Health care utilization prior to out-of-hospital cardiac arrest: a population-based study
Shuvy M, Koh M, Qiu F, Brooks SC, Chan TCY, Cheskes S, Dorian P, Geri F, Lin S, Scales DC, Ko DT. Resuscitation. 2019; 141:158-65. Epub 2019 Apr 27. DOI: 10.1016/j.resuscitation.2019.04.033.
Introduction — Although out-of-hospital cardiac arrest (OHCA) is thought of as a sudden event, recent studies suggest that many patients have symptoms or have sought medical attention prior to their arrest. Our objective was to evaluate patterns of healthcare utilization before OHCA.
Methods — We conducted a population-based cohort study in Ontario, Canada, which included all patients ≥ 20 years, who suffered out-of-hospital cardiac arrest and transferred to an emergency department (ED) from 2007 to 2018. Measurements included emergency room assessments, hospitalizations and physician visits prior to arrest.
Results — The cohort comprised 38,906 patients, their mean age was 66.5 years, and 32.7% were women. Rates of ED assessments and hospital admissions were relatively constant until 90 days prior to arrest where they markedly increased to the time before arrest. Within 90 days, rates of ED assessment, hospitalization, and primary care physician visit were 29.5%, 16.4%, and 70.1%, respectively. Cardiovascular conditions were diagnosed in 14.4% of ED visits, and 33.7% of hospitalizations in this time period. The largest age-difference was the mental and behavioural disorders within 90 days of OHCA in the ED, where rates were 12.2% among patients < 65 years vs. 1.9% for patients ≥ 65 years.
Conclusions — In contrast to the conventional wisdom that OHCA occurs without prior contacts to the health care system, we found that more than 1 in 4 patients were assessed in the ED prior within 90 days of their arrest. Identification of warning signs of OHCA may allow future development of prevention strategies.