A second chance at life : A study about people suffering out-of-hospital cardiac arrest

Abstract: AimThe overall aim of this thesis was to describe people’s lives before and aftersuffering out-of-hospital cardiac arrest with validated myocardial infarction aetiology (OHCA-V). The following specific aims were formulated: describe trends in incidence, outcome and background characteristics among people who suffered OHCA-V (I), describe risk factors and thoughts about lifestyle among survivors(II),elucidate meanings of people’s lived experiences of surviving 1month after the event (III),and elucidate meanings of people’s lived experiencesof surviving 6 and 12 months after the event (IV)MethodsData were collected from the Northern Sweden MONICA myocardial registryand from interviews with people surviving OHCA-V. Quantitative and qualitative methodologies were used for analysis.ResultsThe incidence of OHCA-V decreased during the 19 years studied, and people aged 25-64 had an increased survival rate. The proportion of people with a history of ischemic heart disease (IHD) before the event decreased over theyears. Among people surviving OHCA-V, 60% had no prior history of IHD, but 20% had three cardiovascular risk factors (i.e., hypertension, diabetes mellitus,hypercholesterolemia and/or lipid lowering medication, current smoker). People surviving were aware of their risk factors and their descriptions of their lifestylefocused on the importance of having people around, feeling happy and having a positive outlook on life. They made their own choices regarding how to livetheir lives, which they often referred to as “living a good life.” Meanings of surviving during the first year can be understood as a pendulum ́s motion.Participants narrated they thought about the fact that they had been dead and returned to life. They also expressed they wished to know what had happened tothem while they were dead, but at the same time they wanted to put the event behind them and look forward. People surviving OHCA-V were striving to gettheir ordinary life back, but they also wondered if life would be the same. The cardiac arrest affected their body, which felt unfamiliar to them, and they felt they had to learn to feel secure in their body again. People survivingexpressed they had been given a second chance at life, and they described the event had affected their outlook on life.ConclusionThis thesis shows that people suffering OHCA-V are the most likely to die, but the survival rate is increasing. Many people had no known history of IHD beforethe event, but some had known risk factors for cardiovascular disease. To address these facts it is important for health care to focus both on primary andsecondary preventive measures to avoid complications connected to cardiovascular disease. Participants described their thoughts about their lifestyle,which was connected to what they found important in their lives; preventive 3 measures should be linked to those things to be more successful. People thatsurvived experienced pendulum emotions during their first year, and amovement back and forth in time was expressed. Health care personnel could support people surviving OHCA-V by talking with them about their thoughts connected to the past, present and future.Keywordsincidence, myocardial infarction, out-of-hospital cardiac arrest, survival, trends,life experiences, qualitative research