Department of Critical Care Medicine, University of Pittsburgh School of Medicine, 637 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA, 15261, USA.
Department of Emergency Medicine, University of Pittsburgh School of Medicine, Suite 10028 Forbes Tower, Pittsburgh, PA, 15260, USA.
Resuscitation. 2018 Jul;128:31-36. doi: 10.1016/j.resuscitation.2018.04.032. Epub 2018 Apr 26.
Demographic, social, economic and geographic factors are associated with increased short-term mortality after cardiac arrest. We sought to determine if these factors are additionally associated with long-term outcome differences using a detailed clinical database linked to state-wide administrative data.
We included cardiac arrest patients surviving to hospital discharge from five hospitals in the United States from 2005 to 2013, with follow-up through 2015. We obtained information on sex, race, arrest location, initial rhythm, median ZIP code income, post-arrest illness severity, cardiac catheterization, internal cardioverter-defibrillator insertion, rural residence and drive time from residence to the nearest acute care hospital. We used Cox proportional hazard models identify predictors of mortality.
We included 891 patients followed for 2081 patient-years. There were 340 deaths with median survival 6 years. In adjusted models we identified an interaction effect between median ZIP code income and cardiac catheterization. Among patients who had cardiac catheterization there was an attenuated benefit from cardiac catheterization at progressively lower neighborhood incomes (adjusted HR: 0.21 to 0.46 to 0.56). Residence more than 20 min from the nearest acute care hospital was associated with increased hazard of death (adjusted HR: 1.48; 95%CI: 1.35-1.62), after controlling for rural residence and residence in a Medically Underserved Area/Population. Female patients showed less benefit following ICD placement (male adjusted HR: 0.49; female adjusted HR: 0.66).
There are persistent long-term outcome differences in cardiac arrest survival based on sex, income, and geographic access acute care.
人口统计学、社会经济和地理因素与心搏骤停后短期死亡率的增加有关。我们试图通过使用与全州行政数据相关联的详细临床数据库来确定这些因素是否与长期预后差异相关。
我们纳入了 2005 年至 2013 年期间美国五家医院出院后存活的心搏骤停患者，并随访至 2015 年。我们获得了性别、种族、发病地点、初始节律、中位邮政编码收入、发病后疾病严重程度、心导管检查、内置除颤器植入、农村居住和从住所到最近急症医院的行车时间等信息。我们使用 Cox 比例风险模型确定死亡率的预测因素。
我们纳入了 891 例患者，随访了 2081 人年。共有 340 例死亡，中位生存时间为 6 年。在调整后的模型中，我们发现中位数邮政编码收入和心导管检查之间存在交互效应。在心导管检查的患者中，随着邻里收入的降低，心导管检查的获益逐渐减弱（调整后的 HR：0.21 至 0.46 至 0.56）。距离最近急症医院超过 20 分钟的住所与死亡风险增加相关（调整后的 HR：1.48；95%CI：1.35-1.62），在控制了农村居住和居住在医疗服务不足地区/人群后。女性患者在心律转复除颤器（ICD）放置后获益较少（男性调整后的 HR：0.49；女性调整后的 HR：0.66）。
心搏骤停存活的性别、收入和获得急性护理的地理途径存在持续的长期预后差异。
