Death outside hospital with special reference to heart disease

Area of Science:

• Cardiology
• Public Health
• Emergency Medicine

Background:

• Ischemic heart disease (IHD) is a leading cause of mortality.
• Understanding out-of-hospital cardiac arrest (OHCA) circumstances is crucial for intervention.
• Previous studies have focused on in-hospital cardiac events, leaving a gap in OHCA data.

Purpose of the Study:

• To analyze the circumstances surrounding deaths occurring outside of hospitals in Gothenburg.
• To determine the proportion of out-of-hospital deaths attributable to heart disease, specifically IHD.
• To assess the potential reach of mobile coronary care services for OHCA.

Main Methods:

• Analysis of all deaths (n=1309) in the Gothenburg area over one year (Sept 1975-Aug 1976).
• Detailed review of circumstances for autopsied subjects (<75 years) who died from IHD (n=363, 95% autopsy rate).
• Inclusion of witnessed deaths and ambulance calls for both IHD and other heart disease fatalities.

Main Results:

• Ischemic heart disease (IHD) accounted for 52% (675/1309) of out-of-hospital deaths.
• Of the autopsied IHD deaths, 68% occurred at home, and 59% were witnessed.
• A total of 212 witnessed out-of-hospital cardiac arrest cases with ambulance calls were identified, representing a potential target for mobile coronary care.

Conclusions:

• IHD is the primary cause of out-of-hospital mortality in Gothenburg.
• A substantial number of OHCA events occur in circumstances amenable to intervention by mobile coronary care.
• The study provides an estimate for the maximum annual number of OHCA cases potentially reachable by mobile coronary care within effective resuscitation timeframes.