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Published on: June 12, 2021
Differences in health care utilization prior to cardiac arrest by shockable and non-shockable presenting rhythms: a
Marc W Deyell1, Nathaniel M Hawkins1, Meijiao Guan2
1Division of Cardiology, University of British Columbia, Canada.
Insights
Patients with out-of-hospital cardiac arrest (OHCA) utilized healthcare services more before their event. Non-shockable OHCA patients had higher healthcare use, including non-cardiovascular visits, compared to shockable OHCA patients.
Area of Science:
- Cardiology
- Public Health
- Emergency Medicine
Background:
- Health care utilization often increases before out-of-hospital cardiac arrest (OHCA).
- Previous studies have not differentiated OHCA by shockable versus non-shockable rhythms regarding pre-arrest healthcare use.
- Understanding these differences can inform predictive modeling and preventative strategies.
Purpose of the Study:
- To compare health care utilization patterns in the three years preceding OHCA between patients with shockable and non-shockable rhythms.
- To identify specific types of healthcare encounters (e.g., cardiovascular vs. non-cardiovascular) that differ between these OHCA subgroups.
- To analyze trends in healthcare utilization in the immediate weeks leading up to OHCA.
Main Methods:
- A matched case-control study design was employed.
- Data were sourced from the British Columbia Cardiac Arrest Registry (2009-2019).
- Cases (OHCA patients) were matched 4:1 to controls based on age, sex, and geographic population. Primary outcomes included hospital admissions and emergency department (ED) visits within three years prior to arrest.
Main Results:
- Both shockable (61.2%) and non-shockable (74.8%) OHCA groups showed significantly higher rates of hospital or ED visits within three years compared to controls.
- Non-shockable OHCA patients had a higher odds ratio (3.13) for prior hospital/ED visits than shockable OHCA patients (1.74).
- All healthcare encounters, including cardiovascular and non-cardiovascular, were more frequent in OHCA patients, with non-shockable arrests exhibiting a higher relative rate of non-CV encounters. Biweekly healthcare visits increased 6-24 weeks before OHCA in both groups.
Conclusions:
- Significant differences exist in pre-arrest healthcare utilization between shockable and non-shockable OHCA patients.
- Both OHCA groups demonstrate elevated healthcare use prior to cardiac arrest, with non-shockable cases showing a more pronounced pattern.
- These findings highlight the potential for identifying high-risk individuals through analysis of pre-arrest healthcare utilization patterns.
Background:
Health care utilization has been shown to increase prior to out-of-hospital cardiac arrest (OHCA). However, differences between OHCA presenting with shockable and non-shockable rhythms have not been explored.
Objective:
We examined differences in health care utilization prior to OHCA among patients with shockable and non-shockable rhythms.
Methods:
This was a matched case-control study. Cardiac arrests from 2009 to 2019 were identified in the British Columbia (BC) Cardiac Arrest Registry. Age, sex and geographic population-matched controls were identified. Primary outcomes were hospital admissions or emergency department (ED) visits 3 years prior to arrest. Secondary outcomes included cardiovascular (CV) and non-CV encounters.
Results:
A total of 3461 shockable and 11,470 non-shockable OHCA patients were matched 4:1 to controls. Hospitalization or ED visit in the 3 years prior was 61.2% in the shockable group (48.8% in controls, OR 1.74, 95% CI 1.60-1.88) and 74.8% in the non-shockable group (50.6% in controls, OR 3.13, 95% CI 2.99-3.29). All health care encounters (hospitalization, ED or outpatient visits) were more common in both shockable and non-shockable cardiac arrests, with a higher rate of CV encounters. Non-shockable cardiac arrests had higher relative rates of non-CV encounters. Biweekly rates of hospital and emergency visits leading up to OHCA were increased for both groups, rising at 6-24 weeks prior to arrest.
Conclusion And Relevance:
Shockable and non-shockable OHCA show high rates of health care utilization prior to cardiac arrest. However, there were important differences in health care utilization between the shockable and non-shockable groups.
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