Out-of-hospital cardiac arrest due to coronary heart disease: A comparison of survival before and after the introduction of defribrillators in ambulances

Leslie, WS; Fitzpatrick, Bridie; Morrison, CE; Watt, Gcm; Tunstall-Pedoe, H

doi:10.1016/0300-9572(96)89036-8

Cited by 8 publications

(11 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Many, and probably most, people who died outside hospital in our series had premonitory symptoms, usually chest pain, often lasting for several hours. Similar findings have been reported recently from Glasgow 22. Although the success of media campaigns to induce patients with prolonged chest pain to seek help early has been limited,23 we believe that provision of information to the general public so that they can make informed decisions about the action to take for suspected heart attack can only be beneficial.…”

Section: Discussionsupporting

confidence: 85%

Fatality outside hospital from acute coronary events in three British health districts, 1994-5

1998

BMJ

132

View full text Add to dashboard Cite

Objectives: To provide a contemporary account of the treatment and outcomes of acute coronary attacks in England and Wales and to identify strategies that might improve the outcome. Design: Two year community and hospital based study in three British health districts. Setting: Health districts of Brighton (population 282 000), South Glamorgan (408 000), and York (264 000). Subjects: 3523 men and women under 75 years of age who died outside hospital from acute coronary causes, who were admitted to hospital with acute myocardial infarction, or who developed acute infarction or died unexpectedly from acute coronary causes while they were already in hospital. Interventions: Attempted resuscitation in people having a cardiac arrest outside hospital. Main outcome measures: Total case fatality, case fatality outside and inside hospital, and the effect of resuscitation on case fatality outside hospital. Results: 1589 patients died within 30 days of the acute event. Case fatality was 45% (95% confidence interval 43% to 47%), rising from 27% (160/595) (23% to 31%) at age <55 years to 53% (1019/1916) (51% to 55%) at 65-74 years. Overall, 74% (1172/1589) (72% to 76%) of fatal events happened outside hospital, and there was a negative age gradient (P<0.001) such that 91% (145/160) (87% to 95%) of fatalities occurred outside hospital at age <55 compared with 70% (710/1019) (67% to 73%) at 65-74 years. Without successful resuscitation of 55 patients outside hospital, total case fatality at 30 days would have risen from 45% to 46.7%. Conclusion: Opportunities for reducing fatality from acute coronary attacks lie mainly outside hospital. These results and others imply that survival from cardiac arrest outside hospital might be trebled by improved ambulance and patient response. Proper application of secondary preventive measures for patients with coronary disease could have an even larger impact. Key messages In three health districts during 1994-5 total case fatality for people under 75 years of age was 45% and 74% of fatal events happened outside hospital The likelihood of a fatal event occurring outside hospital was greater for people under 55 years of age (91%) than for those aged 65-74 years (70%) Total fatality was reduced appreciably (by 1.7%) by resuscitation outside hospital, but this proportion might possibly be trebled by further upgrading of ambulance services Because 46% of people who died were already known to have coronary heart disease, improved secondary prevention may have a major part in further reducing mortality

show abstract

Section: Discussionsupporting

confidence: 85%

Fatality outside hospital from acute coronary events in three British health districts, 1994-5

1998

BMJ

132

View full text Add to dashboard Cite

show abstract

“…Finally, the potential for resuscitation, available for 38% of people who died outside hospital in north Glasgow, was fulfilled in less than a third of that number 35. This proportion is much greater elsewhere 34.…”

Section: Discussionmentioning

confidence: 97%

“…This proportion is much greater elsewhere 34. The advent of Heartstart Scotland-the equipping of all emergency ambulances with semiautomatic defibrillators-has had little effect on successful resuscitation outside hospital in north Glasgow35 in contrast to other places 36. Exploration of the possible reasons for these differences is required to maximise the benefit of available services such as Heartstart Scotland.…”

Section: Discussionmentioning

confidence: 99%

Effect of socioeconomic group on incidence of, management of, and survival after myocardial infarction and coronary death: analysis of community coronary event register

Morrison

Woodward

Leslie

et al. 1997

BMJ

151

View full text Add to dashboard Cite

Objective: To investigate the effect of socioeconomic group (with reference to age and sex) on the rate of, course of, and survival after coronary events. Design: Community coronary event register from 1985 to 1991. Setting: City of Glasgow north of the River Clyde, population 196 000. Subjects: 3991 men and 1551 women aged 25-64 years on the Glasgow MONICA coronary event register with definite or fatal possible or unclassifiable events according to the criteria of the World Health Organisation's MONICA project (monitoring trends and determinants in cardiovascular disease). Main outcome measures: Rate of coronary events; proportion of subjects reaching hospital alive; case fatality in admitted patients and in community overall. Results: Event rates increased with age for both sexes and were greater in men than women at all ages. The rate increased 1.7-fold in men and 2.4-fold in women from the least (Q1) to the most (Q4) deprived socioeconomic quarter. The socioeconomic gradient decreased with age and was steeper for women than men. The proportion treated in hospital (66%) decreased with age, was greater in women than men, and decreased in both sexes with increasing deprivation (age standardised odds ratio 0.82 for Q4 v Q1) Case fatality in hospital (20%) increased with age, was greater for women than men when age was standardised, and showed no strong socioeconomic pattern. Overall case fatality in the community (50%) increased with age, was similar between the sexes, and increased from Q1 to Q4 (age standardised odds ratio 1.12 in men, 1.18 in women). Conclusions: Socioeconomic group affects not only death rates from myocardial infarction but also event rates and chance of admission. This should be taken into account when different groups of patients are compared. Because social deprivation is associated with so many more deaths outside hospital, primary and secondary prevention are more likely than acute hospital care to reduce the socioeconomic variation in mortality.

show abstract

“…In the view of results showing that one to two-thirds of MI cases that occur are fatal prior to hospitalization and also that most of the deaths take place within 4 h of the onset of acute symptoms [1,21], attempts to identify patients who tend to delay and modify beliefs that contribute to prolonged delay are highly important both for those at a high risk of being stricken by an acute firsttime MI and for those at risk for a re-infarction, the latter in the light of results showing previous experience of MI not necessarily leading to a reduction in delay time [22]. It is highly important too that family members and significant others are being told to expect denial, are helped to understand that denial is a common reaction, and are made familiar with the diversity of symptoms, so as to be able to help the patient decide in time to seek emergency care.…”

Section: Discussionmentioning

confidence: 99%

Denial in patients with a first-time myocardial infarction: relations to pre-hospital delay and attendance to a cardiac rehabilitation programme

Stenstrom

Nilsson²,

Stridh³

et al. 2005

European Journal of Cardiovascular Prevention & Rehabilitat

View full text Add to dashboard Cite

show abstract

Out-of-hospital cardiac arrest due to coronary heart disease: A comparison of survival before and after the introduction of defribrillators in ambulances

Cited by 8 publications

References 4 publications

Fatality outside hospital from acute coronary events in three British health districts, 1994-5

Fatality outside hospital from acute coronary events in three British health districts, 1994-5

Effect of socioeconomic group on incidence of, management of, and survival after myocardial infarction and coronary death: analysis of community coronary event register

Denial in patients with a first-time myocardial infarction: relations to pre-hospital delay and attendance to a cardiac rehabilitation programme

Contact Info

Product

Resources

About