TY - JOUR
T1 - Regional variation in out-of-hospital cardiac arrest survival in the United States
AU - Girotra, Saket
AU - Van Diepen, Sean
AU - Nallamothu, Brahmajee K.
AU - Carrel, Margaret
AU - Vellano, Kimberly
AU - Anderson, Monique L.
AU - McNally, Bryan
AU - Abella, Benjamin S.
AU - Sasson, Comilla
AU - Chan, Paul S.
N1 - Funding Information:
Drs Girotra (K08HL122527), Nallamothu (R01HL123980), and Chan (K23HL102224, R01HL123980) are funded by the National Heart, Lung, and Blood Institute. CARES was funded by the Centers for Disease Control and Prevention (CDC) from 2004 to 2012. The program is now supported through private funding from the American Red Cross, the Medtronic Foundation Heart Rescue Program, the American Heart Association, Zoll Corporation, and inkind support from Emory University. At present, the CDC provides technical assistance for the CARES program but does not provide any funding.
Publisher Copyright:
© 2016 American Heart Association, Inc.
PY - 2016/5/31
Y1 - 2016/5/31
N2 - Background - Although previous studies have shown marked variation in out-of-hospital cardiac arrest survival across US regions, factors underlying this survival variation remain incompletely explained. Methods and Results - Using data from the Cardiac Arrest Registry to Enhance Survival, we identified 96 662 adult patients with out-of-hospital cardiac arrest in 132 US counties. We used hierarchical regression models to examine county-level variation in rates of survival and survival with functional recovery (defined as Cerebral Performance Category score of 1 or 2) and examined the contribution of demographics, cardiac arrest characteristics, bystander cardiopulmonary resuscitation, automated external defibrillator use, and county-level sociodemographic factors in survival variation across counties. A total of 9317 (9.6%) patients survived to discharge, and 7176 (7.4%) achieved functional recovery. At a county level, there was marked variation in rates of survival to discharge (range, 3.4%-22.0%; median odds ratio, 1.40; 95% confidence interval, 1.32-1.46) and survival with functional recovery (range, 0.8%-21.0%; median odds ratio, 1.53; 95% confidence interval, 1.43-1.62). County-level rates of bystander cardiopulmonary resuscitation and automated external defibrillator use were positively correlated with both outcomes (P<0.0001 for all). Patient demographic and cardiac arrest characteristics explained 4.8% and 27.7% of the county-level variation in survival, respectively. Additional adjustment of bystander cardiopulmonary resuscitation and automated external defibrillator explained 41% of the survival variation, and this increased to 50.4% after adjustment of county-level sociodemographic factors. Similar findings were noted in analyses of survival with functional recovery. Conclusions - Although out-of-hospital cardiac arrest survival varies significantly across US counties, a substantial proportion of the variation is attributable to differences in bystander response across communities.
AB - Background - Although previous studies have shown marked variation in out-of-hospital cardiac arrest survival across US regions, factors underlying this survival variation remain incompletely explained. Methods and Results - Using data from the Cardiac Arrest Registry to Enhance Survival, we identified 96 662 adult patients with out-of-hospital cardiac arrest in 132 US counties. We used hierarchical regression models to examine county-level variation in rates of survival and survival with functional recovery (defined as Cerebral Performance Category score of 1 or 2) and examined the contribution of demographics, cardiac arrest characteristics, bystander cardiopulmonary resuscitation, automated external defibrillator use, and county-level sociodemographic factors in survival variation across counties. A total of 9317 (9.6%) patients survived to discharge, and 7176 (7.4%) achieved functional recovery. At a county level, there was marked variation in rates of survival to discharge (range, 3.4%-22.0%; median odds ratio, 1.40; 95% confidence interval, 1.32-1.46) and survival with functional recovery (range, 0.8%-21.0%; median odds ratio, 1.53; 95% confidence interval, 1.43-1.62). County-level rates of bystander cardiopulmonary resuscitation and automated external defibrillator use were positively correlated with both outcomes (P<0.0001 for all). Patient demographic and cardiac arrest characteristics explained 4.8% and 27.7% of the county-level variation in survival, respectively. Additional adjustment of bystander cardiopulmonary resuscitation and automated external defibrillator explained 41% of the survival variation, and this increased to 50.4% after adjustment of county-level sociodemographic factors. Similar findings were noted in analyses of survival with functional recovery. Conclusions - Although out-of-hospital cardiac arrest survival varies significantly across US counties, a substantial proportion of the variation is attributable to differences in bystander response across communities.
KW - cardiopulmonary resuscitation
KW - heart arrest
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U2 - 10.1161/CIRCULATIONAHA.115.018175
DO - 10.1161/CIRCULATIONAHA.115.018175
M3 - Article
C2 - 27081119
AN - SCOPUS:84963975879
SN - 0009-7322
VL - 133
SP - 2159
EP - 2168
JO - Circulation
JF - Circulation
IS - 22
ER -