Journal article
Regional Variation in Out-of-Hospital Cardiac Arrest Survival in the United States
Circulation (New York, N.Y.), Vol.133(22), pp.2159-2168
05/31/2016
DOI: 10.1161/CIRCULATIONAHA.115.018175
PMCID: PMC4889467
PMID: 27081119
Abstract
Although previous studies have shown marked variation in out-of-hospital cardiac arrest survival across US regions, factors underlying this survival variation remain incompletely explained. Using data from the Cardiac Arrest Registry to Enhance Survival, we identified 96 662 adult patients with out-of-hospital cardiac arrest in 132 US counties. We used hierarchical regression models to examine county-level variation in rates of survival and survival with functional recovery (defined as Cerebral Performance Category score of 1 or 2) and examined the contribution of demographics, cardiac arrest characteristics, bystander cardiopulmonary resuscitation, automated external defibrillator use, and county-level sociodemographic factors in survival variation across counties. A total of 9317 (9.6%) patients survived to discharge, and 7176 (7.4%) achieved functional recovery. At a county level, there was marked variation in rates of survival to discharge (range, 3.4%-22.0%; median odds ratio, 1.40; 95% confidence interval, 1.32-1.46) and survival with functional recovery (range, 0.8%-21.0%; median odds ratio, 1.53; 95% confidence interval, 1.43-1.62). County-level rates of bystander cardiopulmonary resuscitation and automated external defibrillator use were positively correlated with both outcomes (P<0.0001 for all). Patient demographic and cardiac arrest characteristics explained 4.8% and 27.7% of the county-level variation in survival, respectively. Additional adjustment of bystander cardiopulmonary resuscitation and automated external defibrillator explained 41% of the survival variation, and this increased to 50.4% after adjustment of county-level sociodemographic factors. Similar findings were noted in analyses of survival with functional recovery. Although out-of-hospital cardiac arrest survival varies significantly across US counties, a substantial proportion of the variation is attributable to differences in bystander response across communities.
Details
- Title: Subtitle
- Regional Variation in Out-of-Hospital Cardiac Arrest Survival in the United States
- Creators
- Saket GirotraSean van DiepenBrahmajee K NallamothuMargaret CarrelKimberly VellanoMonique L AndersonBryan McNallyBenjamin S AbellaComilla SassonPaul S Chan
- Contributors
- CARES Surveillance Group (Author)HeartRescue Project (Author)
- Resource Type
- Journal article
- Publication Details
- Circulation (New York, N.Y.), Vol.133(22), pp.2159-2168
- DOI
- 10.1161/CIRCULATIONAHA.115.018175
- PMID
- 27081119
- PMCID
- PMC4889467
- NLM abbreviation
- Circulation
- ISSN
- 0009-7322
- eISSN
- 1524-4539
- Publisher
- United States
- Grant note
- R01 HL123980 / NHLBI NIH HHS K08 HL122527 / NHLBI NIH HHS K23 HL102224 / NHLBI NIH HHS
- Language
- English
- Date published
- 05/31/2016
- Academic Unit
- Epidemiology; Interdisciplinary Programs; Geographical and Sustainability Sciences; Internal Medicine
- Record Identifier
- 9983983669402771
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