Abstract
Data regarding long-term clinical outcomes after out-of-hospital cardiac arrest (OHCA) are scarce.
To assess long-term mortality rate in OHCA patients, compare it with the general population age-specific mortality rate and identify relevant predictive factors.
All consecutive patients admitted to the Acute Cardiac Care Unit after OHCA from August 2007 to January 2019 and surviving until hospital discharge were included. All patients received targeted-temperature management according to our local protocol. Stepwise regression techniques and Cox proportional hazards models were used to investigate clinical variables related to long-term survival. The study population was divided into four quartiles according to their age and their mortality rate was compared with age-specific data from the Spanish National Statistics Institute.
The final analysis included 201 patients. Mean age was 57.6±14.2 years and 168 (83.6%) were male. The majority of patients experienced witnessed arrests related to shockable rhythms (176, 87.6%). Median time to ROSC was 18 (IQR 12–27) minutes and 14 patients (7.0%) were discharged in a poor neurological condition (CPC 3–4). Thirty-six patients (17.9%) died after a median follow-up of 40.3 months (18.9–69.1). A prognostic multivariate Cox model was developed and is shown in Table 1. Mortality was mainly driven by neurologic (33.%), cardiovascular (30.6%) and oncologic (30.6%) causes. Annual mortality rate per 1000 patients was statistically superior to that in the general population among the first three age quartiles: 18.08 (6.78–48.16) vs 0.64; 29.62 (12.33–71.16) vs 3.30; 63.07 (33.94–117.22) vs 7.77. Nevertheless, no significant differences were observed among the oldest patients, ranging from 68.6 to 90.7 years: 70.93 (43.45–115.78) vs 54.95.
Table 1. Cox proportional hazard model
| Variable | Hazard Ratio | Std. Err. | p value | 95% Confidence Interval |
|---|---|---|---|---|
| Time from CA to CPR (per minute) | 1.06 | 0.03 | 0.06 | 1.00–1.13 |
| Non-shockable rhythm | 2.93 | 1.11 | 0.01 | 1.39–6.16 |
| Poor LVEF at discharge (per %) | 1.03 | 0.01 | 0.01 | 1.01–1.06 |
| Age at time of CA (per year) | 1.04 | 0.01 | 0.01 | 1.01–1.06 |
| CPC 3–4 at hospital discharge | 3.50 | 1.43 | <0.01 | 1.58–7.78 |
| Variable | Hazard Ratio | Std. Err. | p value | 95% Confidence Interval |
|---|---|---|---|---|
| Time from CA to CPR (per minute) | 1.06 | 0.03 | 0.06 | 1.00–1.13 |
| Non-shockable rhythm | 2.93 | 1.11 | 0.01 | 1.39–6.16 |
| Poor LVEF at discharge (per %) | 1.03 | 0.01 | 0.01 | 1.01–1.06 |
| Age at time of CA (per year) | 1.04 | 0.01 | 0.01 | 1.01–1.06 |
| CPC 3–4 at hospital discharge | 3.50 | 1.43 | <0.01 | 1.58–7.78 |
Table 1. Cox proportional hazard model
| Variable | Hazard Ratio | Std. Err. | p value | 95% Confidence Interval |
|---|---|---|---|---|
| Time from CA to CPR (per minute) | 1.06 | 0.03 | 0.06 | 1.00–1.13 |
| Non-shockable rhythm | 2.93 | 1.11 | 0.01 | 1.39–6.16 |
| Poor LVEF at discharge (per %) | 1.03 | 0.01 | 0.01 | 1.01–1.06 |
| Age at time of CA (per year) | 1.04 | 0.01 | 0.01 | 1.01–1.06 |
| CPC 3–4 at hospital discharge | 3.50 | 1.43 | <0.01 | 1.58–7.78 |
| Variable | Hazard Ratio | Std. Err. | p value | 95% Confidence Interval |
|---|---|---|---|---|
| Time from CA to CPR (per minute) | 1.06 | 0.03 | 0.06 | 1.00–1.13 |
| Non-shockable rhythm | 2.93 | 1.11 | 0.01 | 1.39–6.16 |
| Poor LVEF at discharge (per %) | 1.03 | 0.01 | 0.01 | 1.01–1.06 |
| Age at time of CA (per year) | 1.04 | 0.01 | 0.01 | 1.01–1.06 |
| CPC 3–4 at hospital discharge | 3.50 | 1.43 | <0.01 | 1.58–7.78 |
Figure 1
OHCA survivors face significant mortality during follow-up, and its long term prognostic impact may be higher among younger patients. Age at the time of CA, time from CA to CPR, non-shockable rhythm, poor LVEF and poor neurological condition at discharge are independent predictors of long term mortality.
