European Heart Journal Advance Access published online on October 17, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi604
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1 Section of Cardiology, University of Glasgow, Level 4, Queen Elizabeth Building, Glasgow Royal Infirmary, 10 Alexandra Parade, Glasgow G31 2ER, UK
* To whom correspondence should be addressed. 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%, Conclusion Survival following cardiopulmonary arrest has improved after adjusting for changes in case-mix. Better clinical management has contributed to this improvement.
Received May 10, 2005
Revised August 30, 2005
Accepted September 29, 2005
Clinical research
Post-discharge survival following pre-hospital cardiopulmonary arrest due to cardiac aetiology: temporal trends and impact of changes in clinical management
2 Robertson Centre for Biostatistics, University of Glasgow, Level 11, Boyd Orr Building, University Avenue, Glasgow G12 8QQ, UK
3 Scottish Ambulance Service, Headquarters, 23 Tipperlinn Road, Edinburgh EH10 5UU, UK
4 Department of Cardiology, Royal Infirmary of Edinburgh, Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, UK
Jill P. Pell, E-mail: jill.pell{at}gghb.scot.nhs.uk
Abstract 
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).
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