Trends in short and long-term survival among out-of-hospital cardiac arrest patients alive at hospital arrival
Wong M, Morrison L, Qiu F, Austin PC. Cheskes S, Dorian P, Scales D, Tu J, Verbeek P, Wijeysunder H, Ko D. Circulation. 2014; 130(21):1883-90. Epub 2014 Nov 18.
Background — Out-of-hospital cardiac arrest (OHCA) is associated with a poor prognosis and poses a significant burden to the health care system, but few studies have evaluated whether OHCA incidence and survival have changed over time.
Methods and Results — A population-based cohort study was conducted, including 34,291 OHCA patients older than 20 years who were transported alive to the emergency department of an acute-care hospital from April 1, 2002, to March 31, 2012 in Ontario, Canada. Patients with life-threatening trauma, and those who died prior to hospital arrival were excluded. The overall age- and sex-standardized incidence of OHCA patients who were transported alive was 36 cases/100,000 persons, and did not significantly change over the study period. Cardiac risk factors prevalence increased significantly, whereas the rate of most cardiovascular conditions decreased significantly. The 30-day survival improved from 9.4% in 2002 to 13.6% in 2011; 1-year survival improved from 7.7% to 11.8% (P < 0.001). Patients hospitalized in 2011 were significantly more likely to survive 30 days (adjusted OR: 1.47 [95% CI 1.22-1.77]) and 1 year (adjusted OR: 1.55 [95% CI 1.27-1.91]) compared with 2002. A significant interaction between temporal trends in survival improvement and age group was observed, in which the improvement in survival was largest in youngest age groups.
Conclusions — OHCA patients who were transported alive are increasingly likely to have cardiovascular risk factors but less likely to have prior cardiovascular conditions. The overall incidence of OHCA patients transported to hospital alive did not change over the past decade. Short and longer-term survival after OHCA has substantially improved, with younger patients experiencing the greatest improvement.
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