Diurnal variations in incidence and outcome of out-of-hospital cardiac arrest including prior comorbidity and pharmacotherapy: A nationwide study in Denmark

TY - JOUR

T1 - Diurnal variations in incidence and outcome of out-of-hospital cardiac arrest including prior comorbidity and pharmacotherapy

T2 - A nationwide study in Denmark

AU - Karlsson, Lena I M

AU - Wissenberg, Mads

AU - Fosbøl, Emil L

AU - Hansen, Carolina Malta

AU - Lippert, Freddy K

AU - Bagai, Akshay

AU - McNally, Bryan

AU - Granger, Christopher B

AU - Christensen, Erika Frischknecht

AU - Folke, Fredrik

AU - Rajan, Shahzleen

AU - Weeke, Peter

AU - Nielsen, Søren L

AU - Køber, Lars

AU - Gislason, Gunnar H

AU - Torp-Pedersen, Christian

N1 - Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

PY - 2014/9

Y1 - 2014/9

N2 - Aim: To investigate diurnal variations in incidence and outcomes following out-of-hospital cardiac arrest (OHCA). Methods: OHCA of presumed cardiac etiology were identified through the nationwide Danish Cardiac Arrest Registry (2001-2010). Time of day was divided into three time periods: daytime 07.00-14.59; evening 15.00-22.59; and nighttime 23.00-06.59. Results: We identified 18,929 OHCA patients, aged ≥18 years. The median age was 72 years (IQR 62-80) and the majority were male (67.5%). OHCA occurrence varied across time periods, with 43.9%, 35.7% and 20.6% occurring during daytime, evening and nighttime, respectively. Nighttime patients were more likely to have: severe comorbidity (i.e. COPD), arrest in private home (87.2% vs. 69.0% and 73.0% daytime and evening, respectively), non-witnessed arrest (51.2% vs. 48.4% and 43.7%), no bystander CPR (75.9% vs. 68.4% and 66.1%), longer time interval from recognition of OHCA to rhythm analysis (12. min vs. 11. min and 11. min), and non-shockable heart rhythm (80.1% vs. 70.3% and 69.4%), all p<. 0.0001. Nighttime patients were less likely to achieve return of spontaneous circulation on arrival at the hospital (7.5% vs. 14.8% and 15.1%) and 1-year survival (2.8% vs. 7.2% and 7.1%), p<. 0.0001. Overall, the lower 1-year survival rate persisted after adjusting for patient-related and cardiac-arrest related characteristics mentioned above (OR 0.47, 95%CI 0.37-0.59; OR 0.51, 95%CI 0.40-0.65, compared to daytime and evening, respectively). Conclusions: We found nighttime patients to have a lower survival compared to daytime and evening that persisted when adjusting for patient-related and cardiac-arrest related characteristics including comorbidities.

AB - Aim: To investigate diurnal variations in incidence and outcomes following out-of-hospital cardiac arrest (OHCA). Methods: OHCA of presumed cardiac etiology were identified through the nationwide Danish Cardiac Arrest Registry (2001-2010). Time of day was divided into three time periods: daytime 07.00-14.59; evening 15.00-22.59; and nighttime 23.00-06.59. Results: We identified 18,929 OHCA patients, aged ≥18 years. The median age was 72 years (IQR 62-80) and the majority were male (67.5%). OHCA occurrence varied across time periods, with 43.9%, 35.7% and 20.6% occurring during daytime, evening and nighttime, respectively. Nighttime patients were more likely to have: severe comorbidity (i.e. COPD), arrest in private home (87.2% vs. 69.0% and 73.0% daytime and evening, respectively), non-witnessed arrest (51.2% vs. 48.4% and 43.7%), no bystander CPR (75.9% vs. 68.4% and 66.1%), longer time interval from recognition of OHCA to rhythm analysis (12. min vs. 11. min and 11. min), and non-shockable heart rhythm (80.1% vs. 70.3% and 69.4%), all p<. 0.0001. Nighttime patients were less likely to achieve return of spontaneous circulation on arrival at the hospital (7.5% vs. 14.8% and 15.1%) and 1-year survival (2.8% vs. 7.2% and 7.1%), p<. 0.0001. Overall, the lower 1-year survival rate persisted after adjusting for patient-related and cardiac-arrest related characteristics mentioned above (OR 0.47, 95%CI 0.37-0.59; OR 0.51, 95%CI 0.40-0.65, compared to daytime and evening, respectively). Conclusions: We found nighttime patients to have a lower survival compared to daytime and evening that persisted when adjusting for patient-related and cardiac-arrest related characteristics including comorbidities.

U2 - 10.1016/j.resuscitation.2014.06.012

DO - 10.1016/j.resuscitation.2014.06.012

M3 - Journal article

C2 - 24971509

SN - 0300-9572

VL - 85

SP - 1161

EP - 1168

JO - Resuscitation

JF - Resuscitation

IS - 9

ER -