Outcomes of Patients 65 Years or Older After Out-of-Hospital Cardiac Arrest Based on Location of Cardiac Arrest in Japan

Satoe Okabayashi,Chika Nishiyama,Tetsuhisa Kitamura,Junya Sado,Takeyuki Kiguchi,Kosuke Kiyohara,Taku Iwami,Daisuke Kobayashi,Tasuku Matsuyama,Tomonari Shimamoto,Takashi Kawamura

doi:10.1001/jamanetworkopen.2019.1011

Abstract

Out-of-hospital cardiac arrest (OHCA) is a major public health issue, and in recent years, the number of OHCAs among the elderly population, aged 65 years or older, has significantly increased in developed countries. To evaluate the demographic and clinical characteristics and outcomes of patients 65 years or older who experienced OHCA based on the location-public, residential, or nursing home-where it occurred in Japan. This prospective, nationwide, population-based cohort study used information collected by the All-Japan Utstein Registry to examine data from 293 615 patients 65 years or older who experienced OHCA during the period from January 2013 to December 2015 in Japan. Data analyses were conducted from June to July 2018. The primary outcome was 1-month survival with a favorable outcome that was defined as a cerebral performance category score of 1 or 2 (1, good cerebral performance; 2, moderate cerebral disability; 3, severe cerebral disability; 4, coma or vegetative state; and 5, death or brain death). Multivariable logistic regression analyses were conducted to examine favorable outcome by location. A total of 233 511 patients with OHCA were included in the final analysis; 29 911 (12.8%) occurred in a public location, 157 087 (67.3%) at a residential location, and 46 513 (19.9%) at a nursing home. The median age of the patients was 83.0 years (interquartile range, 76.0-88.0 years), and the proportion of men was 53.1% (124 108 of 233 511). The proportion of favorable neurologic outcomes was 4.5% (1351 of 29 911) in public locations, 1.0% (1555 of 157 087) in residential locations, and 0.6% (301 of 46 513) in nursing homes. Patients with cardiac arrests in public locations had a significantly higher likelihood of achieving a favorable neurologic outcome than those in residential locations (adjusted odds ratio, 1.36; 95% CI, 1.25-1.48), whereas those in nursing homes were less likely to achieve a favorable neurologic outcome (adjusted odds ratio, 0.62; 95% CI, 0.54-0.72). However, this difference in outcomes among patients based on location decreased with age. The outcomes of patients 65 years or older after OHCA differed by the location of the cardiac arrest. These outcomes may be improved by updating existing response measures across all locations.

Highlights

Out-of-hospital cardiac arrest (OHCA) is a major public health issue in developed countries, and in 2017, approximately 120 000 OHCA events occurred in Japan.[1]
Patients with cardiac arrests in public locations had a significantly higher likelihood of achieving a favorable neurologic outcome than those in residential locations, whereas those in nursing homes were less likely to achieve a favorable neurologic outcome
Study Design, Population, and Setting The All-Japan Utstein Registry maintained by the Fire and Disaster Management Agency (FDMA) is a prospective, nationwide OHCA registry that collects data according to the international Utstein style.[9,10]

Summary

Introduction

Out-of-hospital cardiac arrest (OHCA) is a major public health issue in developed countries, and in 2017, approximately 120 000 OHCA events occurred in Japan.[1] Patients 65 years of age or older accounted for more than 80% of all patients with OHCA in Japan.[1,2] The number of elderly people in Japan has been rapidly increasing, and the elderly population is predicted to be 30% of the total Japanese population by 2025.3 As this population ages, OHCA events are expected to increase. The number of elderly people who experience OHCA has increased annually; a significant improvement in the proportion of favorable neurologic outcomes has been noted

Methods

Results

Discussion

Conclusion