European Heart Journal Advance Access originally published online on October 17, 2005
European Heart Journal 2006 27(4):406-412; doi:10.1093/eurheartj/ehi604
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Post-discharge survival following pre-hospital cardiopulmonary arrest due to cardiac aetiology: temporal trends and impact of changes in clinical management
1Section of Cardiology, University of Glasgow, Level 4, Queen Elizabeth Building, Glasgow Royal Infirmary, 10 Alexandra Parade, Glasgow G31 2ER, UK
2Robertson Centre for Biostatistics, University of Glasgow, Level 11, Boyd Orr Building, University Avenue, Glasgow G12 8QQ, UK
3Scottish Ambulance Service, Headquarters, 23 Tipperlinn Road, Edinburgh EH10 5UU, UK
4Department of Cardiology, Royal Infirmary of Edinburgh, Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, UK
Received 10 May 2005; revised 30 August 2005; accepted 29 September 2005; online publish-ahead-of-print 17 October 2005.
* Corresponding author. Greater Glasgow NHS Board, Dalian House, 350 St Vincents Street, Glasgow G3 8YU, UK. Tel: +44 141 201 4544; fax: +44 141 201 4539. E-mail address: jill.pell{at}gghb.scot.nhs.uk
See page 377 for the editorial comment on this article (doi:10.1093/eurheartj/ehi670)
Aims To determine whether survival after discharge following pre-hospital cardiopulmonary arrest has improved.
Methods and results The Heartstart Register was used to identify all 1659 patients discharged alive from Scottish hospitals during 1991–01 following pre-hospital arrest due to cardiac aetiology. The cohort was split into tertiles using year of arrest. A Cox proportional hazards model was used to determine risk of death relative to 1991–93. Patients who survived cardiopulmonary arrest in 1997–01 were less likely to die from any cause (unadjusted HR 0.60, 95% CI 0.48–0.75, P<0.001) or cardiac disease (unadjusted HR 0.50, 95% CI 0.38–0.65, P<0.001). After adjustment for case-mix, there remained significant declines in all-cause (adjusted HR 0.62, 95% CI 0.50–0.78, P<0.001) and cardiac death (adjusted HR 0.52, 95% CI 0.39–0.68, P<0.001). Clinical management had improved, with increased use of thrombolysis (47–63%, 
2 trend, P<0.001), beta-blockers (28–53%, 2 trend, P<0.001), ACE-inhibitors (48–69%, 2 trend, P<0.001), and anti-thrombotics (79–88%, 2 trend, P<001). Adjustment for recorded changes in management attenuated the decline in all-cause death (adjusted HR 0.77, 95% CI 0.60–0.98, P=0.03).
Conclusion Survival following cardiopulmonary arrest has improved after adjusting for changes in case-mix. Better clinical management has contributed to this improvement.
Key Words: Cardiopulmonary arrest • Survival • Epidemiology
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- Post-discharge survival following pre-hospital cardiopulmonary arrest owing to cardiac aetiology
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