Møller Sidsel G, Wissenberg Mads, Møller-Hansen Steen, Folke Fredrik, Malta Hansen Carolina, Kragholm Kristian, Bundgaard Ringgren Kristian, Karlsson Lena, Lohse Nicolai, Lippert Freddy, Køber Lars, Gislason Gunnar, Torp-Pedersen Christian
Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark.
Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark; Emergency Medical Services Copenhagen, University of Copenhagen, Denmark.
Resuscitation. 2020 Mar 1;148:191-199. doi: 10.1016/j.resuscitation.2020.01.019. Epub 2020 Jan 28.
Regional variation in incidence and survival after out-of-hospital cardiac arrest (OHCA) may be caused by many factors including differences in definitions and reporting. We examined regional differences in Denmark.
From the Danish Cardiac Arrest Registry we identified adult OHCA patients between 2009-2014 of presumed cardiac cause. Patients were grouped according to the five administrative/geographical regions of Denmark and survival was examined based on all arrest-cases (30-day survival percentage) and number of survivors per 100,000 inhabitants.
We included 12,902 OHCAs of which 1550 (12.0 %) were alive 30 days after OHCA. No regional differences were observed in age, sex or comorbidities. Incidence of OHCA ranged from 32.9 to 42.4 per 100,000 inhabitants; 30-day survival percentages ranged from 8.5% to 13.8% and number of survivors per 100,000 inhabitants ranged from 3.5 to 5.9, across the regions. In one of the regions car-manned pre-hospital physicians were discontinued from 2011. Here, the incidence of OHCA per 100,000 inhabitants increased markedly from 37.1 in 2011 to 52.2 in 2014 and 30-day survival percentage decreased from 10.9 % in 2011 to 7.5 % in 2014; while the number of survivors per 100,000 inhabitants stagnated from 4.0 in 2011 to 3.9 in 2014. In comparison, survival increased in the other four regions.
Differences in incidence and 30-day survival after OHCA were observed between the five regions of Denmark. Comparisons of survival should not only be based on survival percentages, but also on number of survivors of the background population as inclusion bias can influence survival outcomes.
院外心脏骤停（OHCA）后发病率和生存率的地区差异可能由多种因素引起，包括定义和报告的差异。我们研究了丹麦的地区差异。
从丹麦心脏骤停登记处，我们确定了2009年至2014年期间推测为心脏原因的成年OHCA患者。患者根据丹麦的五个行政/地理区域进行分组，并基于所有心脏骤停病例（30天生存率）和每10万居民中的幸存者数量来检查生存率。
我们纳入了12902例OHCA患者，其中1550例（12.0%）在OHCA后30天存活。在年龄、性别或合并症方面未观察到地区差异。OHCA的发病率在每10万居民中从32.9例到42.4例不等；30天生存率在各地区从8.5%到13.8%不等，每10万居民中的幸存者数量从3.5例到5.9例不等。在其中一个地区，2011年起不再配备院前随车医生。在此，每10万居民中OHCA的发病率从2011年的37.1例显著增加到2014年的52.2例，30天生存率从2011年的10.9%下降到2014年的7.5%；而每10万居民中的幸存者数量从2011年的4.0例停滞到2014年的3.9例。相比之下，其他四个地区的生存率有所提高。
丹麦五个地区之间观察到OHCA后发病率和3天生存率的差异。生存率的比较不仅应基于生存率百分比，还应基于背景人群的幸存者数量，因为纳入偏倚可能影响生存结果。
