Objective To investigate whether chronic clinical comorbidity as collected from emergency medical services (EMS) reports influences survival following out-of-hospital ventricular fibrillation (VF) cardiac arrest.
Design Observational retrospective cohort study.
Setting King County, Washington.
Patients 1043 persons who suffered out-of-hospital VF arrest due to heart disease between January 1, 1999 and December 31, 2003.
Measures Chronic conditions were ascertained and tallied from EMS reports using a uniform abstraction form by persons blinded to outcome status. The outcome was survival to hospital discharge.
Results Seventy-five percent (776/1043) of patients had at least at least one chronic health condition and 51% (529/1043) had prior clinically-recognized heart disease. Overall, increasing count of chronic conditions was inversely associated with the odds of survival to hospital discharge after adjustment for potential confounders (odds ratio [OR] = 0.84 [0.74,0.95] for each additional chronic condition). <BR> The chronic condition-outcome association tended to be more prominent among those with longer EMS response intervals (p = 0.07 for interaction term between condition count and EMS response interval). For example, the OR of survival was 0.72 (0.59,0.88) for each additional chronic condition when the EMS response interval was 8 minutes compared to OR of 0.95 (0.79,1.14) when EMS response interval was 3 minutes.
Conclusion In this cohort, an increasing burden of clinical comorbidity based on review of the EMS report was associated with a lower odds of survival following VF arrest. The findings suggest that chronic conditions influence the arrest pathophysiology and in turn could help guide resuscitation care.
- cardiac arrest
- chronic condition
- emergency medical services
- heart arrest
- ventricular fibrillation
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