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Community-based interventions for sudden cardiac death. Impact, limitations, and changes.

L A Cobb¹, W D Weaver, C E Fahrenbruch

¹Department of Medicine (Cardiology), University of Washington, Seattle.

|January 1, 1992

Summary

Seattle paramedics treated 5,120 ventricular fibrillation (VF) victims since 1970. Despite improved survival rates, VF incidence declined, suggesting reduced heart disease mortality and better VF survivor longevity.

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Area of Science:

Cardiology
Emergency Medicine
Public Health

Background:

Seattle Fire Department paramedics have managed 5,120 out-of-hospital ventricular fibrillation (VF) cases since 1970.
A notable decrease in annual VF incidence over the past decade is observed, likely linked to reduced coronary heart disease mortality.
Survival rates to hospital discharge have averaged 28.9% since 1975, with fluctuations between 24% and 33%.

Purpose of the Study:

To analyze trends in out-of-hospital ventricular fibrillation (VF) incidence, patient demographics, and survival rates in Seattle.
To evaluate the impact of life support improvements and changing patient characteristics on VF outcomes.
To identify future strategies for reducing sudden cardiac death incidence.

Main Methods:

Retrospective analysis of 5,120 out-of-hospital ventricular fibrillation (VF) cases treated by Seattle Fire Department paramedics from 1970 to the present.
Comparison of patient demographics, incidence rates, and survival outcomes over different time periods.
Statistical analysis to assess trends in age, smoking habits, and long-term survival rates of VF survivors.

Main Results:

Average victim age increased from 63.4 to 66.1 years (p<0.0001).
Habitual cigarette smoking decreased among VF arrest survivors (48% to 31%, p<0.0001).
1- and 5-year survival rates improved significantly for recent resuscitation cohorts (e.g., 83% and 57% for 1982-1987 vs. 74% and 44% for 1970-1975, p<0.0001).

Conclusions:

While survival rates have improved, they have not kept pace with efforts in basic and advanced life support.
Future reductions in sudden cardiac death may depend more on addressing coronary atherogenesis than on controlling pre-existing ventricular arrhythmias.
Evaluation of widespread automated defibrillator use by non-medical personnel is warranted.