Prediction model for future OHCAs based on geospatial and demographic data: An observational study.

This study used demographic data in a novel prediction model to identify areas with high risk of out-of-hospital cardiac arrest (OHCA) in order to target prehospital preparedness. We combined data from the nationwide Danish Cardiac Arrest Registry with geographical- and demographic data on a hectare level. Hectares were classified in a hierarchy according to characteristics and pooled to square kilometers (km2). Historical OHCA incidence of each hectare group was supplemented with a predicted annual risk of at least 1 OHCA to ensure future applicability. We recorded 19,090 valid OHCAs during 2016 to 2019. The mean annual OHCA rate was highest in residential areas with no point of public interest and 100 to 1000 residents per hectare (9.7/year/km2) followed by pedestrian streets with multiple shops (5.8/year/km2), areas with no point of public interest and 50 to 100 residents (5.5/year/km2), and malls with a mean annual incidence per km2 of 4.6. Other high incidence areas were public transport stations, schools and areas without a point of public interest and 10 to 50 residents. These areas combined constitute 1496 km2 annually corresponding to 3.4% of the total area of Denmark and account for 65% of the OHCA incidence. Our prediction model confirms these areas to be of high risk and outperforms simple previous incidence in identifying future risk-sites. Two thirds of out-of-hospital cardiac arrests were identified in only 3.4% of the area of Denmark. This area was easily identified as having multiple residents or having airports, malls, pedestrian shopping streets or schools. This result has important implications for targeted intervention such as automatic defibrillators available to the public. Further, demographic information should be considered when implementing such interventions.

Contemporary levels of cardiopulmonary resuscitation training in Denmark.

Aim: Many efforts have been made to train the Danish population in cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use. We assessed CPR and AED training levels among the broad Danish population and volunteer responders. Methods: In November 2018, an electronic cross-sectional survey was sent to (1) a representative sample of the general Danish population (by YouGov) and (2) all volunteer responders in the Capital Region of Denmark. Results: A total of 2,085 people from the general population and 7,768 volunteer responders (response rate 36%) completed the survey. Comparing the general Danish population with volunteer responders, 81.0% (95% CI 79.2-82.7%) vs. 99.2% (95% CI 99.0-99.4%) p < 0.001 reported CPR training, and 54.0% (95% CI 51.8; 56.2) vs. 89.5% (95% CI 88.9-90.2) p < 0.001 reported AED training, at some point in life.In the general population, the unemployed and the self-employed had the lowest proportion of training with CPR training at 71.9% (95% CI 68.3-75.4%) and 65.4% (95% CI 53.8-75.8%) and AED training at 39.0% (95% CI 35.2-42.9%) and 34.6% (95% CI 24.2-46.2%), respectively.Applicable to both populations, the workplace was the most frequent training provider. Among 18-29-year-olds in the general population, most reported training when acquiring a driver's license. Conclusions: A large majority of the Danish population and volunteer responders reported previous CPR/AED training. Mandatory training when acquiring a driver's license and training through the workplace seems to disseminate CPR/AED training effectively. However, new strategies reaching the unemployed and self-employed are warranted to ensure equal access.

The variability of 2D and 3D transthoracic echocardiography applied in a general population : Intermodality, inter- and intraobserver variability.

Assessment of the left ventricular (LV) function by three-dimensional echocardiography (3DE) is potentially superior to 2D echo echocardiography (2DE) for LV performance assessment. However, intra- and interobserver variation needs further investigation. We examined the intra- and interobserver variability between 2 and 3DE in a general population. In total, 150 participants from the Copenhagen City Heart Study were randomly chosen. Two observers assessed left ventricular ejection fraction (LVEF), end-diastolic (EDV) and end-systolic volumes (ESV) by 2DE and 3DE. Inter-, intraobserver and intermodality variabilities are presented as means of difference (MD), limits of agreement (LoA), coefficient of correlation (r), intraclass correlation coefficients (ICC). The lowest MD and LoA and highest r- and ICC-values was generally seen among the 3D acquisitions, with the 3D EDV interobserver as the best performing estimate (r = 0.95, ICC = 0.94). The largest MD, LoA and lowest r- and ICC-values was found in the interobserver 2D LVEF (r = 0.76, ICC = 0.63. For the intraobserver analysis, there were statistically significant differences between observations for all but 3DE EDV (p = 0.06). For interobserver analysis, there were statistically significant differences between observers for all estimates but 2DE EDV (p = 0.11), 3D ejection fraction (p = 0.9), 3DE EDV (p = 0.11) and 3D ESV (p = 0.15). Three-dimensional echocardiography is more robust and reproducible than 2DE and should be preferred for assessment of LV function.

Regional variation in out-of-hospital cardiac arrest: Incidence and survival - A nationwide study of regions in Denmark.

AIM: Regional variation in incidence and survival after out-of-hospital cardiac arrest (OHCA) may be caused by many factors including differences in definitions and reporting. We examined regional differences in Denmark. METHODS: From the Danish Cardiac Arrest Registry we identified adult OHCA patients between 2009-2014 of presumed cardiac cause. Patients were grouped according to the five administrative/geographical regions of Denmark and survival was examined based on all arrest-cases (30-day survival percentage) and number of survivors per 100,000 inhabitants. RESULTS: We included 12,902 OHCAs of which 1550 (12.0 %) were alive 30 days after OHCA. No regional differences were observed in age, sex or comorbidities. Incidence of OHCA ranged from 32.9 to 42.4 per 100,000 inhabitants; 30-day survival percentages ranged from 8.5% to 13.8% and number of survivors per 100,000 inhabitants ranged from 3.5 to 5.9, across the regions. In one of the regions car-manned pre-hospital physicians were discontinued from 2011. Here, the incidence of OHCA per 100,000 inhabitants increased markedly from 37.1 in 2011 to 52.2 in 2014 and 30-day survival percentage decreased from 10.9 % in 2011 to 7.5 % in 2014; while the number of survivors per 100,000 inhabitants stagnated from 4.0 in 2011 to 3.9 in 2014. In comparison, survival increased in the other four regions. CONCLUSION: Differences in incidence and 30-day survival after OHCA were observed between the five regions of Denmark. Comparisons of survival should not only be based on survival percentages, but also on number of survivors of the background population as inclusion bias can influence survival outcomes.