Psychopathological Long-Term Outcomes after Out-of-Hospital Cardiac Arrest - Results from the German Cardiac Arrest Registry (G-CAR)

Background: The German Cardiac Arrest Registry (G-CAR) is a multicenter, prospective registry collecting data on patients with out-of-hospital cardiac arrest (OHCA) in Germany. In addition to focusing on cardiovascular and interventional aspects, the distinguishing feature of G-CAR is the comprehensive long-term follow-up at six and twelve months, paying particular attention to patient-reported psychopathological endpoints.

Methods: As of February 2025, 1,894 patients from 23 centers had been enrolled in G-CAR. Of those, 447 survived for at least six months, and 438 survived for at least twelve months post-OHCA. Survivors were contacted six and twelve months after OHCA and asked to complete five standardized questionnaires. (1) Cognitive function was assessed using the Mini Montreal Cognitive Assessment (Mini-MoCA). (2) Health-related quality of life was measured with the EuroQol-5D-5L (EQ-5D-5L), which comprises five dimensions: Mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. (3) The Hospital Anxiety and Depression Scale (HADS-D) was used to screen for symptoms of anxiety and depression. (4) The Reintegration to Normal Living Index (RNLI) measured the extent to which patients were able to resume social, recreational, and daily activities. (5) Post-traumatic stress symptoms were assessed using the Posttraumatic Stress Scale-14 (PTSS-14).

Results: At the time of the analysis, 6-month follow-up (6M-FU) data were available for 321 patients (71.8%), and 12-month follow-up (12M-FU) data for 243 patients (55.5%). Regarding Mini-MoCA, 68.9% (6M-FU) and 65.4% (12M-FU) of patients achieved a score of ≥11 points, indicating an absence of significant cognitive impairment. With respect to the EQ-5D-5L, at least 75% of patients reported no or only minor limitations across all five dimensions. The most commonly reported moderate to extreme limitations were related to usual activities (6M-FU: 24.3%; 12M-FU: 22.4%) and pain/discomfort (6M-FU: 24.8%; 12M-FU: 20.1%). The fewest limitations were reported regarding self-care (moderate or severe or extreme limitations at 6M-FU: 8.0%; 12M-FU: 5.2%). The number of patients reporting severe or extreme impairments decreased slightly across all dimensions from 6M-FU to 12M-FU. According to the HADS-D, 12.6% (6M-FU) and 14.9% (12M-FU) of patients reported clinically relevant symptoms of anxiety, while an additional 22.4% (6M-FU) and 20.6% (12M-FU) exhibited borderline symptoms. Clinically relevant depressive symptoms were reported by 13.0% (6M-FU) and 12.6% (12M-FU) of patients. The RNLI revealed mean scores of 38.1 (6M-FU) and 38.8 (12M-FU) out of a maximum of 44 points, indicating a generally favorable reintegration into daily and social life over the long-term following OHCA. The mean PTSS-14 scores for patients at 6M-FU and 12M-FU were 30.9 and 31.4, respectively, which are below the cut-off for clinically relevant post-traumatic stress disorder (cut-off: 40 points).

Conclusion: Patients who survive the initial hospitalization after OHCA in Germany have a relatively good quality of life one year after the event and can be well reintegrated into social life. No relevant changes in psychopathological endpoints are anticipated between six and twelve months after OHCA.