Objective To investigate the impact of pre-arrest comorbidities on future out-of-hospital cardiac arrest (OHCA) development using a nationwide dataset.
Methods This population-based, matched case-control study used the national health insurance claims data relevant to OHCA in South Korea from January 2009 to December 2018. Case patients were randomly matched to controls by age, sex and date of cardiac arrest. Controls were defined as patients who did not experience OHCA based on claim codes in national health screening data. The comorbidity burden was assessed using the Charlson Comorbidity Index (CCI).
Results A total of 191 370 OHCA patients were matched to 347 568 controls. The mean CCI in the case group was 3.76, which was significantly higher than that in the control group (1.75, p<0.001). Overall, OHCA was 1.35 (95% CI 1.34 to 1.35) times more likely to occur with every 1 point increase in the CCI. All other comorbidities constituting the CCI were associated with the OHCA risk (p<0.001). Patients with CCI ≥3 presented an OR of 3.71 (95% CI 3.67 to 3.76) for the risk of OHCA occurrence. This association was more pronounced in patients aged <70 years than in those aged ≥70 years (OR (95% CI) 16.07 (15.48 to 16.68) vs 6.50 (6.33 to 6.68)).
Conclusion A high burden of pre-arrest comorbidity was associated with a higher risk of OHCA development, which was more pronounced in patients with less advanced age.
Data availability statement
Data are available on reasonable request. Data are available from the corresponding author on reasonable request and with the permission of Health Insurance Review & Assessment Service of Korea.
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Contributors SIH is the first author and drafted the manuscript. YJK aided in interpreting the results and worked on the manuscript. WYK and Ye-Jee K had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Ye-Jee K contributed to the statistical analysis. WYK designed and supervised the study. All authors contributed to acquisition, analysis, interpretation of data and revised the manuscript for important intellectual content. All authors approved the final version and had final responsibility for the decision to submit for publication. WYK is the guarantor. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.
Funding This work was supported by a grant from the National Research Foundation of Korea, funded by the Korean government (grant number: NRF-2020R1F1A1072171). WYK was supported by a grant from the Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea (grant number: 2017IT0669). YJK was supported by a grant from the Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea (grant number: 2021IT0007).
Disclaimer The National Research Foundation of Korea and the Asan Institute for Life Sciences had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript and decision to submit the manuscript for publication.
Competing interests Support from the National Research Foundation of Korea and the Asan Institute for Life Sciences; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
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