CANADIAN TRENDS IN UTILIZATION OF CARDIAC INTERVENTIONS FOLLOWING OUT-OF-HOSPITAL CARDIAC ARREST: EVIDENCE FOR SUBSTANTIAL UNDERUSE
CCC ePoster Gallery. Angaran P. 10/25/19; 280501; 236
Paul Angaran
Paul Angaran
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Abstract
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BACKGROUND: Out-of-hospital cardiac arrests (OHCAs) are common, and previous studies have suggested that the majority of patients who sustain an OHCA have coronary artery disease with a presumed ischemic precipitant. Contemporary data are lacking on the utilization of guideline-recommended cardiac interventions, including coronary angiography, revascularization, and implantable cardioverter defibrillators (ICD). Our objective was to characterize national and provincial trends in the use of cardiac interventions for patients with OHCA who survive to hospital discharge, particularly in association with diagnosed coronary artery disease.

METHODS AND RESULTS: The Canadian Institute for Health Information National Ambulatory Care Reporting System and Discharge Abstract Database were used to identify patients transported alive and discharged from hospital following OHCA, and identify comorbidities and in-hospital interventions. Patients ages 18-85, who sustained OHCA in Canada between January 1, 2013 and December 31, 2017 and were transported alive to hospital, were identified using International Classification of Disease, Tenth Revision codes associated with cardiac arrest and Canadian Classification of Health Interventions codes for cardiopulmonary resuscitation. Patients were excluded if the arrest was attributed to trauma, had incomplete records, or invalid health card numbers. Only the first event was considered for those with multiple arrests within the study period. Amongst 18,072 OHCA patients who survived to hospital admission, 13,718 survived to discharge (median age 64, 32.1% female). In-hospital mortality was 24.1% over the study period, with no year-to-year changes. Among those discharged alive, there was substantial regional variation between provinces in in-hospital mortality and use of cardiac procedures (Figure). Amongst survivors to discharge, 11.5% were coded for ST-segment elevation myocardial infarction (STEMI). Pre-hospital characteristics are presented (Table). Patients with STEMI, compared to those not coded as STEMI, had higher rates of coding for coronary angiography (65.6% vs 14.0%, p < 0.01), percutaneous coronary intervention (PCI) (52.1% vs 33.3%, p < 0.01), and coronary artery bypass grafting (CABG) (3.0% vs 0.9%, p < 0.01). Use of ICD was low in both STEMI (3.9%) and no STEMI (5.0%) groups. 5.0% of patients ≤65 years old who survived to discharge without STEMI, and did not undergo coronary revascularization, received an ICD.

CONCLUSION: Overall utilization of ICD and coronary interventions following OHCA remains low, irrespective of the presence of a presumed ischemic precipitant. Substantial variation in the use of cardiac interventions and in-hospital mortality for patients surviving OHCA to hospital admission exists between provinces. Survival to discharge rates did not improve over the study period.
BACKGROUND: Out-of-hospital cardiac arrests (OHCAs) are common, and previous studies have suggested that the majority of patients who sustain an OHCA have coronary artery disease with a presumed ischemic precipitant. Contemporary data are lacking on the utilization of guideline-recommended cardiac interventions, including coronary angiography, revascularization, and implantable cardioverter defibrillators (ICD). Our objective was to characterize national and provincial trends in the use of cardiac interventions for patients with OHCA who survive to hospital discharge, particularly in association with diagnosed coronary artery disease.

METHODS AND RESULTS: The Canadian Institute for Health Information National Ambulatory Care Reporting System and Discharge Abstract Database were used to identify patients transported alive and discharged from hospital following OHCA, and identify comorbidities and in-hospital interventions. Patients ages 18-85, who sustained OHCA in Canada between January 1, 2013 and December 31, 2017 and were transported alive to hospital, were identified using International Classification of Disease, Tenth Revision codes associated with cardiac arrest and Canadian Classification of Health Interventions codes for cardiopulmonary resuscitation. Patients were excluded if the arrest was attributed to trauma, had incomplete records, or invalid health card numbers. Only the first event was considered for those with multiple arrests within the study period. Amongst 18,072 OHCA patients who survived to hospital admission, 13,718 survived to discharge (median age 64, 32.1% female). In-hospital mortality was 24.1% over the study period, with no year-to-year changes. Among those discharged alive, there was substantial regional variation between provinces in in-hospital mortality and use of cardiac procedures (Figure). Amongst survivors to discharge, 11.5% were coded for ST-segment elevation myocardial infarction (STEMI). Pre-hospital characteristics are presented (Table). Patients with STEMI, compared to those not coded as STEMI, had higher rates of coding for coronary angiography (65.6% vs 14.0%, p < 0.01), percutaneous coronary intervention (PCI) (52.1% vs 33.3%, p < 0.01), and coronary artery bypass grafting (CABG) (3.0% vs 0.9%, p < 0.01). Use of ICD was low in both STEMI (3.9%) and no STEMI (5.0%) groups. 5.0% of patients ≤65 years old who survived to discharge without STEMI, and did not undergo coronary revascularization, received an ICD.

CONCLUSION: Overall utilization of ICD and coronary interventions following OHCA remains low, irrespective of the presence of a presumed ischemic precipitant. Substantial variation in the use of cardiac interventions and in-hospital mortality for patients surviving OHCA to hospital admission exists between provinces. Survival to discharge rates did not improve over the study period.
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