Abstract 18112: The Association Between Diabetes Status and Survival Following an Out-of-Hospital Cardiac Arrest: A Retrospective Cohort Study
Background: Sudden cardiac arrest (SCA), confirmed absence of cardiac mechanical activity, is the leading cause of heart-related death in the US. Diabetes is associated with autonomic dysfunction (prolonged QTc), cardiac microvascular complications, and increased risk of SCA. Almost 85% of SCA occur out-of-hospital (OHCA), with very poor rates of return of spontaneous circulation (ROSC) and survival to hospital discharge. We sought to determine if diabetes status was associated with survival or ROSC following an OHCA.
Methods: We completed a retrospective cohort study using the Toronto Regional RescuNET Epistry - Cardiac Arrest dataset. Adults ≥ 18 years of age who experienced an non-traumatic OHCA, had data on diabetes status, and were treated by EMS between 2012-2014 were included in the analysis (n=10,097). We used bivariate analyses to examine relationships between diabetes status, Utstein elements and outcomes, and logistic regression to determine predictors of survival.
Results: Of 20,371 OHCAs, 18,912 had data on diabetes status and of those, 10,097 had a diagnosis of diabetes. Diabetes prevalence was 27.8% (95% CI: 27.0-28.7). Compared to adults without diabetes, a larger proportion of those with diabetes had a non-shockable initial rhythm (28.8% vs. 25.1%; p < 0.01), no ROSC at emergency department arrival (57.2% vs. 50.9%, p < 0.001), and did not survive to hospital discharge (92.1% vs. 89.2%, p < 0.001). There were no differences in diabetes status by gender, EMS response time or whether arrest was witnessed. Diabetes status was associated with lower odds of survival, independent from a number of Utstein elements (adjusted OR = 0.79; 95% CI: 0.66-0.93, p = 0.006).
Conclusions: This is the first Canadian study to examine the association between diabetes status and OHCA outcomes. Our findings suggest that diabetes is associated with lower survival, and although the effect appears small, the growing prevalence of diabetes globally suggests future burden related to OHCAs.
Author Disclosures: K. Danielson: None. S. Brennenstuhl: None. I.R. Drennan: None. L.J. Morrison: Employment; Modest; Laurie J. Morrison is supported by the Robert and Dorothy Pitts Chair in Emergency Medicine and Acute Care, Li Ka Shing Knowledge Institute, St Michael’s Hospital. Research Grant; Modest; She holds operating grants in the same content area from Heart and Stroke Foundation of Canada and the Canadian Institute of Health Research. Other Research Support; Modest; Received salary support from the National Institute of Health for her role as Principal Investigator for the Toronto Regional Coordinating Centre for the Resuscitation Outcomes Consortium. M. Parry: None.
- © 2016 by American Heart Association, Inc.