Urban-Rural Differences in Cardiac Arrest Outcomes: A Retrospective Population-Based Cohort Study

Michael S. Connolly; Judah P. Goldstein, PCP; Margaret Currie; Alix J.E. Carter; Steve P. Doucette; Karen Giddens; Katherine S. Allan; Andrew H. Travers; Beau Ahrens; Daniel Rainham; John L. Sapp

doi:10.1016/j.cjco.2021.12.010

Urban-Rural Differences in Cardiac Arrest Outcomes: A Retrospective Population-Based Cohort Study

Michael S. Connolly, Judah P. Goldstein, PCP, Margaret Currie, Alix J.E. Carter, Steve P. Doucette, Karen Giddens, Katherine S. Allan, Andrew H. Travers, Beau Ahrens, Daniel Rainham, John L. Sapp

Medicine

Producción científica: Contribución a una revista › Artículo › revisión exhaustiva

22 Citas (Scopus)

Resumen

Background: Approximately 10% of people who suffer an out-of-hospital cardiac arrest (OHCA) treated by paramedics survive to hospital discharge. Survival differs by up to 19.2% between urban centres and rural areas. Our goal was to investigate the differences in OHCA survival between urban centres and rural areas. Methods: This was a retrospective cohort study of OHCA patients treated by Nova Scotia Emergency Medical Services (EMS) in 2017. Cases of traumatic, expected, and noncardiac OHCA were excluded. Data were collected from the Emergency Health Service electronic patient care record system and the discharge abstract database. Geographic information system analysis classified cases as being in urban centres (population > 1000 people) or rural areas, using 2016 Canadian Census boundaries. The primary outcome was survival to hospital discharge. Multivariable logistic regression covariates were age, sex, bystander resuscitation, whether the arrest was witnessed, public location, and preceding symptoms. Results: A total of 510 OHCAs treated by Nova Scotia Emergency Medical Services were included for analysis. A total of 12% (n = 62) survived to discharge. Patients with OHCAs in urban centres were 107% more likely to survive than those with OHCAs in rural areas (adjusted odds ratio = 2.1; 95% confidence interval = 1.1 to 3.8; P = 0.028). OHCAs in urban centres had a significantly shorter mean time to defibrillation of shockable rhythm (11.2 minutes ± 6.2) vs those in rural areas (17.5 minutes ± 17.3). Conclusions: Nova Scotia has an urban vs rural disparity in OHCA care that is also seen in densely populated OHCA centres. Survival is improved in urban centres. Further improvements in overall survival, especially in rural areas, may arise from community engagement in OHCA recognition and optimized healthcare delivery.

Idioma original	English
Páginas (desde-hasta)	383-389
Número de páginas	7
Publicación	CJC Open
Volumen	4
N.º	4
DOI	https://doi.org/10.1016/j.cjco.2021.12.010
Estado	Published - abr. 2022

Nota bibliográfica

Funding Information:
John L.Sapp received research grants from Johnson and Johnson, Abbott; Honoraria from Medtronic Inc, Johnson and Johnson, Abbott, Varian. Andrew H.Travers serves as a Medical Director EHS, Department of Health and Wellness NS. Alix J.E. Carter serves as a Medical Dirctor Research EHS, Department of Health and Wellness NS. Katherine S. Allan has received Honoraria from Zoll. The remaining authors have no conflicts of interest to disclose.

Funding Information:
This work was funded by a grant from the Maritime Heart Centre Innovation Fund.

Funding Information:
Paula Kennedy, Megi Nallbani, and Mike Janczyszyn have all been essential members of the research team and have provided helpful feedback, support, and direction. Gratitude is extended to Nova Scotia Health Decision Support for assistance with outcomes datasets. We are grateful to Dr Ian Cameron and Mr. Stephen Boyd for their valuable insights and support for the project. The data for this study were made available through the Nova Scotia Department of Health & Wellness. This work was funded by a grant from the Maritime Heart Centre Innovation Fund. John L.Sapp received research grants from Johnson and Johnson, Abbott; Honoraria from Medtronic Inc, Johnson and Johnson, Abbott, Varian. Andrew H.Travers serves as a Medical Director EHS, Department of Health and Wellness NS. Alix J.E. Carter serves as a Medical Dirctor Research EHS, Department of Health and Wellness NS. Katherine S. Allan has received Honoraria from Zoll. The remaining authors have no conflicts of interest to disclose.

Publisher Copyright:
© 2021 The Authors

ASJC Scopus Subject Areas

Cardiology and Cardiovascular Medicine

PubMed: MeSH publication types

Journal Article

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10.1016/j.cjco.2021.12.010

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@article{ede779af668a482cb037ac16d6852a7a,

title = "Urban-Rural Differences in Cardiac Arrest Outcomes: A Retrospective Population-Based Cohort Study",

abstract = "Background: Approximately 10% of people who suffer an out-of-hospital cardiac arrest (OHCA) treated by paramedics survive to hospital discharge. Survival differs by up to 19.2% between urban centres and rural areas. Our goal was to investigate the differences in OHCA survival between urban centres and rural areas. Methods: This was a retrospective cohort study of OHCA patients treated by Nova Scotia Emergency Medical Services (EMS) in 2017. Cases of traumatic, expected, and noncardiac OHCA were excluded. Data were collected from the Emergency Health Service electronic patient care record system and the discharge abstract database. Geographic information system analysis classified cases as being in urban centres (population > 1000 people) or rural areas, using 2016 Canadian Census boundaries. The primary outcome was survival to hospital discharge. Multivariable logistic regression covariates were age, sex, bystander resuscitation, whether the arrest was witnessed, public location, and preceding symptoms. Results: A total of 510 OHCAs treated by Nova Scotia Emergency Medical Services were included for analysis. A total of 12% (n = 62) survived to discharge. Patients with OHCAs in urban centres were 107% more likely to survive than those with OHCAs in rural areas (adjusted odds ratio = 2.1; 95% confidence interval = 1.1 to 3.8; P = 0.028). OHCAs in urban centres had a significantly shorter mean time to defibrillation of shockable rhythm (11.2 minutes ± 6.2) vs those in rural areas (17.5 minutes ± 17.3). Conclusions: Nova Scotia has an urban vs rural disparity in OHCA care that is also seen in densely populated OHCA centres. Survival is improved in urban centres. Further improvements in overall survival, especially in rural areas, may arise from community engagement in OHCA recognition and optimized healthcare delivery.",

author = "Connolly, {Michael S.} and {Goldstein, PCP}, {Judah P.} and Margaret Currie and Carter, {Alix J.E.} and Doucette, {Steve P.} and Karen Giddens and Allan, {Katherine S.} and Travers, {Andrew H.} and Beau Ahrens and Daniel Rainham and Sapp, {John L.}",

note = "Funding Information: John L.Sapp received research grants from Johnson and Johnson, Abbott; Honoraria from Medtronic Inc, Johnson and Johnson, Abbott, Varian. Andrew H.Travers serves as a Medical Director EHS, Department of Health and Wellness NS. Alix J.E. Carter serves as a Medical Dirctor Research EHS, Department of Health and Wellness NS. Katherine S. Allan has received Honoraria from Zoll. The remaining authors have no conflicts of interest to disclose. Funding Information: This work was funded by a grant from the Maritime Heart Centre Innovation Fund. Funding Information: Paula Kennedy, Megi Nallbani, and Mike Janczyszyn have all been essential members of the research team and have provided helpful feedback, support, and direction. Gratitude is extended to Nova Scotia Health Decision Support for assistance with outcomes datasets. We are grateful to Dr Ian Cameron and Mr. Stephen Boyd for their valuable insights and support for the project. The data for this study were made available through the Nova Scotia Department of Health & Wellness. This work was funded by a grant from the Maritime Heart Centre Innovation Fund. John L.Sapp received research grants from Johnson and Johnson, Abbott; Honoraria from Medtronic Inc, Johnson and Johnson, Abbott, Varian. Andrew H.Travers serves as a Medical Director EHS, Department of Health and Wellness NS. Alix J.E. Carter serves as a Medical Dirctor Research EHS, Department of Health and Wellness NS. Katherine S. Allan has received Honoraria from Zoll. The remaining authors have no conflicts of interest to disclose. Publisher Copyright: {\textcopyright} 2021 The Authors",

year = "2022",

month = apr,

doi = "10.1016/j.cjco.2021.12.010",

language = "English",

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TY - JOUR

T1 - Urban-Rural Differences in Cardiac Arrest Outcomes

T2 - A Retrospective Population-Based Cohort Study

AU - Connolly, Michael S.

AU - Goldstein, PCP, Judah P.

AU - Currie, Margaret

AU - Carter, Alix J.E.

AU - Doucette, Steve P.

AU - Giddens, Karen

AU - Allan, Katherine S.

AU - Travers, Andrew H.

AU - Ahrens, Beau

AU - Rainham, Daniel

AU - Sapp, John L.

N1 - Funding Information: John L.Sapp received research grants from Johnson and Johnson, Abbott; Honoraria from Medtronic Inc, Johnson and Johnson, Abbott, Varian. Andrew H.Travers serves as a Medical Director EHS, Department of Health and Wellness NS. Alix J.E. Carter serves as a Medical Dirctor Research EHS, Department of Health and Wellness NS. Katherine S. Allan has received Honoraria from Zoll. The remaining authors have no conflicts of interest to disclose. Funding Information: This work was funded by a grant from the Maritime Heart Centre Innovation Fund. Funding Information: Paula Kennedy, Megi Nallbani, and Mike Janczyszyn have all been essential members of the research team and have provided helpful feedback, support, and direction. Gratitude is extended to Nova Scotia Health Decision Support for assistance with outcomes datasets. We are grateful to Dr Ian Cameron and Mr. Stephen Boyd for their valuable insights and support for the project. The data for this study were made available through the Nova Scotia Department of Health & Wellness. This work was funded by a grant from the Maritime Heart Centre Innovation Fund. John L.Sapp received research grants from Johnson and Johnson, Abbott; Honoraria from Medtronic Inc, Johnson and Johnson, Abbott, Varian. Andrew H.Travers serves as a Medical Director EHS, Department of Health and Wellness NS. Alix J.E. Carter serves as a Medical Dirctor Research EHS, Department of Health and Wellness NS. Katherine S. Allan has received Honoraria from Zoll. The remaining authors have no conflicts of interest to disclose. Publisher Copyright: © 2021 The Authors

PY - 2022/4

Y1 - 2022/4

N2 - Background: Approximately 10% of people who suffer an out-of-hospital cardiac arrest (OHCA) treated by paramedics survive to hospital discharge. Survival differs by up to 19.2% between urban centres and rural areas. Our goal was to investigate the differences in OHCA survival between urban centres and rural areas. Methods: This was a retrospective cohort study of OHCA patients treated by Nova Scotia Emergency Medical Services (EMS) in 2017. Cases of traumatic, expected, and noncardiac OHCA were excluded. Data were collected from the Emergency Health Service electronic patient care record system and the discharge abstract database. Geographic information system analysis classified cases as being in urban centres (population > 1000 people) or rural areas, using 2016 Canadian Census boundaries. The primary outcome was survival to hospital discharge. Multivariable logistic regression covariates were age, sex, bystander resuscitation, whether the arrest was witnessed, public location, and preceding symptoms. Results: A total of 510 OHCAs treated by Nova Scotia Emergency Medical Services were included for analysis. A total of 12% (n = 62) survived to discharge. Patients with OHCAs in urban centres were 107% more likely to survive than those with OHCAs in rural areas (adjusted odds ratio = 2.1; 95% confidence interval = 1.1 to 3.8; P = 0.028). OHCAs in urban centres had a significantly shorter mean time to defibrillation of shockable rhythm (11.2 minutes ± 6.2) vs those in rural areas (17.5 minutes ± 17.3). Conclusions: Nova Scotia has an urban vs rural disparity in OHCA care that is also seen in densely populated OHCA centres. Survival is improved in urban centres. Further improvements in overall survival, especially in rural areas, may arise from community engagement in OHCA recognition and optimized healthcare delivery.

AB - Background: Approximately 10% of people who suffer an out-of-hospital cardiac arrest (OHCA) treated by paramedics survive to hospital discharge. Survival differs by up to 19.2% between urban centres and rural areas. Our goal was to investigate the differences in OHCA survival between urban centres and rural areas. Methods: This was a retrospective cohort study of OHCA patients treated by Nova Scotia Emergency Medical Services (EMS) in 2017. Cases of traumatic, expected, and noncardiac OHCA were excluded. Data were collected from the Emergency Health Service electronic patient care record system and the discharge abstract database. Geographic information system analysis classified cases as being in urban centres (population > 1000 people) or rural areas, using 2016 Canadian Census boundaries. The primary outcome was survival to hospital discharge. Multivariable logistic regression covariates were age, sex, bystander resuscitation, whether the arrest was witnessed, public location, and preceding symptoms. Results: A total of 510 OHCAs treated by Nova Scotia Emergency Medical Services were included for analysis. A total of 12% (n = 62) survived to discharge. Patients with OHCAs in urban centres were 107% more likely to survive than those with OHCAs in rural areas (adjusted odds ratio = 2.1; 95% confidence interval = 1.1 to 3.8; P = 0.028). OHCAs in urban centres had a significantly shorter mean time to defibrillation of shockable rhythm (11.2 minutes ± 6.2) vs those in rural areas (17.5 minutes ± 17.3). Conclusions: Nova Scotia has an urban vs rural disparity in OHCA care that is also seen in densely populated OHCA centres. Survival is improved in urban centres. Further improvements in overall survival, especially in rural areas, may arise from community engagement in OHCA recognition and optimized healthcare delivery.

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Urban-Rural Differences in Cardiac Arrest Outcomes: A Retrospective Population-Based Cohort Study

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