Time trends in long-term mortality after out-of-hospital cardiac arrest, 1980 to 1998, and predictors for death

doi:10.1016/S0002-8703(03)00074-7

American Heart Journal

Volume 145, Issue 5, May 2003, Pages 826-833

https://doi.org/10.1016/S0002-8703(03)00074-7 Get rights and content

Abstract

Background

We studied time trends in long-term survival after out-of-hospital cardiac arrest (OHCA) for patient characteristics and described predictors for death after discharge. Because long-term prognosis among patients with coronary heart disease has improved in the last decades, we hypothesized that the prognosis after OHCA would improve with time.

Methods

We analyzed data that were prospectively collected from all patients discharged from the hospital after OHCA in the community of Göteborg, Sweden, from 1980 to 1998 and divided the data into 2 time periods, 1980 to 1991 and 1991 to1998, with an equal number of patients.

Results

A total of 430 patients were included in the survey. Age, sex proportions, cardiovascular comorbidity, resuscitation factors, and inhospital complications did not change with time. A diagnosis of a precipitating myocardial infarction was more common during period 1 (66% vs 54%). The prescription of aspirin (22% vs 52%), angiotensin-converting enzyme inhibitors (7% vs 29%), anticoagulants (13% vs 27%), and lipid-lowering agents (0% vs 6%) at discharge increased during period 2. Long-term survival did not improve with time; the 5-year mortality rates were 53% in period 1 and 52% in period 2. Independent predictors of an increased risk of death included age (risk ratio [RR] 1.06, 95% CI 1.05–1.08), history of myocardial infarction (RR 2.02, 95% CI 1.51–2.72), history of smoking (RR 1.77, 95% CI 1.29–2.44), and worse cerebral performance at discharge (RR 1.71, 95% CI 1.44–2.02). The prescription of β-blockers at discharge was independently predictive of decreased risk of death (RR 0.63, 95% CI 0.46–0.85).

Conclusion

The long-term survival rate after OHCA did not change. Baseline characteristics remained generally unchanged, but the drugs prescribed at discharge changed in several aspects. Age, a history of myocardial infarction, a history of smoking, cerebral performance category at discharge, and the prescription of β-blockers were independent predictors of outcome.

Section snippets

Target population

Since 1974, the municipality of Göteborg, Sweden, has had an area of 455 km². The development of the total population and the fraction that was aged ≥70 years from 1970 to 1998 are shown in Figure 1. The latter fraction almost doubled between 1970 and 1990. Of the total population, 49% were male. The age distributions of the population according to the Utstein template15 for 1980 and 1998 are displayed in Figure 2. Data on mortality from specific causes was available to the year 1996. In

Results

During the period from 1980 to 1998, the Göteborg EMS initiated advanced cardiac life support in 4919 cases of OHCA, 2868 cases during period 1 and 2051 cases during period 2. Data on hospital admission were missing for 20 patients during period 2. Of the remaining 4899 patients, 1156 (24%) were admitted alive to the hospital and 430 (9%) were finally discharged alive from hospital. Twenty percent of all patients were admitted to the hospital alive during period 1, and 29% of patients were

Discussion

In the patients who were discharged from the hospital alive after OHCA and compared in a division of 2 consecutive periods (between 1980 and 1991 and 1991 and 1998), we did not find any significant changes in age, sex, resuscitation factors, or cardiovascular history, with the exception of smoking, which was less frequent during the latter period. Furthermore, long-term mortality did not change with time.

In another paper,19 we showed that the mean age and the proportion of women increased with

Acknowledgements

We thank Nils-Gunnar Pehrsson for valuable statistical advice.

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Our study shows that age is no longer an important factor for survival in admitted patients. In addition, medical centers are better for the OHCA patients, after adjusting for other factors. This finding suggests that we still need to try our best to treat older OHCA patients without discrimination.
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Sudden cardiac arrest is a major cause of death worldwide.1 High quality resuscitation and early defibrillation improve patient outcomes,2–9 but studies have shown insufficient cardiopulmonary resuscitation (CPR) quality, even during in-hospital professional resuscitation.10–16 CPR becomes ineffective within minutes because of rescuer fatigue, and rescuers commonly misjudge the decrease in quality.10,17,18
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With ethics committee approval and informed consent, 68 teams (2 flight attendants each) performed 12 min of standard CPR with the AED's audiovisual feedback mechanism enabled or disabled. We recorded CPR quality parameters during resuscitation on a manikin in this open, prospective, randomized controlled trial. Between the feedback and control-group we measured differences in compression depth and rate as main outcome parameters and effective compressions, correct hand position, and incomplete decompression as secondary outcome parameters. An effective compression was defined as a compression with correct depth, hand position, and decompression.
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could be considered a strength of our study. Thus, we consider our determination of survival duration to be more accurate than Utstein's protocol,14 which recommended determination of long-term survival relative to discharge from acute hospital care.3–5,25 Duration of hospitalization can be quite variable; in our study, it ranged from 7 to 199 days.
To describe the 3-year survival of patients after out-of-hospital cardiac arrest (OHCA) taking into account the presence of ST-segment elevation myocardial infarction (STEMI) and evaluating prognostic factors associated with pre-hospital and hospital care.
Over a period of 29 months and with the aid of a questionnaire supplied to 24 rescue stations, we prospectively included 560 individuals (415 men; aged 16–97 years, median 68) for whom cardio-pulmonary resuscitation (CPR) for OHCA of confirmed cardiac etiology was attempted.
Of 149 hospitalized individuals, 28.2% survived 1 year and 25.5% survived 3 years after OHCA. In the subgroup of patients with STEMI (26 individuals; 17.5%), 57.7% survived 1 year and 53.9% survived 3 years. In the subgroup of patients without STEMI (n = 123), 22% survived 1 year and 19.5% survived 3 years. The strongest predictors for long-term survival by logistic regression analysis were: age under 70 years, ventricular fibrillation as initial rhythm, CPR without atropine, and STEMI. OHCA occurrence at a public place was an indicator of better survival in the subgroup with STEMI. In the subgroup of patients without STEMI, long-term angiotensin-converting enzyme inhibitor treatment, CPR without atropine, a Glasgow Coma Scale upon hospital admission over 3, no presence of cardiogenic shock, and no manifestations of postanoxic encephalopathy (Fisher's exact test, χ² test) were indicators of better survival.
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^☆: Supported by grants from The Swedish Heart & Lung Foundation, from the Laerdal Foundation, Norway, and from the Göteborg Medical Society.

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Clinical investigationsTime trends in long-term mortality after out-of-hospital cardiac arrest, 1980 to 1998, and predictors for death☆

Abstract

Background

Methods

Results

Conclusion

Section snippets

Target population

Results

Discussion

Acknowledgements

Lancet

Lancet

Am Heart J

Ann Emerg Med

Ann Emerg Med

Ann Emerg Med

Resuscitation

Resuscitation

Am J Cardiol

The burden of cardiovascular diseases mortality in Europe. Task Force of the European Society of Cardiology on Cardiovascular Mortality and Morbidity Statistics in Europe

Eur Heart J

Sex differences in myocardial infarction and coronary deaths in the Scottish MONICA population of Glasgow 1985 to 1991presentation, diagnosis, treatment, and 28-day case fatality of 3991 events in men and 1551 events in women

Circulation

Fatality outside hospital from acute coronary events in three British health districts, 1994-5. United Kingdom Heart Attack Study Collaborative Group

BMJ

Improved long-term prognosis after myocardial infarction 1984-1991

Eur Heart J

PREDICTa simple risk score for clinical severity and long-term prognosis after hospitalization for acute myocardial infarction or unstable angina: the Minnesota heart survey

Circulation

Socioeconomic status and prediction of ventricular fibrillation survival

Am J Public Health

Racial differences in the incidence of cardiac arrest and subsequent survival. The CPR Chicago Project

N Engl J Med

Clinical investigations
Time trends in long-term mortality after out-of-hospital cardiac arrest, 1980 to 1998, and predictors for death☆