Elsevier

Resuscitation

Volume 81, Issue 12, December 2010, Pages 1657-1663
Resuscitation

Clinical paper
Pharmacotherapy and hospital admissions before out-of-hospital cardiac arrest: A nationwide study

https://doi.org/10.1016/j.resuscitation.2010.06.025Get rights and content

Abstract

Background

For out-of-hospital cardiac arrest (OHCA) to be predicted and prevented, it is imperative the healthcare system has access to those vulnerable before the event occurs. We aimed to determine the extent of contact to the healthcare system before OHCA.

Methods

All patients in Denmark with a registered OHCA June 1, 2001–December 31, 2005 were matched on age and sex with 10 random controls from the entire Danish population. We estimated the association with OHCA by conditional logistic regression analyses, and we determined the proportion of patients in contact with the healthcare system before OHCA from hospital admissions or claimed prescriptions.

Results

We identified 12,089 patients with an OHCA. Of these, 62% (7548) and 85% (10,312) were in contact with the healthcare system up to 30 days and 1 year before OHCA, respectively. Association with OHCA up to 30 days before the event pertained to myocardial infarction (odds ratio (OR) = 6.4, 95% confidence interval (CI): 4.7–8.6)); heart failure (OR = 5.1, CI: 4.1–6.3); ischemic heart disease (OR = 1.9, CI: 1.6–2.4); and cardiac dysrhythmia (OR = 1.8, CI: 1.4–2.2). Concomitant pharmacotherapy up to 30 days before OHCA with the strongest association was: corticosteroids (systemic) (OR = 2.7, CI: 2.5–3.0), bronchial dilators (OR = 2.5, CI: 2.3–2.7), anti-psychotic medication (OR = 2.1, CI: 1.9–2.3), and digoxin (OR = 2.1, CI: 2.0–2.3). Similar results were found for associations up to 1 year before OHCA.

Conclusion

Contrary to general belief, the majority of OHCA patients are in contact with the healthcare system shortly before OHCA.

Introduction

Sudden cardiac death (SCD) is the single most important cause of death in the industrialized world with an estimated annual incidence of 295,000 treated out-of-hospital cardiac arrests (OHCA) in the US alone.1 Despite substantial public and political awareness, SCD remains a major clinical and public health problem with a need for clinical strategies for primary and secondary prevention.2 Thus, identifying risk factors predisposing SCD is of great importance in order to identify particular high-risk subgroups within the general population.3

Studies have found that the majority of SCD individuals are from the general population; consequently, these persons are largely unknown to the treating physician as SCD may be the first cardiac event.4 However, these findings were made on a background of registered patient morbidity only and did not include other indicators of healthcare contact. Thus, the aim of this study was to assess hospital admissions and to characterize ongoing concomitant pharmacotherapy in a nationwide OHCA population that would add to the epidemiological knowledge of SCD.

Section snippets

Methods

A unique and permanent personal civil registration number is assigned to all residents in Denmark, enabling individual-level linkage of information between nationwide registers. The Danish Register of Medicinal Product Statistics (national prescription register) holds information on all dispensed drug prescriptions from Danish pharmacies since 1995. Dispensed drugs are classified according to the Anatomical Therapeutic Chemical (ATC) system. Pharmacies in Denmark must register all dispensed

Results

The Danish Cardiac Arrest Register and the Copenhagen MECU yielded 13,701 OHCA in 2001–2005; of these 1414 (10.3%) OHCA were excluded because of no personal civil registration number (non-residents in Denmark, tourists etc.) or because of a misreported civil registration number. Also excluded were 198 (1.5%) OHCA patients who were <14 years of age on January 1, 2001. Thus, the final OHCA study population comprised 12,089 individuals. The randomly selected age-and-sex matched control population

Discussion

The major finding in this nationwide population-based study was that 62% (7548) and 85% (10,312) of all individuals with OHCA between 2001 and 2005 were either admitted to hospital or claimed a prescription for a limited number of drugs shortly before the OHCA. Thus our findings suggest that the majority of OHCA individuals are in contact with the healthcare system shortly before OHCA.

Studies have demonstrated the difficulty associated with identifying and predicting which individuals are

Conclusion

In this study we were able to demonstrate that 62% and 85% of 12,089 patients with OHCA registered 2001–2005 were in contact with the healthcare system 30 days and 1 year before OHCA, respectively. The fact that he majority of OHCA patients are in contact with the healthcare system shortly before OHCA could prove useful when deciding where to focus clinical strategies for primary and secondary prevention of OHCA.

Conflicts of interest

None declared.

Funding

This research was funded by an unrestricted grant (J.nr.7343-09) from the Tryg Foundation (Denmark). The funding source of the study had no role in the study design, data collection, data analysis, data interpretation, writing of the report or the decision to submit for publication. The corresponding author had full access to all of the data and had the final responsibility for the decision to submit for publication.

Acknowledgements

PW, FF, GG, LK, and CTP analysed the data for the present paper. PW wrote the initial draft of the manuscript. All authors contributed to study design, interpretation of the data, intellectual discussion and revision of the manuscript. All authors have read and approved the final version of the manuscript before submission.

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    A Spanish translated version of the summary of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2010.06.025.

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