Time trends in long-term mortality after out-of-hospital cardiac arrest, 1980 to 1998, and predictors for death.

ABSTRACT

BACKGROUND: We studied time trends in long-term survival after out-of-hospital cardiac arrest (OHCA) for patient characteristics and described predictors for death after discharge. Because long-term prognosis among patients with coronary heart disease has improved in the last decades, we hypothesized that the prognosis after OHCA would improve with time. METHODS: We analyzed data that were prospectively collected from all patients discharged from the hospital after OHCA in the community of Göteborg, Sweden, from 1980 to 1998 and divided the data into 2 time periods, 1980 to 1991 and 1991 to1998, with an equal number of patients. RESULTS: A total of 430 patients were included in the survey. Age, sex proportions, cardiovascular comorbidity, resuscitation factors, and inhospital complications did not change with time. A diagnosis of a precipitating myocardial infarction was more common during period 1 (66% vs 54%). The prescription of aspirin (22% vs 52%), angiotensin-converting enzyme inhibitors (7% vs 29%), anticoagulants (13% vs 27%), and lipid-lowering agents (0% vs 6%) at discharge increased during period 2. Long-term survival did not improve with time; the 5-year mortality rates were 53% in period 1 and 52% in period 2. Independent predictors of an increased risk of death included age (risk ratio [RR] 1.06, 95% CI 1.05-1.08), history of myocardial infarction (RR 2.02, 95% CI 1.51-2.72), history of smoking (RR 1.77, 95% CI 1.29-2.44), and worse cerebral performance at discharge (RR 1.71, 95% CI 1.44-2.02). The prescription of beta-blockers at discharge was independently predictive of decreased risk of death (RR 0.63, 95% CI 0.46-0.85). CONCLUSION: The long-term survival rate after OHCA did not change. Baseline characteristics remained generally unchanged, but the drugs prescribed at discharge changed in several aspects. Age, a history of myocardial infarction, a history of smoking, cerebral performance category at discharge, and the prescription of beta-blockers were independent predictors of outcome.