Long term survival and disease burden from out-of-hospital cardiac arrest in Singapore: a population-based cohort study

Ho, Andrew Fu Wah; Lim, Mervyn Jun Rui; Earnest, Arul; Blewer, Audrey L; Graves, Nicholas; Yeo, Jun Wei; Pek, Pin Pin; Tiah, Ling; Ong, Marcus Eng Hock; Chia, Michael Yih Chong; Ng, Yih Yng; Leong, Benjamin Sieu Hon; Gan, Han Nee; Ng, William; Cheah, Si Oon; Mao, Desmond Renhao; Edwin, Nausheen; Arulanandam, Shalini

doi:10.1016/j.lanwpc.2022.100672

Cited by 11 publications

(8 citation statements)

References 44 publications

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“…The all‐cause death has been well explored in previous studies. 8 However, it is unclear whether noncardiovascular or cardiovascular complications contribute more to morbidity and death, due to conflicting results in previous literature. Studies by Cho et al 28 and Lindner et al 29 have observed that OHCA populations with greater proportions of OHCA with cardiac pathogenesis also appear to have correspondingly greater proportions of death related to a cardiovascular cause.…”

Section: Discussionmentioning

confidence: 99%

“… 4 , 9 However, since OHCA is a heterogeneous entity with noncardiac pathogeneses, it is unclear if survivors of OHCA are at increased risk of a subsequent AMI. A previous study conducted in Singapore found that AMI was the third most common cause of death after OHCA 8 but did not investigate whether patients with OHCA with subsequent AMI had a higher mortality rate than those without. 8 Additionally, few studies assess long‐term cardiovascular outcomes after OHCA, especially in the Asian context.…”

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confidence: 98%

“…A previous study conducted in Singapore found that AMI was the third most common cause of death after OHCA 8 but did not investigate whether patients with OHCA with subsequent AMI had a higher mortality rate than those without. 8 Additionally, few studies assess long‐term cardiovascular outcomes after OHCA, especially in the Asian context. 10 , 11 …”

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confidence: 98%

“… 1 , 2 , 3 This is concerning since the morbidity and death of this expanding group of OHCA survivors are a significant public health burden. 4 , 5 , 6 , 7 , 8 …”

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confidence: 99%

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Incidence and Long‐Term Outcomes of Acute Myocardial Infarction Among Survivors of Out‐of‐Hospital Cardiac Arrest

Ho,

Zheng,

et al. 2024

JAHA

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Background Despite the increasing long‐term survival after out‐of‐hospital cardiac arrest (OHCA), the risk of subsequent acute myocardial infarction (AMI) remains poorly understood. We aimed to determine the incidence, predictors, and long‐term outcomes of AMI among survivors of OHCA. Methods and Results We assembled a retrospective cohort of 882 patients with OHCA who survived to 30 days or discharge from the hospital between 2010 and 2019. Survivors of OHCA had an increased risk of subsequent AMI, defined as AMI occurring 30 days after index OHCA or following discharge from the hospital after OHCA, compared with the general population when matched for age and sex (standardized incidence ratio, 4.64 [95% CI, 3.52–6.01]). Age‐specific risks of subsequent AMI for men (standardized incidence ratio, 3.29 [95% CI, 2.39–4.42]) and women (standardized incidence ratio, 6.15 [95% CI, 3.27–10.52]) were significantly increased. A total of 7.2%, 8.3%, and 14.3% of survivors of OHCA had a subsequent AMI at 3 years, 5 years, and end of follow‐up, respectively. Age at OHCA (hazard ratio [HR], 1.04 [95% CI, 1.02–1.06]) and past medical history of prior AMI, defined as any AMI preceding or during the index OHCA event (HR, 1.84 [95% CI, 1.05–3.22]), were associated with subsequent AMI, while an initial shockable rhythm was not (HR, 1.00 [95% CI, 0.52–1.94]). Survivors of OHCA with subsequent AMI had a higher risk of death (HR, 1.58 [95% CI, 1.12–2.22]) than those without. Conclusions Survivors of OHCA are at an increased risk of subsequent AMI compared with the general population. Prior AMI, but not an initial shockable rhythm, increases this risk, while subsequent AMI predicts death. Preventive measures for AMI including cardiovascular risk factor control and revascularization may thus improve outcomes in selected patients with cardiac pathogenesis.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 98%

mentioning

confidence: 98%

“… 1 , 2 , 3 This is concerning since the morbidity and death of this expanding group of OHCA survivors are a significant public health burden. 4 , 5 , 6 , 7 , 8 …”

mentioning

confidence: 99%

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Incidence and Long‐Term Outcomes of Acute Myocardial Infarction Among Survivors of Out‐of‐Hospital Cardiac Arrest

Ho,

Zheng,

et al. 2024

JAHA

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“…Out-of-hospital cardiac arrest (OHCA) is a significant public health challenge, with an age-adjusted incidence rate of 50 per 100,000 person-years in Singapore. 1 A significant proportion of OHCAs present with ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT), so-called “shockable rhythms” that are amenable to defibrillation and are associated with better outcomes as compared to the non-shockable rhythms. 2 According to American Heart Association guidelines, VF/VT is considered shock-refractory if the rhythm persists or recurs after at least 1 shock.…”

Section: Introductionmentioning

confidence: 99%

Machine learning prediction of refractory ventricular fibrillation in out-of-hospital cardiac arrest using features available to EMS

Rahadian,

Okada,

Shahidah

et al. 2024

Resuscitation Plus

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The impacts of anemia burden on clinical outcomes in patients with out‐of‐hospital cardiac arrest

Ho,

Kuo,

Hsu

et al. 2023

Clinical Cardiology

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BackgroundOut‐of‐hospital cardiac arrest (OHCA) has low survival rates, and few patients achieve a desirable neurological outcome. Anemia is common among OHCA patients and has been linked to worse outcomes, but its impact following the return of spontaneous circulation (ROSC) is unclear. This study examines the relationship between anemia burden and clinical outcomes in OHCA patients.HypothesisHigher anemia burden after ROSC may be related to higher mortality and worse neurologic outcomes.MethodsPatients who experienced OHCA and had ROSC were enrolled retrospectively. Anemia burden was defined as the area under curve from the target hemoglobin level over a 72‐h period after OHCA. Hemoglobin level was measured at 12‐h intervals. The clinical outcomes of the study included mortality and neurological outcomes at Day 30.ResultsThe study enrolled 258 nontraumatic OHCA patients who achieved ROSC between January 2017 and December 2021. Among the 162 patients who survived more than 72 h, a higher anemia burden, specifically target hemoglobin levels below 7 (hazard ratio [HR]: 1.129, 95% confidence interval [CI]: 1.013–1.259, p = .029), 8 (HR: 1.099, 95% CI: 1.014–1.191, p = .021), and 9 g/dL (HR: 1.066, 95% CI: 1.001–1.134, p = .046) was associated with higher 30‐day mortality. Additionally, anemia burden with target hemoglobin levels below 7 (HR: 1.129, 95% CI: 1.016–1.248; p = .024) and 8 g/dL (HR: 1.088; 95% CI: 1.008–1.174, p = .031) was linked to worse neurological outcomes.ConclusionsAnemia burden predicts 30‐day mortality and neurological outcomes in OHCA patients who survive more than 72 h. Maintaining higher hemoglobin levels within the first 72 h after ROSC may improve short‐term outcomes.

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Long term survival and disease burden from out-of-hospital cardiac arrest in Singapore: a population-based cohort study

Cited by 11 publications

References 44 publications

Incidence and Long‐Term Outcomes of Acute Myocardial Infarction Among Survivors of Out‐of‐Hospital Cardiac Arrest

Incidence and Long‐Term Outcomes of Acute Myocardial Infarction Among Survivors of Out‐of‐Hospital Cardiac Arrest

Machine learning prediction of refractory ventricular fibrillation in out-of-hospital cardiac arrest using features available to EMS

The impacts of anemia burden on clinical outcomes in patients with out‐of‐hospital cardiac arrest

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