Temporal Patterns in Out-of-Hospital Cardiac Arrest Incidence and Outcome.

IF 14.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JAMA cardiology Pub Date : 2025-07-16 DOI:10.1001/jamacardio.2025.2247

Owen McBride,Amy Poel,Catherine R Counts,Megin Parayil,Camilla Osborne,Chris Drucker,Mickey Eisenberg,David Murphy,Peter Kudenchuk,Michael Sayre,Thomas Rea

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引用次数: 0

Abstract

Importance Incidence and outcome of out-of-hospital cardiac arrest (OHCA) have implications for public health and community strategies to reduce risk and improve resuscitation. Objective To examine temporal patterns in OHCA incidence and outcome. Design, Setting, and Participants This was a retrospective cohort investigation conducted in King County, Washington, between 2001 and 2020. Adults with OHCA treated by emergency medical services (EMS) were included in the analysis. Study data were analyzed from May 2024 to April 2025. Exposures Incidence and clinical outcome of OHCA. Main Outcomes and Measures Annual incidence was calculated per 100 000 person-years and stratified by sex, age group (<65 years and ≥65 years), and initial rhythm (shockable, nonshockable) with change estimated as average annualized change (AAC) percentage. Resuscitation was assessed according to 5-year groups. Temporal trends were evaluated using Poisson regression for incidence and survival to hospital discharge. Results There were 25 118 individuals (median [IQR] age, 65 [53-78] years; 15 994 male [63.7%]) with OHCA treated by EMS during 30 884 504 person-years; survival was 17.7%. Overall incidence was 81.3 per 100 000 person-years, 20.9 for shockable and 59.8 for nonshockable OHCA. There was no evidence of linear temporal change in overall incidence: 88.7 in 2001, 82.1 in 2020 (AAC, -0.5%; 95% CI, -0.9% to 0%). However, temporal patterns depended on rhythm and demographic characteristics. For example, shockable rhythm incidence declined (28.6 in 2001 and 17.9 in 2020; AAC, -2.3%; 95% CI, -2.9% to -1.5%), but change was null among nonshockable arrest (59.8 in 2001 and 63.7 in 2020; AAC, 0.3%; 95% CI, -0.1% to 0.8%). Overall survival to hospital discharge improved over time: 14.7% (859 of 5847 individuals; 2001-2005), 17.4% (1024 of 5885 individuals; 2006-2010), 19.3% (1232 of 6376 individuals; 2011-2015), and 18.9% (1322 of 7010; 2016-2020; P < .001 test for trend). Survival increased from 35% (591 of 1689 individuals) during the 2001 to 2005 period to 47.5% (768 of 1617 individuals) during the 2016 to 2020 period among shockable OHCA and from 6.4% (265 of 4135 individuals) during the 2001 to 2005 period to 10.1% (536 of 5323 individuals) during the 2016 to 2020 period among nonshockable OHCA (P < .001 tests for trend). Temporal improvement was observed in prehospital resuscitation (survival to hospital admission) and in-hospital survival (discharge among those admitted to hospital; P < .001 tests for trend). Outcome improvements corresponded to temporal increase in bystander cardiopulmonary resuscitation (55.5% in 2001-2005 to 73.9% in 2016-2020) and early automated external defibrillator application by non-EMS personnel (2.2% in 2001-2005 to 10.9% in 2016-2020; P < .001 tests for trend). Conclusions and Relevance Results suggest that the overall OHCA incidence did not change over time, although there were differential temporal patterns among clinical subgroups. Survival improved over time overall and according to presenting rhythm, corresponding to favorable trends in community responder, prehospital, and hospital care.

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院外心脏骤停发生率和结果的时间模式

院外心脏骤停（OHCA）的发生率和结果对公共卫生和社区降低风险和改善复苏的策略具有重要意义。目的探讨OHCA发病和预后的时间模式。设计、环境和参与者这是2001年至2020年间在华盛顿金县进行的一项回顾性队列调查。接受紧急医疗服务（EMS）治疗的成年OHCA患者被纳入分析。研究数据分析时间为2024年5月至2025年4月。OHCA的发病率和临床结果。计算每100,000 000人年的年发病率，并按性别、年龄组（<65岁和≥65岁）和初始节律（可休克和非可休克）分层，以平均年化变化（AAC）百分比估计变化。按5年分组评估复苏情况。使用泊松回归评估发病率和生存率至出院的时间趋势。结果25例 118例，中位[IQR]年龄65[53-78]岁；15 994名男性[63.7%])，30 884 504人年；生存率为17.7%。总发病率为81.3 / 10 000人年，休克性OHCA为20.9 / 10，非休克性OHCA为59.8 / 10。总体发病率没有线性时间变化的证据：2001年为88.7,2020年为82.1 (AAC, -0.5%；95% CI, -0.9%至0%)。然而，时间模式取决于节奏和人口特征。例如，突发性心律发生率下降(2001年为28.6,2020年为17.9；AAC, -2.3%;95% CI, -2.9%至-1.5%)，但在非休克性骤停中变化为零(2001年为59.8,2020年为63.7；AAC, 0.3%;95% CI, -0.1%至0.8%)。总生存率随着时间的推移而提高：14.7%(5847例中有859例；2001-2005年),17.4%(1024,5885人；2006-2010年),19.3% (1232 / 6376)；2011-2015年),18.9%(7010人中有1322人；2016 - 2020;p <。001检验趋势)。冲击性OHCA的存活率从2001 - 2005年的35%（1689人中的591人）上升到2016 - 2020年的47.5%（1617人中的768人），非冲击性OHCA的存活率从2001 - 2005年的6.4%（4135人中的265人）上升到2016 - 2020年的10.1%（5323人中的536人）。001检验趋势)。院前复苏（存活至入院）和院内生存(入院患者出院；p <。001检验趋势)。结果的改善对应于旁观者心肺复苏的时间增加（2001-2005年为55.5%，2016-2020年为73.9%）和非ems人员早期使用自动体外除颤器(2001-2005年为2.2%，2016-2020年为10.9%；p <。001检验趋势)。结论和相关性结果表明，尽管临床亚组之间存在不同的时间模式，但总体OHCA发病率并未随时间变化。生存率随着时间的推移总体上有所提高，并根据呈现的节奏，与社区反应者、院前和医院护理的有利趋势相对应。

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来源期刊

JAMA cardiology Medicine-Cardiology and Cardiovascular Medicine

CiteScore

45.80

自引率

1.70%

发文量

264

期刊介绍： JAMA Cardiology, an international peer-reviewed journal, serves as the premier publication for clinical investigators, clinicians, and trainees in cardiovascular medicine worldwide. As a member of the JAMA Network, it aligns with a consortium of peer-reviewed general medical and specialty publications. Published online weekly, every Wednesday, and in 12 print/online issues annually, JAMA Cardiology attracts over 4.3 million annual article views and downloads. Research articles become freely accessible online 12 months post-publication without any author fees. Moreover, the online version is readily accessible to institutions in developing countries through the World Health Organization's HINARI program. Positioned at the intersection of clinical investigation, actionable clinical science, and clinical practice, JAMA Cardiology prioritizes traditional and evolving cardiovascular medicine, alongside evidence-based health policy. It places particular emphasis on health equity, especially when grounded in original science, as a top editorial priority.