P507
Cumulative comorbidity and survival in out-of-hospital cardiac arrest

EU Horizon 2020 - 733381, CVON2017-15 RESCUED, CVON2018-30 Predict2, an unconditional grant from Physio-Control Inc., Redmond, WA USA.

ARREST

Multiple chronic health conditions have been associated with survival after out-of-hospital cardiac arrest (OHCA). The influence of cumulative disease burden on survival rates at successive stages of post-resuscitation care is unknown.

To study the relationship between cumulative disease burden (Charlson Comorbidity Index [CCI]) and survival rates in the course of post-resuscitation care.

From a prospective community-based OHCA registry, 2544 OHCA patients aged ≥18y with presumed cardiac cause in 2010-2014 were included. CCI was determined using medical histories from general practitioners and hospital correspondence, and categorized into: no (CCI = 0), moderate (CCI = 1-2) or high (CCI≥3) disease burden. The following stages of post-resuscitation care were defined: (1) pre-hospital: from OHCA to hospital admission, (2) in-hospital: from hospital admission to hospital discharge. The association between CCI and overall survival and survival at successive stages of care was assessed using logistic regression analyses. Results were stratified according to sex.

In the pre-hospital stage, no association between CCI and survival to hospital admission was found (OR 0.93, 95%CI 0.73-0.1.18, P = 0.61) (Figure 1). In contrast, during the in-hospital stage high CCI was significantly associated with lower survival rate (OR 0.41, 95% CI 0.27-0.61, P < 0.01) (Figure 1), but, when stratified according to sex (pinteraction= <0.01), this association was only statistically significant in men (OR 0.34; 95%CI 0.21-0.55; P < 0.01), and not in women (OR 0.68; 95%CI 0.31-1.50; P = 0.33). When assessed individually, OHCA patients with congestive heart failure (24.8% vs. 12.0%, P < 0.01), peripheral vascular disease (11.7% vs. 5.4%, P < 0.01), diabetes (22.0% vs. 13.2%, P < 0.01), renal disease (17.1% vs. 5.9%, P < 0.01), malignancy (17.8% vs. 9.6%, P < 0.01), chronic pulmonary disorder (19.9% vs. 13.7%, P < 0.01),  or dementia (0.3% vs. 3.0%, P < 0.01),  were less likely to survive during the in-hospital stage.

Pre-existing comorbidity burden plays a significant role in OHCA survival, but only during the in-hospital stage. In order to ultimately improve survival after OHCA, in-hospital care needs further study taking pre-existing comorbidity burden into account.

Abstract Figure 1