Improving Cardiac Arrest Survivorship: A Mental Health Perspective

In the first quarter of the January 2nd NFL game in Cincinnati, Damar Hamlin, a 24-year-old safety for the Buffalo Bills, dropped to the ground after what appeared to be a routine tackle. What we learned later was that Hamlin, a healthy young man with no significant medical history, had suffered a sudden cardiac arrest. 

Since that event, the public has learned a great deal about cardiac arrest. There is one important aspect of this event that impacts the quality of life for survivors going forward but seems to be missing from this discussion: What are the psychological aftereffects of cardiac arrest?

Alexander Presciutti, MA, MSCS from the Center for Health Outcomes and Interdisciplinary Research (CHOIR) in the Department of Psychiatry at Massachusetts General Hospital studies the psychological effects of cardiac arrest. In order to better understand the challenges faced by cardiac arrest survivors and improve the recovery process, Presciutti and his colleagues surveyed members of the Sudden Cardiac Arrest Foundation, an online support group network of cardiac arrest survivors. In addition to the online survey, a subset of long-term survivors completed one-on-one interviews as part of a qualitative study.    

Significant Risk of Psychiatric Symptoms in Survivors and Caregivers 

As part of the online survey, survivors and caregivers completed questionnaires assessing post-traumatic symptoms, depression, anxiety, and quality of life. 

About 1 in 4 cardiac arrest survivors showed significant post-traumatic stress; even more, caregivers reported post-traumatic stress symptoms. Survivors and caregivers also reported significant depressive symptoms and anxiety. Higher levels of post-traumatic stress, depression, and anxiety were associated with worse quality of life. 

While the emergence of psychiatric symptoms, especially post-traumatic stress, is common after a life-threatening event, these symptoms may impact health outcomes. Previous studies have observed that early, elevated post-traumatic symptoms in cardiac arrest survivors were associated with a greater likelihood of experiencing major adverse cardiovascular events and mortality within one year after discharge. This study also indicates the persistence of symptoms in survivors well beyond the initial cardiac arrest.

The Lived Experience of Cardiac Arrest Survivors 

Survivors shared the challenges they faced in the years following their cardiac arrest, revealing themes of preparedness and non-cardiac symptoms. Clinicians plan to use this information to help improve recovery and educate patients on what to expect after surviving cardiac arrest.

Feeling Unprepared

Nearly every survivor felt unprepared for survivorship, attributing this to a lack of appropriate resources and education relevant to recovery. Specifically, they did not receive information outlining accurate expectations for recovery, how to manage challenges, and how to understand and deal with non-cardiac symptoms. “I had no expectation it would be as difficult, that any of this stuff would be as difficult as it has been,” said one interviewee. 

Survivors felt “lost” because of the lack of resources, education, and appropriate expectations — the sense that nobody was there to point them in the right direction.

Non-cardiac Symptoms

Most survivors did not anticipate experiencing non-cardiac symptoms, including executive function and attention deficits, memory problems, brain fog, fatigue, and disorientation, and were surprised and frustrated when they experienced these symptoms.   

Many survivors experienced post-traumatic stress symptoms and noted avoiding physical activity or reminders of the arrest, like the location of arrest, hospitals, etc. Survivors also experienced fear of experiencing repeat arrest, depression, lack of motivation, lethargy, isolation, and feelings of doom and dread. “Everything would be going fine, and then all of a sudden, you’d have this feeling of impending doom or dread, for no reason,” said one survivor.

How to Improve Care for Cardiac Arrest Survivors

Survivors shared their recommendations for improving care for those who survive cardiac arrest:

• Systemic Recommendations: Survivors should receive resources, education, and information outlining appropriate expectations for recovery. This will require education of providers, consistent follow‐up from providers after discharge, and inclusion of caregivers throughout the hospitalization and beyond. 
• Social Recommendations: At the social level, survivors noted the importance of peer support groups, spending time with family and friends, and support for family members and caregivers. Survivors, their families, and caregivers should be guided toward beneficial social resources, such as the Sudden Cardiac Arrest Foundation or the Sudden Cardiac Arrest Association. Peer support groups have been shown to be effective in reducing psychological distress. 
• Individual Coping Recommendations: Survivors noted the value of acceptance, resilient coping, regaining control in one’s life, seeking treatment for non-cardiac symptoms, and focusing on meaning and purpose. Up to this point, survivors have needed to develop their own strategies for adaptation; however, behavioral health providers can draw from these recommendations and work with survivors to identify what works best for each individual.

Presciutti notes that this research points to promising pathways that may improve cardiac arrest survivorship. “As more people are surviving cardiac arrest now than ever before, there is a considerable survivorship base that needs emotional support. We are now focusing our efforts in developing interventions to build resiliency and prevent chronic emotional distress in these survivors and their families.”