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

Lena I M Karlsson; Mads Wissenberg; Emil L Fosbøl; Carolina Malta Hansen; Freddy K Lippert; Akshay Bagai; Bryan McNally; Christopher B Granger; Erika Frischknecht Christensen; Fredrik Folke; Shahzleen Rajan; Peter Weeke; Søren L Nielsen; Lars Køber; Gunnar H Gislason; Christian Torp-Pedersen

doi:10.1016/j.resuscitation.2014.06.012

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

Lena I M Karlsson, Mads Wissenberg, Emil L Fosbøl, Carolina Malta Hansen, Freddy K Lippert, Akshay Bagai, Bryan McNally, Christopher B Granger, Erika Frischknecht Christensen, Fredrik Folke, Shahzleen Rajan, Peter Weeke, Søren L Nielsen, Lars Køber, Gunnar H Gislason, Christian Torp-Pedersen

Department of Clinical Medicine

14 Citations (Scopus)

Abstract

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.

Original language	English
Journal	Resuscitation
Volume	85
Issue number	9
Pages (from-to)	1161–1168
Number of pages	8
ISSN	0300-9572
DOIs	https://doi.org/10.1016/j.resuscitation.2014.06.012
Publication status	Published - Sept 2014

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Karlsson, L. I. M., Wissenberg, M., Fosbøl, E. L., Hansen, C. M., Lippert, F. K., Bagai, A., McNally, B., Granger, C. B., Christensen, E. F., Folke, F., Rajan, S., Weeke, P., Nielsen, S. L., Køber, L., Gislason, G. H., & Torp-Pedersen, C. (2014). Diurnal variations in incidence and outcome of out-of-hospital cardiac arrest including prior comorbidity and pharmacotherapy: A nationwide study in Denmark . Resuscitation, 85(9), 1161–1168. https://doi.org/10.1016/j.resuscitation.2014.06.012

Diurnal variations in incidence and outcome of out-of-hospital cardiac arrest including prior comorbidity and pharmacotherapy : A nationwide study in Denmark . / Karlsson, Lena I M; Wissenberg, Mads; Fosbøl, Emil L et al.

In: Resuscitation, Vol. 85, No. 9, 09.2014, p. 1161–1168.

Research output: Contribution to journal › Journal article › Research › peer-review

Karlsson, LIM, Wissenberg, M, Fosbøl, EL, Hansen, CM, Lippert, FK, Bagai, A, McNally, B, Granger, CB, Christensen, EF, Folke, F, Rajan, S, Weeke, P, Nielsen, SL, Køber, L, Gislason, GH & Torp-Pedersen, C 2014, 'Diurnal variations in incidence and outcome of out-of-hospital cardiac arrest including prior comorbidity and pharmacotherapy: A nationwide study in Denmark ', Resuscitation, vol. 85, no. 9, pp. 1161–1168. https://doi.org/10.1016/j.resuscitation.2014.06.012

@article{6f426a46544e4c7d90e728df1a79df24,

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

abstract = "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.",

author = "Karlsson, {Lena I M} and Mads Wissenberg and Fosb{\o}l, {Emil L} and Hansen, {Carolina Malta} and Lippert, {Freddy K} and Akshay Bagai and Bryan McNally and Granger, {Christopher B} and Christensen, {Erika Frischknecht} and Fredrik Folke and Shahzleen Rajan and Peter Weeke and Nielsen, {S{\o}ren L} and Lars K{\o}ber and Gislason, {Gunnar H} and Christian Torp-Pedersen",

year = "2014",

month = sep,

doi = "10.1016/j.resuscitation.2014.06.012",

language = "English",

volume = "85",

pages = "1161–1168",

journal = "Resuscitation",

issn = "0300-9572",

publisher = "Elsevier Ireland Ltd",

number = "9",

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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

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 -

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

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