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Matta A, Philippe J, Nader V, Levai L, Moussallem N, Kazzi AA, Ohlmann P. Predictors and rate of survival after Out-of-Hospital Cardiac Arrest. Curr Probl Cardiol 2024; 49:102719. [PMID: 38908728 DOI: 10.1016/j.cpcardiol.2024.102719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 06/19/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) is a major public health concern and encloses a wide spectrum of causes. The purpose of this study is to assess predictors and rate of survival at hospital discharge and long-term in the setting of OHCA. The secondary endpoint is to compare OHCA-survival outcomes of presumed ischemic versus non ischemic cause. METHODS A retrospective cohort was conducted on 318 consecutive patients admitted for OHCA at Civilian Hospitals of Colmar between 2010 and 2019. Data concerning baseline characteristics, EKG, biological parameters, and coronary angiograms were collected. We observed the living status (alive or dead) of each of study's participants by March 2023. RESULTS The observed survival rate was 34.3 % at hospital discharge and 26.7 % at 7.1-year follow up. The mean age of study population was 63 ± 16 years and 32.7 % were women. 65.7 % of OHCA-patients underwent coronary angiography that revealed a significant coronary artery disease (CAD) in half of study participants. Primary angioplasty was performed in 43.4 % of study population. The in-hospital mortality rate was significantly higher in those with RBBB (83.7 % vs. 62.5 %, p = 0.004), diabetes mellitus (84.2 % vs. 59.9 %, p < 0.001), arterial hypertension (72.2 % vs. 57.7 %, p = 0.007), peripheral arterial disease (79.2 % vs. 52.2 %, p = 0.031) whereas it was lower in case of anterior STEMI (43.9 % vs 71.4 %, p < 0.001), presence of obstructive CAD (52.2 % vs. 79.2 %, p < 0.001), primary angioplasty performance (48.6 % vs. 78.9 %, p < 0.001), initial shockable rhythm (43.8 % vs. 88.6 %, p < 0.001), initial chest pain (49.4 % vs. 71.5 %, p < 0.001). After adjusting on covariates, the Cox model only identified an initial shockable rhythm as independent predictor of survival at hospital discharge [HR = 0.185, 95 %CI (0.085-0.404), p < 0.001] and 7-year follow up [HR = 0.201, 95 %CI (0.082-0.492), p < 0.001]. The Kaplan-Meier and log Rank test showed a difference in survival outcomes between OHCA with versus without CAD (p < 0.001). CONCLUSION The proportion of OHCA-survivors is small despite the development of emergency health care system. Initial shockable rhythm is the strong predictor of survival. OHCA of presumed coronary cause is associated with a better long-term survival outcome.
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Affiliation(s)
- Anthony Matta
- Department of cardiology, Civilian Hospitals of Colmar, Colmar, France; School of medicine and medical sciences, Holy Spirit University of Kaslik, P.O.Box 446, Jounieh, Lebanon.
| | - John Philippe
- Department of cardiology, Civilian Hospitals of Colmar, Colmar, France
| | - Vanessa Nader
- Department of cardiology, Civilian Hospitals of Colmar, Colmar, France
| | - Laszlo Levai
- Department of cardiology, Civilian Hospitals of Colmar, Colmar, France
| | - Nicolas Moussallem
- School of medicine and medical sciences, Holy Spirit University of Kaslik, P.O.Box 446, Jounieh, Lebanon
| | - Amin A Kazzi
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Patrick Ohlmann
- Department of cardiology, Strasbourg University Hospital, Strasbourg, France
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Abbott EE, Buckler DG, Hsu JY, Abella BS, Richardson LD, Carr BG, Zebrowski AM. Association of Racial Residential Segregation With Long-Term Outcomes and Readmissions After Out-of-Hospital Cardiac Arrest Among Medicare Beneficiaries. J Am Heart Assoc 2023; 12:e030138. [PMID: 37750559 PMCID: PMC10727234 DOI: 10.1161/jaha.123.030138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 08/10/2023] [Indexed: 09/27/2023]
Abstract
Background The national impact of racial residential segregation on out-of-hospital cardiac arrest outcomes after initial resuscitation remains poorly understood. We sought to characterize the association between measures of racial and economic residential segregation at the ZIP code level and long-term survival and readmissions after out-of-hospital cardiac arrest among Medicare beneficiaries. Methods and Results In this retrospective cohort study, using Medicare claims data, our primary predictor was the index of concentration at the extremes, a measure of racial and economic segregation. The primary outcomes were death up to 3 years and readmissions. We estimated hazard ratios (HRs) across all 3 types of index of concentration at the extremes measures for each outcome while adjusting for beneficiary demographics, treating hospital characteristics, and index hospital procedures. In fully adjusted models for long-term survival, we found a decreased hazard of death and risk of readmission for beneficiaries residing in the more segregated White communities and higher-income ZIP codes compared with the more segregated Black communities and lower-income ZIP codes across all 3 indices of concentration at the extremes measures (race: HR, 0.87 [95% CI, 0.81-0.93]; income: HR, 0.75 [95% CI, 0.69-0.78]; and race+income: HR, 0.77 [95% CI, 0.72-0.82]). Conclusions We found a decreased hazard of death and risk for readmission for those residing in the more segregated White communities and higher-income ZIP codes compared with the more segregated Black communities and lower-income ZIP codes when using validated measures of racial and economic segregation. Although causal pathways and mechanisms remain unclear, disparities in outcomes after out-of-hospital cardiac arrest are associated with the structural components of race and wealth and persist up to 3 years after discharge.
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Affiliation(s)
- Ethan E. Abbott
- Department of Emergency Medicine, Icahn School of Medicine at Mount SinaiNew YorkNY
- Department of Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew YorkNY
- Institute for Health Equity Research, Icahn School of Medicine at Mount SinaiNew YorkNY
| | - David G. Buckler
- Department of Emergency Medicine, Icahn School of Medicine at Mount SinaiNew YorkNY
| | - Jesse Y. Hsu
- Department of Biostatistics, Epidemiology, and InformaticsUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPA
| | - Benjamin S. Abella
- Center for Resuscitation Science and Department of Emergency Medicine, University of PennsylvaniaPhiladelphiaPA
| | - Lynne D. Richardson
- Department of Emergency Medicine, Icahn School of Medicine at Mount SinaiNew YorkNY
- Department of Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew YorkNY
- Institute for Health Equity Research, Icahn School of Medicine at Mount SinaiNew YorkNY
| | - Brendan G. Carr
- Department of Emergency Medicine, Icahn School of Medicine at Mount SinaiNew YorkNY
- Department of Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Alexis M. Zebrowski
- Department of Emergency Medicine, Icahn School of Medicine at Mount SinaiNew YorkNY
- Department of Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew YorkNY
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Paratz ED, Nehme E, Heriot N, Bissland K, Rowe S, Fahy L, Anderson D, Stub D, La Gerche A, Nehme Z. A two-point strategy to clarify prognosis in >80 year olds experiencing out of hospital cardiac arrest. Resuscitation 2023; 191:109962. [PMID: 37683995 DOI: 10.1016/j.resuscitation.2023.109962] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND The global population is aging, with the number of ≥80-year-olds projected to triple over the next 30 years. Rates of out-of-hospital cardiac arrest (OHCA) are also increasing within this age group. METHODS The Victorian Ambulance Cardiac Arrest Registry was utilised to identify OHCAs in patients aged ≥80 years between 2002-2021. Predictors of survival to discharge were defined and a prognostic score derived from this cohort. RESULTS 77,628 patients experienced OHCA of whom 25,269 (32.6%) were ≥80 years (80-90 years = 18,956; 90-100 years = 6,148; >100 years = 209). The number of patients ≥80 years increased over time both absolutely (p = 0.002) and proportionally (p = 0.028). 619 (2.4%) patients survived to discharge without change over time. Older ages had no difference in witnessed OHCA status but were less likely to have shockable rhythm (OR 0.50 (95% CI 0.44-0.57) for 90-100-year-olds, OR 0.28 (95% CI 0.12-0.63) for 90-100-year-olds). If OHCA was witnessed and there was a shockable rhythm then survival was 14%; if one factor was present survival was 5-6% and if neither factor was present, survival was 0.09%. These survival rates enabled derivation of a simplified prognostic assessment score - the '15/5/0' score - highly comparable to a previously-published American cohort. CONCLUSIONS Elderly OHCA rates have increased to one-third of caseload. The most important factors predicting survival were whether the OHCA was witnessed and there was a shockable rhythm. We present a simple two-point '15/5/0' prognostic score defining which patients will gain most from advanced resuscitative measures.
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Affiliation(s)
- Elizabeth D Paratz
- Department of Sports Cardiology, Baker Heart & Diabetes Institute, 75 Commercial Rd, Prahran, VIC 3181, Australia; Department of Cardiology, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia; Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Parkville, VIC 3000, Australia; Ambulance Victoria, Centre for Research and Evaluation, 31 Joseph St, Blackburn, North VIC 3130, Australia. https://twitter.com/@pretzeldr
| | - Emily Nehme
- Ambulance Victoria, Centre for Research and Evaluation, 31 Joseph St, Blackburn, North VIC 3130, Australia; School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia
| | - Natalie Heriot
- Ambulance Victoria, Centre for Research and Evaluation, 31 Joseph St, Blackburn, North VIC 3130, Australia
| | - Kenneth Bissland
- Department of Geriatric Medicine, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia
| | - Stephanie Rowe
- Department of Sports Cardiology, Baker Heart & Diabetes Institute, 75 Commercial Rd, Prahran, VIC 3181, Australia; Department of Cardiology, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia; Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Parkville, VIC 3000, Australia
| | - Louise Fahy
- Department of Sports Cardiology, Baker Heart & Diabetes Institute, 75 Commercial Rd, Prahran, VIC 3181, Australia; Department of Cardiology, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia
| | - David Anderson
- Ambulance Victoria, Centre for Research and Evaluation, 31 Joseph St, Blackburn, North VIC 3130, Australia; School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia; Department of Cardiology, Alfred Health, 55 Commercial Rd, Prahran, VIC 3181, Australia
| | - Dion Stub
- Ambulance Victoria, Centre for Research and Evaluation, 31 Joseph St, Blackburn, North VIC 3130, Australia; School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia; Department of Cardiology, Alfred Health, 55 Commercial Rd, Prahran, VIC 3181, Australia
| | - Andre La Gerche
- Department of Sports Cardiology, Baker Heart & Diabetes Institute, 75 Commercial Rd, Prahran, VIC 3181, Australia; Department of Cardiology, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia; Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Parkville, VIC 3000, Australia
| | - Ziad Nehme
- Ambulance Victoria, Centre for Research and Evaluation, 31 Joseph St, Blackburn, North VIC 3130, Australia; School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia; Department of Paramedicine, Monash University, McMahons Road, Frankston, VIC 3199, Australia
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Chan PS, Merritt R, McNally B, Chang A, Al-Araji R, Mawani M, Ahn KO, Girotra S. Bystander CPR and Long-Term Survival in Older Adults With Out-of-Hospital Cardiac Arrest. JACC. ADVANCES 2023; 2:100607. [PMID: 38084207 PMCID: PMC10713355 DOI: 10.1016/j.jacadv.2023.100607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 06/09/2023] [Accepted: 06/24/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Most studies on bystander cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest (OHCA) have focused on in-hospital or short-term survival. OBJECTIVES The purpose of this study was to examine the association between bystander CPR and long-term survival outcomes for OHCA. METHODS Within the Cardiac Arrest Registry to Enhance Survival, we identified 152,653 patients with OHCA ≥65 years of age or older. Using multivariable hierarchical logistic regression, we first examined the association between bystander CPR and in-hospital survival. Then, among those surviving to discharge and linked to Medicare files, we evaluated the association between bystander CPR and long-term mortality over 5 years using multivariable Cox regression. RESULTS Overall, 58,464 (38.3%) received bystander CPR. Patients receiving bystander CPR were more likely to have an OHCA that was witnessed, in a public location, and with an initial shockable rhythm. Bystander CPR was associated with a 24% higher likelihood of surviving to hospital discharge (10.2% vs 5.5%; adjusted relative risk: 1.24 [95% CI: 1.19-1.29]; P < 0.001), and this survival benefit was similar (interaction P = 0.24) for those who were 65 to 74, 75 to 84, and ≥85 years of age. Among patients surviving to hospital discharge (median follow-up of 31 months), bystander CPR was additionally associated with lower long-term mortality vs those without bystander CPR (adjusted hazard ratio: 0.78 [95% CI: 0.73-0.84]; P < 0.001), and this benefit was also consistent across age groups (interaction P = 0.13). CONCLUSIONS In older adults with OHCA, bystander CPR was associated with higher rates of in-hospital survival. This survival benefit was not attenuated by competing mortality risks but increased in magnitude after hospital discharge.
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Affiliation(s)
- Paul S. Chan
- Saint Luke’s Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Robert Merritt
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Bryan McNally
- Department of Emergency Medicine, Emory University and Rollins School of Public Health, Atlanta, Georgia, USA
| | - Anping Chang
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rabab Al-Araji
- Emory University and Rollins School of Public Health, Atlanta, Georgia, USA
| | - Minaz Mawani
- University of Georgia College of Public Health, Atlanta, GA, USA
| | - Ki Ok Ahn
- Department of Medicine, Hanyang University College of Medicine and Myongji Hospital, Seoul, South Korea
| | - Saket Girotra
- University of Texas-Southwestern, Dallas, Texas, USA
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