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Heimburg K, Lilja G, Blennow Nordström E, Friberg H, Gregersen Oestergaard L, Grejs AM, Keeble TR, Mion M, Nielsen N, Rylander C, Segerström M, Thomsen IK, Ullén S, Undén J, Wise MP, Cronberg T, Tornberg ÅB. Agreement between self-reported and objectively assessed physical activity among out-of-hospital cardiac arrest survivors. Clin Physiol Funct Imaging 2024; 44:144-153. [PMID: 37830144 DOI: 10.1111/cpf.12860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 09/04/2023] [Accepted: 10/11/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Low level of physical activity is a risk factor for new cardiac events in out-of-hospital cardiac arrest (OHCA) survivors. Physical activity can be assessed by self-reporting or objectively by accelerometery. AIM To investigate the agreement between self-reported and objectively assessed physical activity among OHCA survivors HYPOTHESIS: Self-reported levels of physical activity will show moderate agreement with objectively assessed levels of physical activity. METHOD Cross-sectional study including OHCA survivors in Sweden, Denmark, and the United Kingdom. Two questions about moderate and vigorous intensity physical activity during the last week were used as self-reports. Moderate and vigorous intensity physical activity were objectively assessed with accelerometers (ActiGraph GT3X-BT) worn upon the right hip for 7 consecutive days. RESULTS Forty-nine of 106 OHCA survivors answered the two questions for self-reporting and had 7 valid days of accelerometer assessment. More physically active days were registered by self-report compared with accelerometery for both moderate intensity (median 5 [3:7] vs. 3 [0:5] days; p < 0.001) and vigorous intensity (1 [0:3] vs. 0 [0:0] days; p < 0.001). Correlations between self-reported and accelerometer assessed physical activity were sufficient (moderate intensity: rs = 0.336, p = 0.018; vigorous intensity: rs = 0.375, p = 0.008), and agreements were fair and none to slight (moderate intensity: k = 0.269, p = 0.001; vigorous intensity: k = 0.148, p = 0.015). The categorization of self-reported versus objectively assessed physical activity showed that 26% versus 65% had a low level of physical activity. CONCLUSION OHCA survivors reported more physically active days compared with the results of the accelerometer assessment and correlated sufficiently and agreed fairly and none to slightly.
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Affiliation(s)
- Katarina Heimburg
- Neurology, Department of Clinical Sciences Lund, Skane University Hospital, Lund University, Lund, Sweden
| | - Gisela Lilja
- Neurology, Department of Clinical Sciences Lund, Skane University Hospital, Lund University, Lund, Sweden
| | - Erik Blennow Nordström
- Neurology, Department of Clinical Sciences Lund, Skane University Hospital, Lund University, Lund, Sweden
| | - Hans Friberg
- Intensive and Perioperative Care, Department of Clinical Sciences Lund, Skane University Hospital, Lund University, Malmö, Sweden
| | - Lisa Gregersen Oestergaard
- DEFACTUM, Central Denmark Region, Aarhus, Denmark
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Anders M Grejs
- Department of Intensive Care Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas R Keeble
- Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon, UK
- Anglia Ruskin School of Medicine, Medical Technology Research Center, Chelmsford, UK
| | - Marco Mion
- Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon, UK
| | - Niklas Nielsen
- Anaesthesiology and Intensive Care, Department of Clinical Sciences Lund, Helsingborg Hospital, Lund University, Lund, Sweden
| | - Christian Rylander
- Anaesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Magnus Segerström
- Department of Neurology and Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ida Katrine Thomsen
- Department of Clinical Medicine, Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus University, Aarhus, Denmark
| | - Susann Ullén
- Clinical Studies Sweden - Forum South, Skane University Hospital, Lund, Sweden
| | - Johan Undén
- Anaesthesiology and Intensive Care Medicine, Department of Clinical Sciences Malmö, Skane University Hospital, Lund University, Lund, Sweden
- Operation and Intensive Care, Hallands Hospital Halmstad, Halmstad, Sweden
| | - Matthew P Wise
- Adult Critical Care, University Hospital of Wales, Cardiff, UK
| | - Tobias Cronberg
- Neurology, Department of Clinical Sciences Lund, Skane University Hospital, Lund University, Lund, Sweden
| | - Åsa B Tornberg
- Department of Health Sciences, Lund University, Lund, Sweden
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Blennow Nordström E, Vestberg S, Evald L, Mion M, Segerström M, Ullén S, Bro-Jeppesen J, Friberg H, Heimburg K, Grejs AM, Keeble TR, Kirkegaard H, Ljung H, Rose S, Wise MP, Rylander C, Undén J, Nielsen N, Cronberg T, Lilja G. Neuropsychological outcome after cardiac arrest: results from a sub-study of the targeted hypothermia versus targeted normothermia after out-of-hospital cardiac arrest (TTM2) trial. Crit Care 2023; 27:328. [PMID: 37633944 PMCID: PMC10463667 DOI: 10.1186/s13054-023-04617-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/16/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND Cognitive impairment is common following out-of-hospital cardiac arrest (OHCA), but the nature of the impairment is poorly understood. Our objective was to describe cognitive impairment in OHCA survivors, with the hypothesis that OHCA survivors would perform significantly worse on neuropsychological tests of cognition than controls with acute myocardial infarction (MI). Another aim was to investigate the relationship between cognitive performance and the associated factors of emotional problems, fatigue, insomnia, and cardiovascular risk factors following OHCA. METHODS This was a prospective case-control sub-study of The Targeted Hypothermia versus Targeted Normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial. Eight of 61 TTM2-sites in Sweden, Denmark, and the United Kingdom included adults with OHCA of presumed cardiac or unknown cause. A matched non-arrest control group with acute MI was recruited. At approximately 7 months post-event, we administered an extensive neuropsychological test battery and questionnaires on anxiety, depression, fatigue, and insomnia, and collected information on the cardiovascular risk factors hypertension and diabetes. RESULTS Of 184 eligible OHCA survivors, 108 were included, with 92 MI controls enrolled. Amongst OHCA survivors, 29% performed z-score ≤ - 1 (at least borderline-mild impairment) in ≥ 2 cognitive domains, 14% performed z-score ≤ - 2 (major impairment) in ≥ 1 cognitive domain while 54% performed without impairment in any domain. Impairment was most pronounced in episodic memory, executive functions, and processing speed. OHCA survivors performed significantly worse than MI controls in episodic memory (mean difference, MD = - 0.37, 95% confidence intervals [- 0.61, - 0.12]), verbal (MD = - 0.34 [- 0.62, - 0.07]), and visual/constructive functions (MD = - 0.26 [- 0.47, - 0.04]) on linear regressions adjusted for educational attainment and sex. When additionally adjusting for anxiety, depression, fatigue, insomnia, hypertension, and diabetes, executive functions (MD = - 0.44 [- 0.82, - 0.06]) were also worse following OHCA. Diabetes, symptoms of anxiety, depression, and fatigue were significantly associated with worse cognitive performance. CONCLUSIONS In our study population, cognitive impairment was generally mild following OHCA. OHCA survivors performed worse than MI controls in 3 of 6 domains. These results support current guidelines that a post-OHCA follow-up service should screen for cognitive impairment, emotional problems, and fatigue. TRIAL REGISTRATION ClinicalTrials.gov, NCT03543371. Registered 1 June 2018.
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Affiliation(s)
- Erik Blennow Nordström
- Neurology, Department of Clinical Sciences Lund, Skane University Hospital, Lund University, Lund, Sweden.
| | | | - Lars Evald
- Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark
| | - Marco Mion
- Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon, UK
- Medical Technology Research Centre, Anglia Ruskin School of Medicine, Chelmsford, UK
| | - Magnus Segerström
- Department of Neurology and Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Susann Ullén
- Clinical Studies Sweden - Forum South, Skane University Hospital, Lund, Sweden
| | - John Bro-Jeppesen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Hans Friberg
- Intensive and Perioperative Care, Department of Clinical Sciences Lund, Skane University Hospital, Lund University, Malmö, Sweden
| | - Katarina Heimburg
- Neurology, Department of Clinical Sciences Lund, Skane University Hospital, Lund University, Lund, Sweden
| | - Anders M Grejs
- Department of Intensive Care Medicine and Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Thomas R Keeble
- Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon, UK
- Medical Technology Research Centre, Anglia Ruskin School of Medicine, Chelmsford, UK
| | - Hans Kirkegaard
- Research Centre for Emergency Medicine, Emergency Department and Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Hanna Ljung
- Neurology, Department of Clinical Sciences Lund, Skane University Hospital, Lund University, Lund, Sweden
| | - Sofia Rose
- Clinical Psychology, Cardiff and Vale University Health Board, NHS Wales, Cardiff, UK
| | - Matthew P Wise
- Adult Critical Care, University Hospital of Wales, Cardiff, UK
| | - Christian Rylander
- Anaesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Johan Undén
- Intensive and Perioperative Care, Department of Clinical Sciences Lund, Skane University Hospital, Lund University, Malmö, Sweden
- Operation and Intensive Care, Hallands Hospital Halmstad, Halmstad, Sweden
| | - Niklas Nielsen
- Anesthesiology and Intensive Care, Department of Clinical Sciences Lund, Helsingborg Hospital, Lund University, Lund, Sweden
| | - Tobias Cronberg
- Neurology, Department of Clinical Sciences Lund, Skane University Hospital, Lund University, Lund, Sweden
| | - Gisela Lilja
- Neurology, Department of Clinical Sciences Lund, Skane University Hospital, Lund University, Lund, Sweden
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Blennow Nordström E, Lilja G, Vestberg S, Ullén S, Friberg H, Nielsen N, Heimburg K, Evald L, Mion M, Segerström M, Grejs AM, Keeble T, Kirkegaard H, Ljung H, Rose S, Wise MP, Rylander C, Undén J, Cronberg T. Neuropsychological outcome after cardiac arrest: a prospective case control sub-study of the Targeted hypothermia versus targeted normothermia after out-of-hospital cardiac arrest trial (TTM2). BMC Cardiovasc Disord 2020; 20:439. [PMID: 33028221 PMCID: PMC7542852 DOI: 10.1186/s12872-020-01721-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 09/30/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND This study is designed to provide detailed knowledge on cognitive impairment after out-of-hospital cardiac arrest (OHCA) and its relation to associated factors, and to validate the neurocognitive screening of the Targeted Hypothermia versus Targeted Normothermia after Out-of-Hospital Cardiac Arrest trial (TTM2-trial), assessing effectiveness of targeted temperature management after OHCA. METHODS This longitudinal multi-center clinical study is a sub-study of the TTM2-trial, in which a comprehensive neuropsychological examination is performed in addition to the main TTM2-trial neurocognitive screening. Approximately 7 and 24 months after OHCA, survivors at selected study sites are invited to a standardized assessment, including performance-based tests of cognition and questionnaires of emotional problems, fatigue, executive function and insomnia. At 1:1 ratio, a matched control group from a cohort of acute myocardial infarction (MI) patients is recruited to perform the same assessment. We aim to include 100 patients per group. Potential differences between the OHCA patients and the MI controls at 7 and 24 months will be analyzed with a linear regression, using composite z-scores per cognitive domain (verbal, visual/constructive, working memory, episodic memory, processing speed, executive functions) as primary outcome measures. Results from OHCA survivors on the main TTM2-trial neurocognitive screening battery will be compared with neuropsychological test results at 7 months, using sensitivity and specificity analyses. DISCUSSION In this study we collect detailed information on cognitive impairment after OHCA and compare this to a control group of patients with acute MI. The validation of the TTM2 neurocognitive screening battery could justify its inclusion in routine follow-up. Our results may have a potential to impact on the design of future follow-up strategies and interventions after OHCA. TRIAL REGISTRATION ClinicalTrials.gov, NCT03543371 . Registered 1 June 2018.
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Affiliation(s)
- Erik Blennow Nordström
- Lund University, Skane University Hospital, Center for Cardiac Arrest at Lund University, Neurology Research Unit, Department of Clinical Sciences Lund, Neurology, Remissgatan 4, 221 85, Lund, Sweden.
| | - Gisela Lilja
- Lund University, Skane University Hospital, Center for Cardiac Arrest at Lund University, Neurology Research Unit, Department of Clinical Sciences Lund, Neurology, Remissgatan 4, 221 85, Lund, Sweden
| | | | - Susann Ullén
- Skane University Hospital, Clinical Studies Sweden - Forum South, Lund, Sweden
| | - Hans Friberg
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Intensive and Perioperative Care, Malmö, Sweden
| | - Niklas Nielsen
- Lund University, Helsingborg Hospital, Department of Clinical Sciences Lund, Anesthesiology and Intensive Care, Lund, Sweden
| | - Katarina Heimburg
- Lund University, Skane University Hospital, Center for Cardiac Arrest at Lund University, Neurology Research Unit, Department of Clinical Sciences Lund, Neurology, Remissgatan 4, 221 85, Lund, Sweden
| | - Lars Evald
- Hammel Neurorehabilitation and Research Centre, Hammel, Denmark
| | - Marco Mion
- Essex Cardiothoracic Centre, Basildon and Thurrock University Hospitals, Basildon, UK
| | - Magnus Segerström
- Sahlgrenska University Hospital, Department of Neurology and Department of Cardiology, Gothenburg, Sweden
| | - Anders M Grejs
- Aarhus University Hospital and Aarhus University, Research Centre for Emergency Medicine, Emergency Department and Department of Clinical Medicine, Aarhus, Denmark
| | - Thomas Keeble
- Essex Cardiothoracic Centre, Basildon and Thurrock University Hospitals, Basildon, UK
- Department of Allied Health and Medicine, Anglia Ruskin School of Medicine, Chelmsford, UK
| | - Hans Kirkegaard
- Aarhus University Hospital and Aarhus University, Research Centre for Emergency Medicine, Emergency Department and Department of Clinical Medicine, Aarhus, Denmark
| | - Hanna Ljung
- Lund University, Skane University Hospital, Center for Cardiac Arrest at Lund University, Neurology Research Unit, Department of Clinical Sciences Lund, Neurology, Remissgatan 4, 221 85, Lund, Sweden
| | - Sofia Rose
- Clinical Psychology, Cardiff and Vale University Health Board, NHS Wales, Cardiff, UK
| | | | - Christian Rylander
- Sahlgrenska Academy, University of Gothenburg, Institute of Clinical Sciences, Department of Anaesthesiology and Intensive Care Medicine, Gothenburg, Sweden
| | - Johan Undén
- Lund University, Skane University Hospital, Department of Clinical Sciences Malmö, Anaesthesiology and Intensive Care Medicine, Lund, Sweden
| | - Tobias Cronberg
- Lund University, Skane University Hospital, Center for Cardiac Arrest at Lund University, Neurology Research Unit, Department of Clinical Sciences Lund, Neurology, Remissgatan 4, 221 85, Lund, Sweden
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