Post-discharge survival following pre-hospital cardiopulmonary arrest due to cardiac aetiology: temporal trends and impact of changes in clinical management

Pell, J., Corstorphine, M., McConnachie, A., Walker, N., Caldwell, J., Marsden, A., Grubb, N. and Cobbe, S. (2006) Post-discharge survival following pre-hospital cardiopulmonary arrest due to cardiac aetiology: temporal trends and impact of changes in clinical management. European Heart Journal, 27(4), pp. 406-412. (doi:10.1093/eurheartj/ehi604)

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Abstract

Aims To determine whether survival after discharge following pre-hospital cardiopulmonary arrest has improved. Methods and results The Heartstart Register was used to identify all 1659 patients discharged alive from Scottish hospitals during 1991–01 following pre-hospital arrest due to cardiac aetiology. The cohort was split into tertiles using year of arrest. A Cox proportional hazards model was used to determine risk of death relative to 1991–93. Patients who survived cardiopulmonary arrest in 1997–01 were less likely to die from any cause (unadjusted HR 0.60, 95% CI 0.48–0.75, P<0.001) or cardiac disease (unadjusted HR 0.50, 95% CI 0.38–0.65, P<0.001). After adjustment for case-mix, there remained significant declines in all-cause (adjusted HR 0.62, 95% CI 0.50–0.78, P<0.001) and cardiac death (adjusted HR 0.52, 95% CI 0.39–0.68, P<0.001). Clinical management had improved, with increased use of thrombolysis (47–63%, χ2 trend, P<0.001), beta-blockers (28–53%, χ2 trend, P<0.001), ACE-inhibitors (48–69%, χ2 trend, P<0.001), and anti-thrombotics (79–88%, χ2 trend, P<001). Adjustment for recorded changes in management attenuated the decline in all-cause death (adjusted HR 0.77, 95% CI 0.60–0.98, P=0.03). Conclusion Survival following cardiopulmonary arrest has improved after adjusting for changes in case-mix. Better clinical management has contributed to this improvement.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:McConnachie, Professor Alex and Caldwell, Dr Jane and Pell, Professor Jill and Cobbe, Professor Stuart
Authors: Pell, J., Corstorphine, M., McConnachie, A., Walker, N., Caldwell, J., Marsden, A., Grubb, N., and Cobbe, S.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Public Health
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Centre for Population and Health Sciences
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Journal Name:European Heart Journal
ISSN:0195-668X

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