title: Comorbidity and favorable neurologic outcome after out-of-hospital cardiac arrest in patients of 70 years and older.
abstract: BACKGROUND
  Advanced age is reported to be associated with lower survival after out-of-hospital cardiac arrest (OHCA). We aimed to establish survival rate and neurological outcome at hospital discharge after OHCA in older patients and evaluated whether pre-OHCA comorbidity was associated with favorable neurologic outcome.
  
  
  METHODS
  From a prospective registry of all cardiopulmonary resuscitation (CPR) attempts after OHCA, we established survival in 1332 patients aged ≥ 70 years in whom resuscitation with non-traumatic etiology was attempted in 2009-2011. Pre-OHCA factors (age, gender, residing in long-term care institution, Charlson Comorbidity Index [CCI] score) and resuscitation parameters (initial rhythm, bystander witnessed, bystander CPR and time to defibrillator connection) with survival at hospital discharge with favorable neurologic outcome were regressed in the 851 patients of whom CCI was known.
  
  
  RESULTS
  We found a 12% survival to discharge rate in patients aged ≥ 70 years (70-79 years: 16%; ≥ 80 years: 8%, p=0.001). Among surviving patients, 90% survived with favorable neurologic outcome. In a model with only pre-OHCA factors age was significantly associated with outcome (age OR 0.94, 95%CI 0.91-0.98), p = 0.003). High CCI score (≥ 4) was not statistically significant when associated with survival (7% vs. 12%, OR 0.53, 95%CI (0.25-1.13), p = 0.10). When adjusted for resuscitation parameters, OR for high CCI was 0.71 (95% CI 0.28-1.80, p = 0.47), also none of the other pre-OHCA factors remained statistically significant.
  
  
  CONCLUSIONS
  In the Netherlands, the survival rate in older patients was 12%; the great majority survived with favorable neurologic outcome. Resuscitation-related factors and not comorbidity determine outcome after OHCA in older patients.
authors.affiliation: Department of Cardiology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands. Electronic address: s.g.beesems@amc.nl.
authors.forename: Stefanie G
authors.initials: SG
authors.lastname: Beesems
authors.affiliation: Department of Cardiology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
authors.forename: Marieke T
authors.initials: MT
authors.lastname: Blom
authors.affiliation: Julius Center for Health Sciences and Primary Care, Utrecht University Medical Center, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
authors.forename: Martine H A
authors.initials: MH
authors.lastname: van der Pas
authors.affiliation: Department of Cardiology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
authors.forename: Michiel
authors.initials: M
authors.lastname: Hulleman
authors.affiliation: Section of Geriatrics, Department of Internal Medicine, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
authors.forename: Esther M M
authors.initials: EM
authors.lastname: van de Glind
authors.affiliation: Section of Geriatrics, Department of Internal Medicine, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands; Department of Geriatrics, Gelre Hospitals, Postbus 9014, 7300 DS Apeldoorn, The Netherlands.
authors.forename: Barbara C
authors.initials: BC
authors.lastname: van Munster
authors.affiliation: Department of Cardiology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
authors.forename: Jan G P
authors.initials: JG
authors.lastname: Tijssen
authors.affiliation: Department of Cardiology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
authors.forename: Hanno L
authors.initials: HL
authors.lastname: Tan
authors.affiliation: Julius Center for Health Sciences and Primary Care, Utrecht University Medical Center, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
authors.forename: Johannes J M
authors.initials: JJ
authors.lastname: van Delden
authors.affiliation: Department of Cardiology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
authors.forename: Rudolph W
authors.initials: RW
authors.lastname: Koster
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D015897:Comorbidity; D004632:Emergency Medical Services; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009422:Nervous System Diseases / Q000453:epidemiology*; D009426:Netherlands / Q000453:epidemiology; D058687:Out-of-Hospital Cardiac Arrest / Q000453:epidemiology* / Q000628:therapy; D010351:Patient Discharge / Q000639:trends; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome
keywords: Advance care planning; Aging; Cardiopulmonary resuscitation; Comorbidity; Survival