Socioeconomic and geographic differences in ablation of atrial fibrillation in Norway - a national cohort study.

BACKGROUND: The aim of this study was to analyse whether there are patient related or geographic differences in the use of catheter ablation among atrial fibrillation patients in Norway. METHODS: National population-based data on individual level of all Norwegians aged 25 to 75 diagnosed with atrial fibrillation from 2008 to 2017 were used to study the proportion treated with catheter ablation. Survival analysis, by Cox regression with attained age as time scale, separately by gender, was applied to examine the associations between ablation probability and educational level, income level, place of residence, and follow-up time. RESULTS: Substantial socioeconomic and geographic variation was documented. Atrial fibrillation patients with high level of education and high income were more frequently treated with ablation, and the education effect increased with increasing age. Patients living in the referral area of St. Olavs Hospital Trust had around three times as high ablation rates as patients living in the referral area of Finnmark Hospital Trust. CONCLUSIONS: Differences in health literacy, patient preference and demands are probably important causes of socioeconomic variation, and studies on how socioeconomic status influences the choice of treatment are warranted. Some of the geographic variation may reflect differences in ablation capacity. However, geographic variation related to differences in clinical practice and provider preferences implies a need for clearer guidelines, both at the specialist level and at the referring level.

Cortical Thickness and Cognitive Performance After Out-of-Hospital Cardiac Arrest.

BACKGROUND: Cognitive impairment is common in long-term survivors of out-of-hospital cardiac arrest (OHCA) but corresponding neuroimaging data are lacking. OBJECTIVES: This study explored the relationship among the cortical brain structure, cognitive performance, and clinical variables after OHCA. METHODS: Three months after resuscitation, 13 OHCA survivors who had recovered from a coma to living independently and 19 healthy controls were assessed by cerebral magnetic resonance imaging and neuropsychological tests quantifying memory, fine-motor coordination, and attention/executive functions. Cortical thickness (Cth) and surface area (SA) were compared between groups and analyzed for relationships with cognitive performance as well as the clinical variables of coma duration and the time to return of spontaneous circulation (ROSC). All analyses were controlled for age and sex. RESULTS: Analyses of SA revealed no significant differences. Compared with controls, survivors had significantly reduced memory and fine-motor coordination and significantly thinner cortex in large clusters in the frontal, parietal, and inferior temporal cortices, with additional regions in the left occipital lobe and the left temporal lobe. Widespread thinner cortical regions were significantly associated with decreased memory performance in survivors when compared with those in controls and were significantly associated with an increased time to ROSC and increased coma duration in the OHCA group. Increased coma duration, but not increased time to ROSC, was significantly correlated with cognitive test performance. CONCLUSIONS: The results suggest that widespread Cth reductions correspond to the cognitive impairments observed after OHCA. Neuroimaging studies of long-term OHCA survivors are warranted to guide the development of diagnostics and treatment options.

Memory performance, global cerebral volumes and hippocampal subfield volumes in long-term survivors of Out-of-Hospital Cardiac Arrest.

AIM: We explored the associations between global brain volumes, hippocampal subfield volumes and verbal memory performance in long-term survivors of out-of-hospital cardiac arrest (OHCA). METHODS: Three months after OHCA, survivors and healthy, age-matched controls were assessed with cerebral MRI and the California Verbal Learning Test-II (CVLT-II). Volumetric brain segmentation was performed automatically by FreeSurfer. RESULTS: Twenty-six OHCA survivors who were living independently in regular homes at the time of assessment and 19 controls participated in the study. Thirteen of the survivors had been conscious upon arrival to the emergency department. The other 13 survivors had 0.5-7 days of inpatient coma before recovery. Memory was poorer in the OHCA group that had been comatose beyond initial hospital admission compared to both other groups. Total cortical volumes, total hippocampus volumes and several hippocampal subfield volumes were significantly smaller in the OHCA group comatose beyond initial hospital admission compared to controls. No significant differences between the OHCA group conscious upon emergency department arrival and the other two groups were found for brain volumes. No significant differences were observed between any groups for white matter or total subcortical volumes. In OHCA survivors with recovery from inpatient coma, the various CVLT-II trials were significantly, but differentially, correlated to total gray matter volume, cortical volume and the hippocampal subfield subiculum. CONCLUSION: In this small, single-site study, both hippocampal volume and cortical volume were smaller in good outcome OHCA survivors 3 months after resuscitation in comparison to healthy controls. Smaller cerebral volumes were correlated with poorer memory performance.

Alterations in cognitive outcome between 3 and 12 months in survivors of out-of-hospital cardiac arrest.

OBJECTIVES: To prospectively investigate cognitive recovery from 3 to 12 months after resuscitation from out-of-hospital cardiac arrest (OHCA) and the associations between cognitive performance at 3 months and health-related quality of life (HRQL), psychological distress and work status after 12 months. METHODS: At both assessments, neuropsychological tests were used to measure aspects of general mental ability, verbal and visual memory, psychomotor speed and executive function. The Short Form-36 (SF-36) was used to measure mental and physical HRQL, and the Hospital Anxiety and Depression Scale (HADS) to assess psychological distress. RESULTS: 33 survivors completed both exams (31 males, mean age 58.6 years, SD=13). The OHCAs were witnessed and due to cardiac origins. Nine patients were awake at admission to the hospital. Longer coma duration was associated with poorer cognitive results. Memory impairments were the most common symptom. The mean changes and effect sizes indicated minor improvements in cognitive performance from 3 to 12 months (Hedges g≤.26). Reliable change indices for an individual's results further confirmed the stability of the group statistics. The HADS scores showed increased depressive symptoms, and mental HRQL was reduced from 3 to 12 months. Higher reports of psychological distress were related to worse HRQL. Work participation increased. Better cognitive results at 3 months were correlated with better HRQL and return to work at 12 months. CONCLUSIONS: The current data describe stability in results from 3 to 12 months. A worse cognitive performance at 3 months and higher reports of psychological distress were associated with lower HRQL.

Relevance of cognition to health-related quality of life in good-outcome survivors of out-of-hospital cardiac arrest.

OBJECTIVE: For survivors of out-of-hospital cardiac arrest (OHCA) with good outcomes, it is not known whether and how health-related quality of life is affected by the cognitive impairments frequently observed in these patients. This study explores how neuropsychological tests of memory, exe-cutive and psychomotor functioning relate to the physical and mental aspects of health-related quality of life in functionally independent and community dwelling OHCA survivors discharged early from hospital. METHODS: The study included 42 adult survivors (mean age 62 years, 38 males). Health-related quality of life was measured approximately 3 months post-OHCA with the Medical Outcome Study Short Form 36 (SF-36). Cognition was measured with established neuropsychological tests. Regression analyses were used to examine associations between neuropsychological domains and physical and mental health-related quality of life, respectively, when controlling for age, education and length of coma. RESULTS: The physical, but not the mental, component of the SF-36 was significantly worse than Norwegian population data. Neuropsychological tests showed frequent impairments most often in the memory domain. Worse psychomotor functioning was associated with worse physical health-related quality of life, whereas worse memory performance was associated with worse mental health-related quality of life. CONCLUSION: The cognitive impairments frequently reported in OHCA survivors with good outcomes may compromise health-related quality of life. Cognitive functioning should be addressed even in survivors with rapid recovery.

Determinants of cognitive outcome in survivors of out-of-hospital cardiac arrest.

AIM: To describe cognitive functioning with neuropsychological tests and examine predictors of cognitive outcome in adult survivors of out-of-hospital cardiac arrest (OHCA) of cardiac cause. METHOD: The study was prospective and took place at the University hospital of North-Norway. Only patients eligible of neuropsychological assessment three months after OHCA were asked to participate. Cognitive test performance was compared to large samples of age-corrected normative data. General linear models were used to determine predictors of a cognitive composite score and performance on separate cognitive tests. The predictors assessed were coma duration, hypothermia treatment and time to restoration of spontaneous circulation. We aimed to control for demographic variables, medical comorbidity and affective symptoms. RESULTS: 45 survivors (4 women) completed the assessment. Neuropsychological tests of fine motor functioning, memory, attention and executive functions were significantly below normative means. Depending on the test, impairment ranged from 9 to 31%. For twenty-five survivors (56%), all cognitive tests were within the normal range. Shorter coma duration and induced hypothermia treatment were associated with favourable cognitive outcomes and explained 45% of the variability in the cognitive composite score. Coma duration was predictive across all cognitive tests, hypothermia treatment of specific tests of memory, attention and executive functioning. CONCLUSIONS: Cognitive outcome was normal in more than half of the survivors. Shorter coma duration and induced hypothermia were associated with favourable cognitive outcomes in the participating survivors three months after OHCA. Institutional protocol number: 2009/1395.