Abstract 19291: A Multi-Statewide 5-Year Initiative to Improve Care for Out-of-Hospital Cardiac Arrest: Primary Results From the HeartRescue Project
Background: The HeartRescue Project is a 5 state public health initiative focused on establishing state-wide out-of-hospital cardiac arrest (OHCA) systems of care. Each state worked to engage OHCA stakeholders to measure and improve care at the community, emergency medical services (EMS), and hospital levels. We evaluated temporal patterns of case-capture, OHCA care, and survival.
Methods: The investigation includes all persons ≥18 years treated for OHCA due to heart disease by EMS and captured in the statewide registry from 2011-2015. Using descriptive statistics and logistic regression, we evaluated temporal patterns in evidence-based care and survival for all-rhythm and Utstein OHCA.
Results: A total of 65,141 OHCA (including 10,086 Utstein) patients treated by 330 EMS agencies and 411 hospitals were identified. From 2011 to 2015, the case-capture rate for the incidence of EMS-treated OHCA case-capture for the 5 states (total adult population of 32.1 million) increased from 21 (n=6,777) to 50 (n=16,128) per 100,000 person-years (p for trend <0.001). Overall survival to hospital discharge was 11.4% OHCAs overall and 33.8% in the Utstein group. We observed a temporal increase in evidence-based care, including bystander cardiopulmonary resuscitation (46.1% to 48.3%, p for trend <0.001), automated external defibrillator (AED) application (3.5% to 6.2%, p for trend <0.001), police AED application (4.2% to 6.5%, p for trend <0.001) among OHCA overall; and a decrease in hospital-based targeted temperature management (56.3% to 51.7%, p for trend < 0.001) for the Utstein group admitted to hospital. In analyses restricted to EMS agencies participating for at least 4 consecutive years, there was no evidence of a temporal trend in survival among OHCA overall arrests (adjusted Odds Ratio [OR] 0.98, 95% CI 0.96-1.01, per calendar year) or in the Utstein group (OR 1.01, 95% CI 0.97-1.05, per calendar year).
Conclusions: The HeartRescue Project engaged a large population-based geography, improved statewide case-capture rates, and demonstrated a relatively high rate of survival compared to prior published reports but no temporal increase in overall survival was observed. These findings present future opportunities to improve OHCA care and survival.
Author Disclosures: S. van Diepen: None. S. Girotra: None. B. Abella: Research Grant; Significant; Medtronic Foundation, Phillips Healthcare. Ownership Interest; Significant; Resuscor. Consultant/Advisory Board; Significant; Velomedix. L. Becker: Research Grant; Significant; Laerdal Medical, Phillips Healthcare, Cardiac Science, Medtronic Foundation. Honoraria; Significant; Phillips Healthcare. B. Bowbrow: Research Grant; Significant; Medtronic Foundation. P.S. Chan: None. C. Fahrenbruch: None. C. Granger: Research Grant; Significant; Medtronic Foundation. J.G. Jollis: Research Grant; Significant; Medtronic Foundation. B. McNally: None. L. White: None. D. Yannopoulus: Research Grant; Significant; Medtronic Foundation, NIH. T.D. Rea: Research Grant; Modest; Medtronic Foundation, Medic One Foundation, Life Sciences Discovery Fund.
- © 2016 by American Heart Association, Inc.