title: Post-discharge survival following pre-hospital cardiopulmonary arrest due to cardiac aetiology: temporal trends and impact of changes in clinical management.
abstract: OBJECTIVE
  To determine whether survival after discharge following pre-hospital cardiopulmonary arrest has improved.
  
  
  RESULTS
  The Heartstart Register was used to identify all 1659 patients discharged alive from Scottish hospitals during 1991-01 following pre-hospital arrest due to cardiac aetiology. The cohort was split into tertiles using year of arrest. A Cox proportional hazards model was used to determine risk of death relative to 1991-93. Patients who survived cardiopulmonary arrest in 1997-01 were less likely to die from any cause (unadjusted HR 0.60, 95% CI 0.48-0.75, P<0.001) or cardiac disease (unadjusted HR 0.50, 95% CI 0.38-0.65, P<0.001). After adjustment for case-mix, there remained significant declines in all-cause (adjusted HR 0.62, 95% CI 0.50-0.78, P<0.001) and cardiac death (adjusted HR 0.52, 95% CI 0.39-0.68, P<0.001). Clinical management had improved, with increased use of thrombolysis (47-63%, chi2 trend, P<0.001), beta-blockers (28-53%, chi2 trend, P<0.001), ACE-inhibitors (48-69%, chi2 trend, P<0.001), and anti-thrombotics (79-88%, chi2 trend, P<001). Adjustment for recorded changes in management attenuated the decline in all-cause death (adjusted HR 0.77, 95% CI 0.60-0.98, P=0.03).
  
  
  CONCLUSIONS
  Survival following cardiopulmonary arrest has improved after adjusting for changes in case-mix. Better clinical management has contributed to this improvement.
authors.affiliation: Section of Cardiology, University of Glasgow, Level 4, Queen Elizabeth Building, Glasgow Royal Infirmary, 10 Alexandra Parade, Glasgow G31 2ER, UK. jill.pell@gghb.scot.nhs.uk
authors.forename: Jill P
authors.initials: JP
authors.lastname: Pell
authors.forename: Mhairi
authors.initials: M
authors.lastname: Corstorphine
authors.forename: Alex
authors.initials: A
authors.lastname: McConnachie
authors.forename: Nicola L
authors.initials: NL
authors.lastname: Walker
authors.forename: Jane C
authors.initials: JC
authors.lastname: Caldwell
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Marsden
authors.forename: Neil R
authors.initials: NR
authors.lastname: Grubb
authors.forename: Stuart M
authors.initials: SM
authors.lastname: Cobbe
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003327:Coronary Disease / Q000150:complications* / Q000401:mortality; D003688:Deinstitutionalization / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D006323:Heart Arrest / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D009204:Myocardial Revascularization; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D012606:Scotland / Q000453:epidemiology; D012959:Socioeconomic Factors; D016019:Survival Analysis