Project Summary: Many patients now survive out-of-hospital cardiac arrest (OHCA), however gaps in knowledge about long-term outcomes result in a fragmented and underdeveloped continuum of care to achieve recovery. Recovery is defined as significant improvement in functional and cognitive outcomes, and health- related quality of life (HRQoL). OHCA Survivors with favorable recovery patterns may potentially go back to work and/or social roles. Prior studies assessing recovery domains after OHCA are small, limited to single centers, and short-term outcomes i.e., 1-3 months. Identifying individual patient patterns of recovery over longer-term, and the ability to predict who will be likely to need more intensive support after discharge would allow interventions to be targeted more efficiently. It is also crucial that we offer patients and their families the best information available about a patient's prospects for continued recovery even in the absence of modifiable intervention targets. This study will be among the first to focus on a new equitable science of OHCA survivorship itself, seeking empirically derived targets for preserving or restoring recovery. Our single-center pilot study has found that nearly one-third of the OHCA survivors had clinically important differences between long-term (12 months) and short-term (3 months) functional outcomes with large between- individual variability in recovery (i.e., improvement or worsening). We found that inpatient acute rehabilitation was associated with better functional recovery patterns at 12 months compared to other dispositions, but Black race and Hispanic/Latinx had worse recovery patterns than non-Hispanic Whites. To fill this gap, we propose an ancillary study to the NINDS/NHLBI-funded ICECAP trial, conducted within the 60 sites of the NIH emergency care trials network, to describe recovery (functional outcome [primary], Cognition, and HRQoL outcomes [secondary]) in a large, well-characterized, racially/ethnically diverse, representative cohort of US OHCA patients. We will enroll n=1,000 who were screened for ICECAP and survive to hospital discharge. The parent ICECAP trial includes a telephone follow-up visit at 1 month and an in-person visit at 3 months. The ancillary study will add two telephone/videoconferencing visits at 6 and 9 months and an in-person visit at 12 months after OHCA. For Aim 1, we will describe between-patient variability in recovery (i.e., improvement in functional, cognitive, and HRQoL outcomes) from 3 to 12 months after OHCA, and test whether changes are associated with illness severity scores, and critical care interventions performed during the acute care stay. Aim 2 will test whether receipt of acute inpatient rehabilitation (vs outpatient therapy/no therapy/skilled nursing facility) within 1 month of hospital discharge is associated with greater improvement in recovery outcomes from 3 to 12 months. Finally, in Aim 3, we will test whether non-Hispanic Black and Hispanic/Latinx patients have less favorable changes in recovery outcomes between 3 and 12 months and explore mechanisms for such disparities.

PROJECT NARRATIVE Despite the significant public health burden associated with out-of-hospital cardiac arrest (OHCA), our understanding of the trajectory of long-term recovery and key contributors to survivorship and reaching a `new normal' after OHCA is limited. POST- ICECAP, an ancillary study to an ongoing NIH funded trial, will be the first, and certainly the largest study to describe the recovery in the most diverse group of OHCA survivors. It will comprehensively assess the relationship between the initial severity of the OHCA, critical care interventions, inpatient rehabilitation, and social determinants of health with improvement or deterioration in dependence on others for everyday activities, cognition, and quality of life in the first 12 months after survival from OHCA.