Abstract
Background: Although outcomes of out-of-hospital cardiac arrest (OHCA) patients have improved substantially over time, little is known regarding factors that may influence their longer term prognosis. The main objective of this study was to examine independent predictors of long-term mortality for OHCA survivors. Methods: A population-based study was conducted using the Toronto Rescu Epistry database with linkage to administrative data in Ontario, Canada. OHCA patients who survived to hospital discharge in the Great Toronto Area from 2005 to 2010 were included. Multivariable hierarchical regression models were constructed to determine the independent association of factors predicting 1-year and 3-years mortality. Results: Among the 13,755 OHCA patients who were eligible for study inclusion, 704 patients were alive at discharge and were included in this analysis. Their mean age was 60 years old, 27% were women, 35% had diabetes, and 9.4% had previous myocardial infarction. Mortality rates were 11.5% at one year and 19.6% at three years. Older age, cerebrovascular disease (OR = 2.74), renal disease (OR = 4.12) were significantly associated with higher mortality at one year (Table). In contrast, patients who had shockable initial rhythm (OR = 0.31), those who received coronary revascularization (OR = 0.41), or implantable cardioverter defibrillator (OR = 0.19) were associated with substantially lower risk of mortality. Factors associated with 3-year mortality were mostly similar as compared to one year, except for cancer which was highly significant for 3-year mortality (OR = 6). These models had high discrimination ability with area under the ROC of 0.89 for 1-year model and 0.88 for 3-year model. Conclusions: Non-cardiac comorbidities are the main drivers of adverse mortality for long term survivors of OHCA. Invasive cardiac procedures such as coronary revascularizations and ICD implantations are associated with significantly improved outcomes.
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