Cardiac Arrest - Risks and Outcomes

Description

Abstract
About 10000 individuals suffer a cardiac arrest (CA) in Sweden every year. Approximately 1/10 survives if the CA occurs outside of the hospital while 3/10 survives if the arrest occurs within the hospital. Little is known about which comorbidities and acute conditions that affect survival the most and currently there are no effective scoring systems to help physicians to assess the chances of survival. There is also scarce evidence about which risk factors, including genetics, that predict the risk of future CA in a healthy population.

In paper I, all in-hospital CA occuring between 2007-2010 at Malmö University Hospital (n=287) were analysed with regard to survival, taking comordidities and acute conditions into consideration. Pre-Arrest Morbidity score (PAM) and Prognosis After Resuscitation score (PAR) were calculated for each patient. We found that age, malignancy, poor functional status, hyponatremia and elevated heart rate were associated with poor survival. The PAM- and PAR-score had an overall low accuracy to predict survival.

In paper II, the “Good Outcome Following Attempted Resuscitation” score (GO-FAR) was evaluated on the same cohort. The GO-FAR score was designed to assess the chance of survival with Cerebral Performance Category (CPC) = 1. Our results showed that the score had a high accuracy of estimating chance of survival, even when applied on a population with different demographics than originally investigated.

In paper III, we investigated midlife risk factors for future CA in a healthy population by means of combining the Malmö Diet and Cancer-study (MDC) (n=30447) with the local cardiac arrest registry (n=2758). The study had a follow-up time of 17.6 years (SD 4.6) and during this period, 378 cases of CA occurred. Smoking, dyslipidemia, diabetes and previous heart failure, cardiovascular- or cerebrovascular disease increased the risk of future CA of cardiac aetiology, while smoking, hypertension and obesity were the most important risk factors for future CA of non-cardiac aetiology.

In paper IV, we investigated the risk of future CA in relation to a genetic risk score (GRS) for coronary artery disease. The same cohort was used as in paper III but with those patients with prevalent heart failure, cardiovascular- or cerebrovascular disease excluded. A total number of 23300 subjects remained out of which 252 CAs occurred during a 18.9 year (SD 4.4) follow-up. Multivariate analysis showed a clear association between the GRS and CA of cardiac aetiology but no such association between the GRS and CA of non-cardiac aetiology. Further analyses were therefore directed towards CA of cardiac aetiology (n=181). A composite score consisting of low-, medium- and high genetic risk together with traditional cardiovascular risk factors was created. The composite score was divided into deciles and further into groups of low- (D1-3), medium- (D4-9) and high risk (D10). Comparison of the groups of high- versus low risk, yielded a hazard ratio (HR) of 82.19 {(95% CI 20.07- 336.69) (P<0.001)} for future CA.

Period	2013 Jan 1 → 2017 Oct 27
Examinee/Supervised person	Marcus Ohlsson
Examination/Supervision held at	Cardiovascular Research - Hypertension
Degree of Recognition	International