title: Time trends in long-term mortality after out-of-hospital cardiac arrest, 1980 to 1998, and predictors for death.
abstract: BACKGROUND
  We studied time trends in long-term survival after out-of-hospital cardiac arrest (OHCA) for patient characteristics and described predictors for death after discharge. Because long-term prognosis among patients with coronary heart disease has improved in the last decades, we hypothesized that the prognosis after OHCA would improve with time.
  
  
  METHODS
  We analyzed data that were prospectively collected from all patients discharged from the hospital after OHCA in the community of Göteborg, Sweden, from 1980 to 1998 and divided the data into 2 time periods, 1980 to 1991 and 1991 to1998, with an equal number of patients.
  
  
  RESULTS
  A total of 430 patients were included in the survey. Age, sex proportions, cardiovascular comorbidity, resuscitation factors, and inhospital complications did not change with time. A diagnosis of a precipitating myocardial infarction was more common during period 1 (66% vs 54%). The prescription of aspirin (22% vs 52%), angiotensin-converting enzyme inhibitors (7% vs 29%), anticoagulants (13% vs 27%), and lipid-lowering agents (0% vs 6%) at discharge increased during period 2. Long-term survival did not improve with time; the 5-year mortality rates were 53% in period 1 and 52% in period 2. Independent predictors of an increased risk of death included age (risk ratio [RR] 1.06, 95% CI 1.05-1.08), history of myocardial infarction (RR 2.02, 95% CI 1.51-2.72), history of smoking (RR 1.77, 95% CI 1.29-2.44), and worse cerebral performance at discharge (RR 1.71, 95% CI 1.44-2.02). The prescription of beta-blockers at discharge was independently predictive of decreased risk of death (RR 0.63, 95% CI 0.46-0.85).
  
  
  CONCLUSIONS
  The long-term survival rate after OHCA did not change. Baseline characteristics remained generally unchanged, but the drugs prescribed at discharge changed in several aspects. Age, a history of myocardial infarction, a history of smoking, cerebral performance category at discharge, and the prescription of beta-blockers were independent predictors of outcome.
authors.affiliation: Division of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Engdahl
authors.forename: Angela
authors.initials: A
authors.lastname: Bång
authors.forename: Jonny
authors.initials: J
authors.lastname: Lindqvist
authors.forename: Johan
authors.initials: J
authors.lastname: Herlitz
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000704:Analysis of Variance; D000925:Anticoagulants / Q000627:therapeutic use; D016887:Cardiopulmonary Resuscitation; D002648:Child; D002675:Child, Preschool; D003327:Coronary Disease / Q000401:mortality / Q000628:therapy; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D006323:Heart Arrest / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000628:therapy; D010351:Patient Discharge; D017678:Sex Distribution; D012907:Smoking / Q000453:epidemiology; D015996:Survival Rate; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors
chemical_list: D000925:Anticoagulants