Cobb Leonard A, Fahrenbruch Carol E, Olsufka Michele, Copass Michael K
Department of Medicine, University of Washington and Harborview Medical Center, 325 Ninth Ave, Seattle, WA 98104, USA.
JAMA. 2002 Dec 18;288(23):3008-13. doi: 10.1001/jama.288.23.3008.
Recent reports from 2 European cities and an earlier observation from Seattle, Wash, suggest that the number of patients treated for out-of-hospital ventricular fibrillation (VF) has declined.
To analyze the incidence of cardiac arrest and to examine relationships among incidence, sex, race, age, and first identified cardiac rhythm in Seattle.
DESIGN, SETTING, AND PATIENTS: Population-based study of all cardiac arrest cases with presumed cardiac etiology who received advanced life support from Seattle Fire Department emergency medical services during specified periods between 1979 and 2000. United States Census data for Seattle in 1980, 1990, and 2000 were used to determine incidence rates for treated cardiac arrest with adjustments for age and sex.
Changes in incidence of cardiac arrest and initial recorded cardiac rhythm.
The adjusted annual incidence of cardiac arrest with VF as the first identified rhythm decreased by about 56% from 1980 to 2000 (from 0.85 to 0.38 per 1000; relative risk [RR], 0.44; 95% confidence interval [CI], 0.37-0.53). Similar reductions occurred in blacks (54%; RR, 0.45; 95% CI, 0.26-0.79) and whites (53%; RR, 0.47; 95% CI, 0.38-0.58) and was most evident in men (57%; RR, 0.43; 95% CI, 0.35-0.53), in whom the baseline incidence was relatively high. When all treated arrests with presumed cardiac etiology were considered, that incidence decreased by 43% (RR, 0.58; 95% CI, 0.49-0.67) in men but negligibly in women, for whom a relatively low incidence of VF also declined but was offset by more cases with asystole or pulseless electrical activity.
We observed a major decline in the incidence of out-of-hospital VF and in all cases of treated cardiac arrest presumably due to heart disease in Seattle. These changes likely reflect the national decline in coronary heart disease mortality.
来自欧洲两个城市的近期报告以及华盛顿州西雅图市早期的一项观察结果表明，院外心室颤动（VF）的治疗患者数量有所下降。
分析西雅图市心脏骤停的发病率，并研究发病率与性别、种族、年龄以及首次确认的心律之间的关系。
设计、地点和患者：对1979年至2000年特定时间段内，由西雅图消防部门紧急医疗服务提供高级生命支持的所有疑似心脏病因的心脏骤停病例进行基于人群的研究。使用1980年、1990年和2000年西雅图市的美国人口普查数据来确定经年龄和性别调整后的治疗性心脏骤停发病率。
心脏骤停发病率和初始记录的心律变化。
以VF为首次确认心律的心脏骤停调整后年发病率从1980年到2000年下降了约56%（从每1000人0.85例降至0.38例；相对风险[RR]，0.44；95%置信区间[CI]，0.37 - 0.53）。黑人（54%；RR，0.45；95% CI，0.26 - 0.79）和白人（53%；RR，0.47；95% CI，0.38 - 0.58）也出现了类似的下降，在男性中最为明显（57%；RR，0.43；95% CI，0.35 - 0.53），男性的基线发病率相对较高。当考虑所有疑似心脏病因的治疗性心脏骤停时，男性的发病率下降了43%（RR，0.58；95% CI，0.49 - 0.67），而女性的下降幅度可忽略不计，女性VF发病率相对较低，虽也有所下降，但被更多的心脏停搏或无脉电活动病例所抵消。
我们观察到西雅图市院外VF发病率以及所有疑似心脏病的治疗性心脏骤停病例数大幅下降。这些变化可能反映了全国冠心病死亡率的下降。
