Pharmacotherapy and hospital admissions before out-of-hospital cardiac arrest: a nationwide study.
BACKGROUND
For out-of-hospital cardiac arrest (OHCA) to be predicted and prevented, it is imperative the healthcare system has access to those vulnerable before the event occurs. We aimed to determine the extent of contact to the healthcare system before OHCA.


METHODS
All patients in Denmark with a registered OHCA June 1, 2001-December 31, 2005 were matched on age and sex with 10 random controls from the entire Danish population. We estimated the association with OHCA by conditional logistic regression analyses, and we determined the proportion of patients in contact with the healthcare system before OHCA from hospital admissions or claimed prescriptions.


RESULTS
We identified 12,089 patients with an OHCA. Of these, 62% (7548) and 85% (10,312) were in contact with the healthcare system up to 30 days and 1 year before OHCA, respectively. Association with OHCA up to 30 days before the event pertained to myocardial infarction (odds ratio (OR)=6.4, 95% confidence interval (CI): 4.7-8.6)); heart failure (OR=5.1, CI: 4.1-6.3); ischemic heart disease (OR=1.9, CI: 1.6-2.4); and cardiac dysrhythmia (OR=1.8, CI: 1.4-2.2). Concomitant pharmacotherapy up to 30 days before OHCA with the strongest association was: corticosteroids (systemic) (OR=2.7, CI: 2.5-3.0), bronchial dilators (OR=2.5, CI: 2.3-2.7), anti-psychotic medication (OR=2.1, CI: 1.9-2.3), and digoxin (OR=2.1, CI: 2.0-2.3). Similar results were found for associations up to 1 year before OHCA.


CONCLUSIONS
Contrary to general belief, the majority of OHCA patients are in contact with the healthcare system shortly before OHCA.
Weeke
Peter
P
Department of Cardiology, Copenhagen University Hospital Gentofte, Denmark. pw@heart.dk
Folke
Fredrik
F
Gislason
Gunnar H
GH
Lippert
Freddy K
FK
Olesen
Jonas B
JB
Andersson
Charlotte
C
Fosbøl
Emil L
EL
Charlot
Mette G
MG
Kanters
Jørgen K
JK
Poulsen
Henrik E
HE
Nielsen
Søren Loumann
SL
Køber
Lars
L
Torp-Pedersen
Christian
C
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000368:Aged; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000628:therapy; D001993:Bronchodilator Agents / Q000627:therapeutic use; D003718:Denmark; D004077:Digoxin / Q000627:therapeutic use; D005260:Female; D015438:Health Behavior; D006333:Heart Failure / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy; D017202:Myocardial Ischemia / Q000628:therapy; D058687:Out-of-Hospital Cardiac Arrest / Q000517:prevention & control*; D010343:Patient Admission; D012044:Regression Analysis
D000305:Adrenal Cortex Hormones; D014150:Antipsychotic Agents; D001993:Bronchodilator Agents; D004077:Digoxin