Published Online
on August 25, 2003

A more recent version of this article appeared on September 9, 2003

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Submitted on April 15, 2003
Revised on June 11, 2003
Accepted on June 13, 2003

Temporal Patterns in Long-Term Survival After Resuscitation From Out-of-Hospital Cardiac Arrest

Thomas D. Rea MD, MPH^*, Matthew Crouthamel BA, Mickey S. Eisenberg MD, PhD, Linda J. Becker MA, and Ann R. Lima BS

From the University of Washington (T.D.R., M.C., M.S.E.), and Public Health (T.D.R., M.S.E., L.J.B., T.H.), Seattle-King County, Emergency Medical Services Division, Seattle, and the Center for Health Statistics (A.R.L.), Washington State Department of Health, Olympia, Wash.

^* To whom correspondence should be addressed. E-mail: rea123{at}u.washington.edu.

Background--During the past quarter century, advances in treatment of cardiovascular disease have occurred that might potentially benefit survivors of sudden cardiac arrest (SCA). Little is known, however, about the temporal patterns in long-term survival among persons resuscitated from SCA. We hypothesized that long-term survival would improve over time and that this temporal pattern would be most evident for cardiac causes of death.

Methods and Results--The investigation was a retrospective cohort study of survival among persons who were discharged alive from the hospital after resuscitation from out-of-hospital SCA due to heart disease in King County, Wash, between May 1, 1976, and December 31, 2001 (n=2035). Calendar time was divided into four 5-year intervals: 1976 to 1980, 1981 to 1985, 1986 to 1990, and 1991 to 1995, and one 6-year interval, 1996 to 2001. Age-adjusted survival curves were constructed, and Cox proportional-hazards regression was used to compute hazard ratios (HRs) for the association between mortality and time period. During 11 201 person-years of follow-up, 1334 persons died. Compared with the initial time period, the HR for total mortality was 0.86 (95% confidence interval, 0.73 to 1.01) for 1981 to 1985, 0.82 (0.69 to 0.96) for 1986 to 1990, 0.66 (0.55 to 0.79) for 1991 to 1995, and 0.58 (0.47 to 0.71) for 1996 to 2001 (HR for trend=0.87 [0.84 to 0.91] for each successive time period). In analyses that assessed cardiac mortality, an even stronger temporal association was evident (HR for trend=0.79 [0.75 to 0.84]).

Conclusions--Long-term survival after resuscitation from SCA improved steadily over time in this cohort. To continue this trend, future studies should identify circumstances in which proven treatments are underutilized as well as investigate new therapies that might benefit survivors of SCA.

Key words: heart arrest • epidemiology • mortality • survival

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