Occurrence Of Out-of-hospital Cardiac Arrest Research Articles

Common ECG abnormalities pose increased risks of out-of-hospital cardiac arrest

Abstract Background It is known that 40%-60% of all sudden cardiac deaths occur as the first sign of unrecognized heart disease which poses a challenge in preventing early cardiac death (1). While many common ECG abnormalities have previously been associated with an increased risk of cardiac morbidity and mortality, knowledge of what abnormalities are associated with out-of-hospital cardiac arrest (OHCA) is lacking (2,3). Purpose To investigate the association between a range of common ECG abnormalities and the risk of subsequent OHCA. Methods From 2000 to 2020, patients acquiring an ECG at a Danish hospital or in an ambulance in Denmark were followed until either having OHCA, emigrating, death from other causes or end of study (01-01-2021), whichever came first. Only the index ECG and first occurrence of OHCA for each patient were considered for analysis. Data on patient age and gender were obtained through the Danish Civil Registration System. A multivariable Cox regression, adjusted for patient gender and age at ECG acquisition, was performed to assess the risk (hazard ratio [HR] with 95% confidence interval [95% CI]) of OHCA for various common ECG abnormalities. P-values less than 0.05 were considered significant. Results In total 2,037,003 patients were included, of which 26,446 (13.0%) had OHCA during follow-up after ECG acquisition. Patient characteristics and distribution of ECG abnormalities between the OHCA and non-OHCA patients are shown in Table 1. Patients with OHCA were older and more frequently male (both p < 0.001). ECG abnormalities were also generally more frequent among OHCA patients than non-OHCA patients. Median follow-up time for the entire cohort was 2063 days. The results of the multivariable Cox regression are shown in Figure 1. All assessed ECG abnormalities resulted in significantly higher risk of later OHCA with HR (95% CI) ranging between 1.0521 (1.0512-1.0531) and 1.0554 (1.0544-1.0563) when also adjusting for patient age and gender. Conclusion Common ECG abnormalities were associated with a significantly increased risk of OHCA. Further research is needed to investigate the mechanisms behind specific ECG abnormalities and OHCA occurrence and to determine the validity of ECG screening in preventing OHCA.Table 1Figure 1, SL = Sokolow-Lyon

Bystander defibrillation for out-of-hospital cardiac arrest in Ireland

AimsTo describe and explore predictors of bystander defibrillation in Ireland during the period 2012 to 2020. To examine the relationship between bystander defibrillation and health system developments. MethodsNational level Out of Hospital Cardiac Arrest (OHCA) registry data were interrogated, focusing on patients who had defibrillation performed. Bystander defibrillation (as compared to EMS initiated defibrillation) was the key outcome of concern. Logistic regression models were built and refined by fitting predictors, performing stepwise variable selection and by adding pairwise interactions that improved fit. ResultsThe data included 5,751 cases of OHCA where defibrillation was performed. Increasing year over time (OR 1.17, 95% CI 1.13, 1.21) was associated with increased adjusted odds of bystander defibrillation. Non-cardiac aetiology was associated with reduced adjusted odds of bystander defibrillation (OR 0.30, 95% CI 0.21, 0.42), as were increasing age in years (OR 0.99, 95% CI 0.987, 0.996) and night-time occurrence of OHCA (OR 0.67, 95% CI 0.53, 0.83). Six further variables in the final model (sex, call response interval, incident location (home or other), who witnessed collapse (bystander or not witnessed), urban or rural location, and the COVID period) were involved in significant interactions. Bystander defibrillation was in general less likely in urban settings and at home locations. Whilst women were less likely to receive bystander defibrillation overall, in witnessed OHCAs, occurring outside the home, in urban areas and outside of the COVID-19 period women were more likely, to receive bystander defibrillation. ConclusionsDefibrillation by bystanders has increased incrementally over time in Ireland. Interventions to address sex and age-based disparities, alongside interventions to increase bystander defibrillation at night, in urban settings and at home locations are required.

Effects of pre-existing type 1 diabetes mellitus on survival outcome following out-of-hospital cardiac arrest: a registry-based observational study in Sweden

BackgroundIt has been estimated that 80% of cases of out-of-hospital cardiac arrest (OHCA) are due to cardiac causes. It is well-documented that diabetes is a risk factor for conditions associated...

Do air pollutants levels during the previous 48 hours predict out-of-hospital cardiac arrest incidence compared to same-day pollutants levels?

Abstract Funding Acknowledgements None. Introduction Association between air pollutants (APs) levels and out-of-hospital cardiac arrest (OHCA) at the same day of the measurements have been previously described. Whether APs levels measured during the previous 48 hours may predict OHCA occurrence is not known. Purpose To analyse whether same-day APs levels compared to APs levels during the previous 48 hours are associated with OHCA incidence. Methods OHCA admissions on five Cardiac Intensive Care Units of our city were assessed during September-2020 to December-2021. Free access data regarding particulate matter (PM10), carbon monoxide (CO), nitrogen dioxide (NO2) and ozone (O3) levels during the same period were also registered. APs measures occurred each hour daily at three different spots, delivering more than 31000 measurements. APs levels during the previous 48 hours and during the index day were compared between OHCA-free days (OHCA-Fd) and OHCA-days. Results 179 patients were included. Main demographic characteristics are shown on table 1. Daily OHCA incidence and APs mean levels/month are shown in Table 2. As shown at table 3 same-day higher NO2 and lower O3 levels were found on OHCA-days compared to OHCA-fd: 41 ±10 vs. 36 ±9 µg/m3, p=0.016 for NO2 and 45 ±13 vs. 51 ±11 µg/m3, p= 0.003 for O3. As shown on Table 2 same day mean O3 levels were also higher from April to September compared to the rest of the year (p<0.001). OHCA incidence was lower in this same period (p<0.001). There wasn’t any association between OHCA incidence and APs (NO2, O3, PM10 and CO) measured at any moment during the event's prior 48 hours. Conclusions Same-day higher NO2 and lower O3 levels were associated to a higher OHCA incidence in our city. On the other hand, association between OHCA and NO2, O3, PM10 or CO measurements during the previous 48 hours was not found in our cohort. Reducing production of NO2 (i.e., reducing fossil-fuel consumption) may reduce OHCA risk during that same day.

Trends in presumed drug overdose out-of-hospital cardiac arrests in San Francisco, 2015–2023

IntroductionEstimates of the prevalence of drug-related out of hospital cardiac arrest (OHCA) vary, ranging from 1.8% to 10.0% of medical OHCA. However, studies conducted prior to the recent wave of fentanyl deaths likely underestimate the current prevalence of drug-related OHCA. We evaluated recent trends in drug-related OHCA, hypothesizing that the proportion of presumed drug-related OHCA treated by emergency medical services (EMS) has increased since 2015. MethodsWe conducted a retrospective analysis of OHCA patients treated by EMS providers in San Francisco, California between 2015 and 2023. Participants included OHCA cases in which resuscitation was attempted by EMS. The study exposure was the year of arrest. Our primary outcome was the occurrence of drug-related OHCA, defined as the EMS impression of OHCA caused by a presumed or known overdose of medication(s) or drug(s). ResultsFrom 2015 to 2023, 5044 OHCA resuscitations attended by EMS (average 561 per year) met inclusion criteria. The median age was 65 (IQR 50–79); 3508 (69.6%) were male. The EMS impression of arrest etiology was drug-related in 446/5044 (8.8%) of OHCA. The prevalence of presumed drug-related OHCA increased significantly each year from 1% in 2015 to 17.6% in 2023 (p-value for trend = 0.0001). After adjustment, presumed drug-related OHCA increased by 30% each year from 2015-2023. ConclusionDrug-related OHCA is an increasingly common etiology of OHCA. In 2023, one in six OHCA was presumed to be drug related. Among participants less than 60 years old, one in three OHCA was presumed to be drug related.

Neurological outcomes in traffic accidents: A propensity score matching analysis of medical and non-medical origin cases of out-of-hospital cardiac arrest

AimThis study aimed to comprehensively compare the characteristics of out-of-hospital cardiac arrest (OHCA) with medical and non-medical origins attributed to traffic accidents and explore the potential association between the cases with a medical origin and neurologically favorable outcomes. MethodsIn this retrospective nationwide population-based study, baseline data were collected between January 2018 and December 2020. We analyzed 5091 OHCA associated with traffic accidents on the road scene. Only those encounters involving treatment or transport by prehospital emergency medical technicians were included. The characteristics of OHCA incidents and their outcomes were analyzed by categorizing patients into “medical origin” and “non-medical origin” groups. ResultsMedical-origin cases exhibited several distinct characteristics, including higher frequencies of occurrence during the daytime (79.3% [706/890] vs. 68.9% [2895/4201], p < 0.001), a higher prevalence among male (77.8% [692/890] vs. 68.3% [2871/4201], p < 0.001) and younger patients (median [25–75%]: 63 years [42–77] vs. 66 years [50–76], p = 0.003), a higher proportion of shockable initial rhythms(10.5% [93/890] vs. 1.1% [45/4201], p < 0.001), an increased number of cases requiring advanced airway management (33.8% [301/890] vs. 28.5% [1199/4201], p = 0.002) and adrenaline administration by emergency medical teams (26.9% [239/890] vs. 21.7% [910/4201], p < 0.001), and shorter transport times (55.3% [492/890] vs. 60.9% [2558/4201], p = 0.002) compared to non-medical-origin cases. However, medical-origin cases also had lower witness rates (42.8% [381/890] vs. 27.2% [1142/4201], p < 0.001) and were less likely to be transported to higher-level hospitals (55.3% [492/890] vs. 60.9% [2558/4201], p = 0.002). Propensity score matching analysis identified factors associated with favorable neurological outcomes in medical-origin traffic accidents. The adjusted odds ratios were as follows: 8.46 (3.47–20.61) for cases with shockable initial rhythms, 2.36 (1.01–5.52) for cases involving traffic accidents due to medical origin, and 0.09 (0.01–0.67) for cases where advanced airway management was provided. ConclusionIn this retrospective study, the occurrence of OHCAs of medical origin involving traffic accidents were associated with favorable neurological outcomes. These cases more frequently demonstrated favorable factors for survival compared to those classified as of non-medical origin. The findings have important implications for public health and EMS professionals, they will guide future research aimed at optimizing prehospital care strategies and improving survival rates for similar cases.

Early modelling of the effects and healthcare costs of the Dutch citizen-rescuer system for out-of-hospital cardiac arrests.

1) to analyse the total average healthcare costs of a patient with an out-of-hospital cardiac arrest (OHCA), as well as estimating the operational costs of the citizen-rescuer system (CRS); 2) to conduct an early modelling of the effects and healthcare costs of the Dutch CRS in comparison to no CRS. A health economic modelling study was conducted. Adult patients with OHCA from cardiac causes in the province of Limburg (the Netherlands) were included. The time horizon was from OHCA occurrence up to one year after hospital discharge. First, the total average healthcare costs of OHCA patients were analysed as well as the yearly operating costs of the CRS. Second, an early modelling was conducted to compare from the healthcare perspective the healthcare costs of OHCA patients with the CRS being activated but no responders attended (CRS-NV) versus the CRS being activated with attendance of ≥1 responder(s) (CRS-V). The total average healthcare costs per patient are €42,533. The yearly operating costs for the CRS are approximately €1.5 million per year in the Netherlands. The early modelling of costs and effects showed that the incremental healthcare costs per patient thus were €4,131 in the CRS-V versus the CRS-NV group (€25,184 in the CRS-V group and €21,053 in the CRS-NV group). Incremental quality-adjusted life years (QALYs) was 5 per 100 patients (16 per 100 patients in the CRS-V group versus 11 per 100 patients in the CRS-NV group). The incremental cost-effectiveness ratio (ICER) was €79,662 per QALY for the CRS-V group. This study shows that patients in the CSR-V group had additional health care costs of €4,131 per patient compared to patients in the CRS-NV group. This increase is caused by patients surviving more often, who then continue to utilise health services, which results in a (logic) increase in healthcare costs. For future research, accurate and up-to-date data on effectiveness and costs of the CRS needs to be collected.

Observational analysiS of out-of-hospital Cardiac Arrest occurRence and temporal variability patterns in subpopulation of southern POLand from 2006 to 2018: OSCAR-POL registry.

Temporal variability of out-of-hospital cardiac arrest (OHCA) occurrence was presented in previous studies, however, the data regarding long-term observation is scarce. The aim of this study was to investigate the temporal variability of OHCA occurrence during a long-time period and analyze the circadian pattern within particular timeframes. The retrospective analysis of 5058 OHCA cases was made covering the period from January 1st, 2006 to December 31st, 2018. Circadian, weekly, monthly and seasonal variabilities were investigated. The circadian variability of OHCA occurrence was assessed within particular years, seasons of the year, and days of the week. The highest OHCA incidence was observed between 08:00 and 08:59 and the lowest between 01:00 and 01:59 (7.1% vs. 1.6%, p < 0.001). After division into 6-h intervals, a significantly lower number of OHCA cases occurred between 00:00 and 05:59 (12.3%) in comparison to the highest number observed in between 06:00 and 11:59 (12.3% vs. 33.5%, p < 0.001). The highest OHCA occurrence was observed on Monday (14.9%), however, no weekly variability was found (p = 0.557). The highest OHCA occurrence was observed in the winter and lowest in the summer (27.4% vs. 22.8%, p < 0.001). Significant circadian variability was observed for every day of the week, every season and year during the observation period (p < 0.001). Circadian, monthly and seasonal variability of OHCA occurrence was confirmed in the long-term observation with no differences between particular days of the week. Significant circadian variability was observed within days of the week, seasons of the year, and particular years.

Association between bystander intervention and emergency medical services and the return of spontaneous circulation in out-of-hospital cardiac arrests occurring at a train station in the Tokyo metropolitan area: A retrospective cohort study

AimThe purpose of this study was to stratify patients who achieved return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OHCA) with bystander procedures pre-emergency medical service (EMS) arrival and those who achieved ROSC with procedures post-EMS arrival, compare outcomes at 1-month, and identify factors associated with pre-EMS-arrival-ROSC. MethodsA retrospective cohort analysis of OHCAs occurring at stations in the Tokyo metropolitan area between 2014 and 2018 was conducted. Subjects were stratified by ROSC phase (categorized as pre- and post-EMS arrival and non-ROSC). Survival at 1-month post-OHCA and the percentage of favourable neurological function in each ROSC phase were analysed. In addition, factors associated with Pre-EMS-arrival-ROSC were identified using multivariable logistic regression analysis. The time of occurrence of OHCA was classified into four-time categories as follows. Rush hour on morning [7:00–9:00], Rush hour on evening [17:00–21:00], Daytime [9:00–17:00], and Night or Early morning [21:00–7:00]. ResultsAmong the 63,089 OHCA in the dataset, 702 were analysed. At 1-month after OHCA occurrence, Pre-EMS-arrival ROSC had higher survival rates than post-EMS-arrival ROSC (86.8% vs. 54.1%) and CPC1-2 rates (73.6% vs. 38.5%). Pre-EMS-arrival ROSC was associated (adjusted odds ratio [95% confidence interval]) with non-older-adult patients (1.59 [1.05–2.43]), witnessed OHCA (1.82 [1.03–3.31]), evening rush-hour (17:00–21:00; 2.08 [1.05–4.11]), conventional CPR (33.42 [7.82–868.44]), hands-only CPR (17.06 [4.30–436.48]), bystander defibrillation performed once (3.31 [1.59–6.99]). ConclusionsIn an OHCA at a station in Tokyo, ROSC achieved with bystander treatment alone had a better outcome at 1-month compared to ROSC with EMS intervention

Out-of-Hospital Cardiac Arrest in Individuals With Human Immunodeficiency Virus: A Nationwide Population-Based Cohort Study.

Little data exist on the risk and outcomes of out-of-hospital cardiac arrest (OHCA) in people with HIV (PWH). We aimed to describe OHCA in PWH as compared with the general population in terms of incidence, characteristics, and survival. This nationwide study assessed all individuals aged 18-85 years between 2001 and 2019 in Denmark. The cumulative incidence of OHCA was computed using cause-specific Cox models accounting for competing risk of death. Among 6 565 309 individuals, 6 925 (median age: 36; interquartile range [IQR]: 28-44 y; 74% males) were infected at some point with HIV. The incidence of OHCA was 149 (95% CI: 123-180)/100 000 person-years in PWH versus 64 (95% CI: 64-65)/100 000 person-years in people without HIV (P < .001). Age at the time of cardiac arrest was 52 (IQR: 44-61) years in PWH versus 69 (IQR: 59-77) years in individuals without HIV (P < .001). In a multivariable model adjusted for age, sex, hypertension, diabetes, heart failure, ischemic heart disease, atrial fibrillation, chronic obstructive pulmonary disease, cancer, and renal failure, PWH had a 2-fold higher risk of OHCA (hazard ratio: 2.84; 95% CI: 2.36-3.43; P < .001). Thirty-day mortality (89% vs 88%; P = .80) was comparable to individuals without HIV. HIV is an independent risk factor for OHCA, and those who experience OHCA with HIV are much younger than those without HIV. Almost 90% of PWH died 1 month after OHCA. Further research should strive to find out how to reduce OHCA occurrence in this population.

Research on the Rescue Time of the Taiwan Marathon Emergency Medical Service System Between 2013 and 2021.

While there are several studies on marathon injuries worldwide, there are no related studies on the Taipei Marathon regarding the rescue time of onsite injury cases, the incidence of out-of-hospital cardiac arrest (OHCA) cases, and the success rate of recovery of spontaneous circulation (ROSC). This study aims to fill that gap. The rescue time onsite of contact injury cases was in the prime time for lifesaving. Descriptive epidemiological study. Level 2c. This is a retrospective study of numerical and timeflow data using descriptive statistics. Our data were obtained from records of the Taipei Marathon from 2013 to 2021. These included (1) notification data, (2) the time record of the emergency care personnel in contact with patients, (3) incidence of OHCA, (4) the success rate of ROSC, (5) the location of occurrence of OHCA, and (6) emergency medical service capacity and configuration. The average time taken for first contact was 1.56 minutes in OHCA cases, and the total incidence rate of OHCA in 9 years was 4 people per 100,000 people, with a 100% ROSC success rate. Further, the location of OHCA cases was mostly in Q4 of the race (66.67%), followed by Q3 (22.22%) and Q2 (1.11%). The average number of emergency care personnel per marathon was 78, spread across 6 rescue and 6 medical stations and equipped with 8 ambulances and 35 automated external defibrillators. Shortening the arrival time of medical personnel to the scene and implementing a complete chain of survival can improve survival rates. Other ways to provide faster and more timely emergency rescue services require further study. Contact with patients as soon as possible, timely implementation of cardiopulmonary resuscitation, and use of an automated external defibrillator are the basic requirements of the chain of survival theory.

Pre-arrest comorbidity burden and the future risk of out-of-hospital cardiac arrest in Korean adults

ObjectiveTo investigate the impact of pre-arrest comorbidities on future out-of-hospital cardiac arrest (OHCA) development using a nationwide dataset.MethodsThis population-based, matched case-control study used the national health insurance claims data relevant...

Individual socioeconomic status and risk of out-of-hospital cardiac arrest: A nationwide case-control analysis.

Area-level socioeconomic status (SES) is associated with the incidence of out-of-hospital cardiac arrest (OHCA); however, the effects of individual-level SES on OHCA occurrence are unknown. This study investigated whether individual-level SES is associated with the occurrence of OHCA. This case-control study used data from the nationwide OHCA registry and the National Health Information Database (NHID) in Korea. All adult patients with OHCA of a medical etiology from 2013 to 2018 were included. Four controls were matched to each OHCA patient based on age and sex. The exposure was individual-level SES measured by insurance type and premium, which is based on income in Korea. National Health Insurance (NHI) beneficiaries were divided into four groups (Q1-Q4), and medical aid beneficiaries were separately classified as the lowest SES group. The adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for the outcomes were calculated. Stratified analyses were conducted according to age and sex. A total of 105,443 cases were matched with 421,772 controls. OHCA occurred more frequently in the lower SES groups. Compared with the highest SES group (Q1), the aORs for OHCA occurrence increased as the SES decreased (aORs [95% CI] were 1.21 [1.19-1.24] for Q2, 1.33 [1.31-1.36] for Q3, 1.32 [1.30-1.35] for Q4, and 2.08 [2.02-2.13] for medical aid). Disparity by individual-level SES appeared to be greater in males than in females and greater in the young and middle-aged adults than in older adults. Low individual-level SES was associated with a higher probability of OHCA occurrence. Efforts are needed to reduce SES disparities in the occurrence of OHCA.

Out-of-hospital cardiac arrest and in-hospital mortality among COVID-19 patients: A population-based retrospective cohort study.

Background/purposePredictors for out-of-hospital cardiac arrest (OHCA) in COVID-19 patients remain unclear. We identified the predictors for OHCA and in-hospital mortality among such patients in community isolation centers.MethodsFrom May 15 to June 20, 2021, this cohort study recruited 2555 laboratory-confirmed COVID-19 patients admitted to isolation centers in Taiwan. All patients were followed up until death, discharge from the isolation center or hospital, or July 16, 2021. OHCA was defined as cardiac arrest confirmed by the absence of circulation signs and occurring outside the hospital. Multinomial logistic regressions were used to determine factors associated with OHCA and in-hospital mortality.ResultsOf the 37 deceased patients, 7 (18.9%) had OHCA and 30 (81.1%) showed in-hospital mortality. The mean (SD) time to OHCA was 6.6 (3.3) days from the symptom onset. After adjusting for demographics and comorbidities, independent predictors for OHCA included age ≥65 years (adjusted odds ratio [AOR]: 13.24, 95% confidence interval [CI]: 1.85–94.82), fever on admission to the isolation center (AOR: 12.53, 95% CI: 1.68–93.34), and hypoxemia (an oxygen saturation level below 95% on room air) (AOR: 26.54, 95% CI: 3.18–221.73). Predictors for in-hospital mortality included age ≥65 years (AOR: 10.28, 95% CI: 2.95–35.90), fever on admission to the isolation centers (AOR: 7.27, 95% CI: 1.90–27.83), and hypoxemia (AOR: 29.87, 95% CI: 10.17–87.76).ConclusionsTime to OHCA occurrence is rapid in COVID-19 patients. Close monitoring of patients’ vital signs and disease severity during isolation is important, particularly for those with older age, fever, and hypoxemia.

Occurrence and Temporal Variability of Out-of-Hospital Cardiac Arrest during COVID-19 Pandemic in Comparison to the Pre-Pandemic Period in Poland-Observational Analysis of OSCAR-POL Registry.

An investigation of the chronobiology of out-of-hospital cardiac arrest (OHCA) during the coronavirus disease 2019 (COVID-19) pandemic and the differences in comparison to the 6-year pre-pandemic period. A retrospective analysis of the dispatch cards from the Emergency Medical Service between January 2014 and December 2020 was performed within the OSCAR-POL registry. The circadian, weekly, monthly, and seasonal variabilities of OHCA were investigated. A comparison of OHCA occurrence between the year 2020 and the 6-year pre-pandemic period was made. A total of 416 OHCAs were reported in 2020 and the median of OHCAs during the pre-pandemic period was 379 (interquartile range 337–407) cases per year. Nighttime was associated with a decreased number of OHCAs (16.6%) in comparison to afternoon (31.5%, p < 0.001) and morning (30.0%, p < 0.001). A higher occurrence at night was observed in 2020 compared to 2014–2019 (16.6% vs. 11.7%, p = 0.001). Monthly and seasonal variabilities were observed in 2020. The months with the highest OHCA occurrence in 2020 were November (13.2%) and October (11.1%) and were significantly higher compared to the same months during the pre-pandemic period (9.1%, p = 0.002 and 7.9%, p = 0.009, respectively). Autumn was the season with the highest rate of OHCA, which was also higher compared to the pre-pandemic period (30.5% vs. 25.1%, p = 0.003). The COVID-19 pandemic was related to a higher occurrence of OHCA. The circadian, monthly, and seasonal variabilities of OHCA occurrence were confirmed. In 2020, the highest occurrence of OHCA was observed in October and November, which coincided with the highest occurrence of COVID-19 infections in Poland.

Does age influence out-of-hospital cardiac arrest incidence and outcomes among women? Insights from the Paris SDEC.

Age and sex disparities in out-of-hospital cardiac arrest (OHCA) have been described. Reproductive age may have a protected effect on females vs. males, although results are conflicting. We aimed to clarify this using the Paris Sudden Death Expertise Centre (SDEC) registry. The Paris SDEC registry collects OHCAs occurring in the Greater Paris Area. We included all OHCAs of presumed cardiac causes occurring between 2013 and 2018. Patients were divided into age groups: 1-13, 13-50, 50-75, and >75 years. Sex and age disparities in OHCA incidence and outcomes were analysed using multivariable negative binomial and logistic regression models. There were 19 782 OHCAs meeting inclusion criteria: 0.37% aged 1-13 years, 12.4% aged 13-50 years, 40.4% aged 50-75 years, and 46.9% aged >75 years. Adjusted incidence rate ratios (IRRs) in females vs. males were for the youngest to the older age groups: 1.29 [95% confidence interval (CI) 0.78-2.13], 0.54 [0.49-0.59], 0.60 [0.56-0.64], and 0.75 [0.67-0.84]. At reproductive age, females were more likely than males to have a return of spontaneous circulation [adjusted odds ratio (OR) 1.60 (1.27-2.02)], to be alive at hospital admission [OR: 1.49 (1.18-1.89)]. In both sexes, patients aged 13-50 years were more likely to survive at hospital discharge than those aged 50-75 years [males: OR 1.81 (1.49-2.20), females: 2.24 (1.54-3.25)]. However, at reproductive age, no sex disparity was observed in survival at hospital discharge [OR: 1.16 (0.75-1.80)]. Incidence rate ratios were similar between pre- and post-menopausal aged patients. At reproductive age, no sex disparity in survival at hospital discharge was observed, suggesting that menopausal status may not influence OHCA occurrence and prognosis.

A spatiotemporal data mining study to identify high-risk neighborhoods for out-of-hospital cardiac arrest (OHCA) incidents

Out-of-hospital cardiac arrest (OHCA) is a worldwide health problem. The aim of the study is to utilize the territorial-wide OHCA data of Hong Kong in 2012–2015 to examine its spatiotemporal pattern and high-risk neighborhoods. Three techniques for spatiotemporal data mining (SaTScan’s spatial scan statistic, Local Moran’s I, and Getis Ord Gi*) were used to extract high-risk neighborhoods of OHCA occurrence and identify local clusters/hotspots. By capitalizing on the strengths of these methods, the results were then triangulated to reveal “truly” high-risk OHCA clusters. The final clusters for all ages and the elderly 65+ groups exhibited relatively similar patterns. All ages groups were mainly distributed in the urbanized neighborhoods throughout Kowloon. More diverse distribution primarily in less accessible areas was observed among the elderly group. All outcomes were further converted into an index for easy interpretation by the general public. Noticing the spatial mismatches between hospitals and ambulance depots (representing supplies) and high-risk neighborhoods (representing demands), this setback should be addressed along with public education and strategic ambulance deployment plan to shorten response time and improve OHCA survival rate. This study offers policymakers and EMS providers essential spatial evidence to assist with emergency healthcare planning and informed decision-making.

Abstract 10158: Clinical Features and Outcome-Predictors of Patients with Out-of-Hospital Cardiac Arrest Complicating Acute Myocardial Infarction

Background: Although short-term mortality of acute myocardial infarction (AMI) has decreased dramatically, sudden cardiac arrest is still one of serious complication. We assessed the clinical characteristics and prognosis’ predictors of AMI patients with out-of-hospital cardiac arrest (OHCA). Methods: We retrospectively analyzed consecutive patients with AMI who were treated with emergency percutaneous coronary intervention between 2004 and 2017. Patients with OHCA were compared with those without OHCA. Results: Among 2,101 AMI patients, 95 (4.7%) presented OHCA. Younger age (odds ratio [OR]: 0.95; 95% confidence interval [CI]: 0.93-0.97; p&lt;0.0001), absence of coronary risk factors such as, diabetes mellitus (OR: 0.51; 95% CI: 0.30-0.85; p=0.01) or dyslipidemia (OR: 0.56; 95% CI: 0.36-0.88; p=0.01), left main trunk (LMT) and left anterior descending artery (LAD) as culprit lesion (OR: 3.26; 95% CI: 1.99-5.33; p&lt;0.0001), and renal deficiency (OR: 3.64; 95% CI: 2.27-5.84; p&lt;0.0001) were significantly associated with incidence of OHCA. The 30-day mortality of patients with OHCA was more than 5-hold higher compared with those without OHCA (32.6% vs. 4.5%, p&lt;0.0001). In multivariate logistic regression analysis, LMT or LAD as culprit lesion (OR: 12.18; 95% CI: 2.27-65.41; p=0.04), glucose level (OR: 1.01; 95% CI: 1.00-1.01; p=0.01) and renal deficiency (OR: 3.35; 95% CI: 1.07-10.53; p=0.04) were found as independent predictors of 30-day mortality among AMI patients with OHCA. Conclusions: About 1 of 20 AMI patients presented with OHCA and younger age, absence of coronary risk factors, and anterior wall infarction were associated with OHCA occurrence.

Sex differences in incidence of out-of-hospital cardiac arrest across ethnic and socioeconomic groups: a population-based cohort study in the Netherlands

Abstract Background Current out-of-hospital cardiac arrest (OHCA) prevention strategies are suboptimal due to the inability to identify subgroups at high risk. Insight into the occurrence of OHCA within general populations may help to target prevention strategies. Case registries suggest that there may be substantial differences in emergency medical service (EMS)-attended OHCA incidence between men and women. However, due to a lack of individual-level prospective data, relative sex differences across ethnic groups and socioeconomic (SES) groups have not been studied. Purpose We investigated sex differences in OHCA incidence, overall and across ethnic groups and SES groups. Methods We performed a retrospective population-based cohort study, combining individual-level data on ethnicity and income (as SES measure) from Statistics Netherlands of all men and women aged ≥25 years living in one study region in the Netherlands on 01–01–2009 (n=1,688,285) with prospectively collected EMS-attended OHCA cases (n=5,676) from the ARREST registry until 31-12-2015. We calculated age-standardised incidence rates of OHCA. Sex differences were assessed with Cox proportional hazards regression analyses, adjusted for age, ethnicity and income, in the overall population, and across ethnic and SES groups. Results Overall, the age-standardised incidence rate of OHCA was lower in women than in men (30.9 versus 87.3 per 100,000 person-years), corresponding with a hazard ratio (HR) of 0.33 (95% confidence interval [CI] 0.31–0.35). While incidence rates varied across subgroups (range: 22.6–104.6 per 100,000 person-years), the sex differences in hazard for OHCA existed in all income quintiles (HR range: 0.30–0.35) and ethnic groups (HR range: 0.19–0.40), except among Moroccans (HR 0.89, 95% CI 0.51–1.57). Conclusion In most ethnic groups and all SES groups, women have a substantial, yet lower OHCA incidence rate than men. This confirms that men are an important target group for OHCA prevention strategies across social strata. Nevertheless, considering potentially differential aetiology as well as the lower survival rates among women, women will also benefit from targeted prevention strategies. Funding Acknowledgement Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Union's Horizon 2020 research and innovation programme under acronym ESCAPE-NET (grant number 733381) and the COST Action PARQ (grant agreement number CA19137).ZonMw Gender and Health (grant number 8492ehab724.06458) and Gender and Prevention (grant number 555003016) programmes.

Racial disparities in out-of-hospital cardiac arrest in Denmark

Abstract Introduction American studies have pointed out racial disparities regarding sudden cardiac death occurrence and outcomes. Black individuals have higher sudden cardiac death rates and lower survival compared with white subjects (1). Although income and social status partly explain differences in outcomes (2), sudden cardiac death is 2-fold higher in black individuals after adjustment on these characteristics (3,4). In Denmark, immigrants account for 9.1% of the population (5) but to date, no data exists regarding Out-of-Hospital Cardiac Arrest (OHCA) incidence. Purpose The main objective of this study was to compare the incidence of OHCA among native and immigrant individuals between 2001 and 2014 in Denmark. Methods This nationwide study included all patients identified from the Danish Cardiac Arrest Registry with OHCA of presumed cardiac cause between 18 and 80 years from 2001 to 2014 (6). The primary outcome was OHCA occurrence defined as a clinical condition of cardiac arrest resulting in resuscitation efforts either by bystanders or by EMS personnel. The immigrant status was defined as native or immigrant according to the national database from Statistics Denmark. An immigrant was defined as a person born abroad whose both parents were either foreign citizens or born abroad. The odds ratio of OHCA between immigrants and native Danes were adjusted according to age, sex, income, and education level. Results A total of 33,730 OHCA were recorded between 2001 and 2014. Among them, 1,684 occurred in immigrants and 32,046 in natives. Compared to natives, immigrant victims of OHCA were younger (62.0 [51.0, 71.0] vs. 66.0 [56.0, 74.0], p&amp;lt;0.001), and more often had a history of diabetes (20.5% vs. 14.0; p&amp;lt;0.001), myocardial infarction (11.9% vs. 8.7%; p&amp;lt;0.001) and chronic heart failure (17.0% vs. 14.7%; p&amp;lt;0.01). Female proportion was not statistically different between the two groups (30.2% vs. 31.3% of immigrants and natives respectively; p=0.32). The incidence of OHCA was 61.0/100,000 person-years in natives and 35.0/100,000 person-years in immigrants (OR=0.57; 95% CI 0.54–0.60; p&amp;lt;0.001). Between 2001 and 2014, the OHCA incidence decreased from 71.4 [67.9–75.0] to 70.9 [68.2–73.6]/100 000 person-years in natives (p=0.99) and from 40.2 [30.8–51.5] to 36.5 [31.1–42.6] /100,000 person-years in immigrants (p=0.91) (Figure). After logistic regression, compared to natives, the immigrant status was associated with 0.61-fold odds of OHCA when adjusting on age and sex (OR=0.61; 95% CI 0.59–0.65; p&amp;lt;0.001), and 0.65-fold odds of OHCA when adjusting on age, sex, income, and education level (OR=0.66; 95% CI 0.63–0.70; p&amp;lt;0.001). Conclusion This is the first study assessing the incidence of OHCA in immigrants versus natives in a European country. Despite higher cardiovascular burden, the incidence of OHCA was lower in immigrants even when adjusted on sex, age, income, and education reflecting a selection of individuals migrating to Denmark. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Fédération Française de Cardiologie