Long-term prognosis and causes of death among survivors after out-of-hospital cardiac arrest: A population-based longitudinal study

Abstract

BackgroundWe aimed to identify the long-term prognosis and causes of death of out-of-hospital cardiac arrest (OHCA) survivors. MethodsUsing claims data from the National Health Insurance Service (NHIS) database, we included 4937 OHCA patients (aged ≥ 18 years) who were hospitalized between January 2005 and December 2015 and had survived for 30 days or more. The endpoints were long-term mortality and causes of death. Subgroup analyses were performed based on whether cardiac procedures were performed, and risk factors associated with cardiac and noncardiac deaths were identified. ResultsWe followed 4937 OHCA patients for a median of 3.3 years and up to 14 years of follow-up. The all-cause 1-, 3-, 5-, and 10-year cumulative mortality were 35.2%, 46.5%, 52.3%, and 62.7%, respectively. Regarding the 1130 OHCA survivors who had undergone cardiac procedures, the all-cause 1-, 3-, 5-, and 10-year cumulative mortality were 10.7%, 16.9%, 21.4%, and 30.6%, respectively. More patients (56.2%) died from noncardiovascular causes than from cardiovascular causes (43.8%) among the 2738 total patients who had died. The proportion of patients with cardiac death was significantly higher in the patient group with a cardiac procedure than in the group without a cardiac procedure (49.6% vs. 31.7%; P value < 0.001). A higher Charlson comorbidity index (CCI) was associated with an increased risk of cardiac mortality in the cardiac procedure group. ConclusionsThe long-term mortality among OHCA survivors remains high, particularly within the first year. Individual characteristics are crucial for the follow-up of OHCA survivors and may help improve their long-term prognosis.