.ijcard.2025.134043

The role of in-hospital traumatic distress after out-of-hospital cardiac arrest in later fatigue, sleep quality, and health-related quality of life

Int J Cardiol. 2025 Nov 24:445:134043. doi: 10.1016/j.ijcard.2025.134043. Online ahead of print.

Authors

Vicky L Joshi¹, Frederik Dornonville de la Cour², Dea Siggaard Stenbæk³, Britt Borregaard⁴, Christian Hassager⁵, Mette Kirstine Wagner⁶

Affiliations

¹ Department of Physiotherapy and Paramedicine, Glasgow Caledonian University, Glasgow, UK. Electronic address: vicky.joshi@gcu.ac.uk.
² Neurorehabilitation Research and Knowledge Centre, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark; Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark; The Elsass Foundation, Charlottenlund, Denmark.
³ Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Psychology, University of Copenhagen, Copenhagen K, Denmark.
⁴ Department of Cardiology, University Hospital of Southern Denmark, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, C, Denmark.
⁵ Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
⁶ Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.

PMID: 41297707
DOI: 10.1016/j.ijcard.2025.134043

Abstract

Aim: To investigate potential in-hospital cognitive and psychopathological factors associated with fatigue three months after out-of-hospital cardiac arrest (OHCA).

Methods: This was a multicenter prospective cohort study conducted across three heart centers in Denmark. While in-hospital, OHCA survivors were screened for cognitive impairment using the Montreal Cognitive Assessment, self-reported symptoms of anxiety and depression using the Hospital Anxiety and Depression Scale, and traumatic distress using the Impact of Event Scale - Revised. At three-month follow-up, fatigue severity was assessed with the Fatigue Severity Scale (FSS). FSS ≥ 4 indicates clinically important fatigue. Logistic regression models were applied.

Results: Overall, 173 survivors were included (mean age 63.1 ± 11.7 years). At follow-up, the median FSS score was 3.2 points (IQR 2-9) and 42 % of survivors presented with clinically important fatigue (FSS ≥ 4). Those with fatigue were more often female, had longer hospital stays, reported greater in-hospital symptoms of anxiety, depression and traumatic distress, poorer sleep quality and health-related quality of life at follow-up. In the multivariable regression model, including age, sex, length of stay, anxiety, depression, traumatic distress and sleep quality, only traumatic distress was independently associated with FSS ≥ 4 (OR 4.6, 95 % CI: 1.5-14.7, p = 0.009).

Conclusion: More than a third of OHCA survivors self-reported fatigue at three-month follow-up. In-hospital symptoms of traumatic distress were associated with higher odds of fatigue. While these findings underscore the potential value of early identification of traumatic distress, further research is needed to evaluate the benefits of screening and to identify interventions to support recovery after cardiac arrest.

Keywords: Cardiac arrest; Fatigue; Health-related quality of life; Patient-reported outcome measures; Resuscitation; Survivorship; Traumatic distress.