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Patient, health service factors and variation in mortality following resuscitated out-of-hospital cardiac arrest in acute coronary syndrome : analysis of the Myocardial Ischaemia National Audit Project
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Couper, Keith, Kimani, Peter K., Gale, Chris P., Quinn, Tom, Squire, Iain B., Marshall, A. (Andrea), Black, John J. M., Cooke, Matthew, Ewings, Bob, Long, John and Perkins, Gavin D. (2018) Patient, health service factors and variation in mortality following resuscitated out-of-hospital cardiac arrest in acute coronary syndrome : analysis of the Myocardial Ischaemia National Audit Project. Resuscitation, 124 . pp. 49-57. doi:10.1016/j.resuscitation.2018.01.011 ISSN 0300-9572.
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Official URL: http://dx.doi.org/10.1016/j.resuscitation.2018.01....
Abstract
Aims
To determine patient and health service factors associated with variation in hospital mortality among resuscitated cases of out-of-hospital cardiac arrest (OHCA) with acute coronary syndrome (ACS).
Methods
In this cohort study, we used the Myocardial Ischaemia National Audit Project database to study outcomes in patients hospitalised with resuscitated OHCA due to ACS between 2003 and 2015 in the United Kingdom. We analysed variation in inter-hospital mortality and used hierarchical multivariable regression models to examine the association between patient and health service factors with hospital mortality.
Results
We included 17604 patients across 239 hospitals. Overall hospital mortality was 28.7%. In 94 hospitals that contributed at least 60 cases, mortality by hospital ranged from 10.7% to 66.3% (median 28.6%, IQR 23.2% to 39.1%)). Patient and health service factors explained 36.1% of this variation.
After adjustment for covariates, factors associated with higher hospital mortality included increasing serum glucose, ST-Elevation myocardial infarction (STEMI) diagnosis, and initial admission to a primary percutaneous coronary intervention (pPCI) capable hospital. Hospital OHCA volume was not associated with mortality. The key modifiable factor associated with lower mortality was early reperfusion therapy in STEMI patients.
Conclusion
There was wide variation in inter-hospital mortality following resuscitated OHCA due to ACS that was only partially explained by patient and health service factors. Hospital OHCA volume and pPCI capability were not associated with lower mortality. Early reperfusion therapy was associated with lower mortality in STEMI patients.
Item Type: | Journal Article | ||||||
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Subjects: | R Medicine > RC Internal medicine | ||||||
Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Statistics and Epidemiology Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Library of Congress Subject Headings (LCSH): | Cardiac arrest -- Treatment -- Great Britain, Ischemia -- Databases -- Great Britain | ||||||
Journal or Publication Title: | Resuscitation | ||||||
Publisher: | Elsevier Ireland Ltd | ||||||
ISSN: | 0300-9572 | ||||||
Official Date: | 5 January 2018 | ||||||
Dates: |
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Volume: | 124 | ||||||
Page Range: | pp. 49-57 | ||||||
DOI: | 10.1016/j.resuscitation.2018.01.011 | ||||||
Status: | Peer Reviewed | ||||||
Publication Status: | Published | ||||||
Access rights to Published version: | Restricted or Subscription Access | ||||||
Date of first compliant deposit: | 8 January 2018 | ||||||
Date of first compliant Open Access: | 5 January 2019 | ||||||
RIOXX Funder/Project Grant: |
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