Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa. Email:
Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa.
Cardiovasc J Afr. 2022;33(5):260-266. doi: 10.5830/CVJA-2022-019. Epub 2022 Jun 8.
The incidence of out-of-hospital cardiac arrest (OHCA) is expected to increase in sub-Saharan Africa along with the incidence of cardiovascular disease. In low-resource settings (LRS), OHCA carries a negligible survival rate. Interventions to improve OHCA survival might not be cost effective for many LRS, and therefore need to be targeted to areas of high incidence. The aim of this study was to describe the temporal and geographic distribution of OHCA in the City of Cape Town, South Africa, and their proximity to percutaneous coronary intervention (PCI) resources.
In this retrospective study, OHCA data between 1 January and 31 December 2018 were extracted from public and one private emergency medical services in the Western Cape. For temporal analysis, distribution of OHCA according to time of day, day of the week and month of the year were subjected to chi-squared testing. For geospatial analysis, cluster and outlier, and hotspot analyses were performed. Proximity analysis was employed to determine the driving time from OHCA location to the closest PCI-capable facility.
A total of 929 patients with OHCA received an emergency medical services response in the City of Cape Town, corresponding to an annual prevalence of 23.2 per 100 000 persons. The distribution of OHCA incidence was not explained by month of the year ( = 0.08) or day of the week ( = 0.67). A statistically significant variation in OHCA incidence was explained by time of day ( < 0.01) with 30% ( = 279) of all OHCAs occurring from 05:00 to 09:59. Geospatial analysis yielded a large area of hotspots (99% confidence interval) over the centre of the metropole, Cape Flats and southern suburbs. The median (interquartile range) driving time from the incident to the closest PCI-capable facility was 10:22 (08:05) minutes.
Incidents of OHCA occurred predominantly at home during the mid-morning, with hotspots around the city centre and residential suburbs of Cape Town. While the incidents occurred close to PCI-capable facilities, some areas remained underserved and access to PCI for OHCA victims may be impossible due to socio-economic factors. With an increase in OHCA incidence expected, it is essential that contextual, cost-effective management interventions be developed and implemented.
随着心血管疾病发病率的上升，撒哈拉以南非洲地区的院外心脏骤停（OHCA）发病率预计将会增加。在资源匮乏地区（LRS），OHCA 的存活率微乎其微。对于许多 LRS 来说，提高 OHCA 生存率的干预措施可能并不具有成本效益，因此需要针对发病率较高的地区进行靶向治疗。本研究旨在描述南非开普敦市 OHCA 的时间和地理分布及其与经皮冠状动脉介入治疗（PCI）资源的接近程度。
在这项回顾性研究中，从西开普省的一家公共和一家私人紧急医疗服务机构中提取了 2018 年 1 月 1 日至 12 月 31 日期间的 OHCA 数据。为了进行时间分析，根据一天中的时间、一周中的天数和一年中的月份对 OHCA 的分布进行了卡方检验。为了进行地理空间分析，进行了聚类和异常值以及热点分析。采用接近度分析来确定从 OHCA 地点到最近的具备 PCI 能力的设施的行车时间。
在开普敦市，共有 929 名 OHCA 患者接受了紧急医疗服务响应，其年患病率为每 100000 人 23.2 例。OHCA 发病率的分布与月份（ = 0.08）或周几（ = 0.67）无关。一天中的时间（ < 0.01）可以很好地解释 OHCA 发病率的变化，其中 30%（ = 279）的 OHCA 发生在 05:00 至 09:59 之间。地理空间分析显示，大都市中心、开普弗拉特和南部郊区的热点区域（99%置信区间）很大。从事件地点到最近的具备 PCI 能力的设施的中位（四分位距）行车时间为 10:22（08:05）分钟。
OHCA 事件主要发生在上午家中，市中心和开普敦的居民区周围有热点。尽管事件发生在靠近具备 PCI 能力的设施附近，但由于社会经济因素，一些地区的服务仍然不足，OHCA 患者可能无法获得 PCI。随着 OHCA 发病率的增加，必须制定和实施具有背景和成本效益的管理干预措施。
