Post-discharge survival following pre-hospital cardiopulmonary arrest due to cardiac aetiology: temporal trends and impact of changes in clinical management

Eur Heart J. 2006 Feb;27(4):406-12. doi: 10.1093/eurheartj/ehi604. Epub 2005 Oct 17.


Aims: To determine whether survival after discharge following pre-hospital cardiopulmonary arrest has improved.

Methods and results: The Heartstart Register was used to identify all 1659 patients discharged alive from Scottish hospitals during 1991-01 following pre-hospital arrest due to cardiac aetiology. The cohort was split into tertiles using year of arrest. A Cox proportional hazards model was used to determine risk of death relative to 1991-93. Patients who survived cardiopulmonary arrest in 1997-01 were less likely to die from any cause (unadjusted HR 0.60, 95% CI 0.48-0.75, P<0.001) or cardiac disease (unadjusted HR 0.50, 95% CI 0.38-0.65, P<0.001). After adjustment for case-mix, there remained significant declines in all-cause (adjusted HR 0.62, 95% CI 0.50-0.78, P<0.001) and cardiac death (adjusted HR 0.52, 95% CI 0.39-0.68, P<0.001). Clinical management had improved, with increased use of thrombolysis (47-63%, chi2 trend, P<0.001), beta-blockers (28-53%, chi2 trend, P<0.001), ACE-inhibitors (48-69%, chi2 trend, P<0.001), and anti-thrombotics (79-88%, chi2 trend, P<001). Adjustment for recorded changes in management attenuated the decline in all-cause death (adjusted HR 0.77, 95% CI 0.60-0.98, P=0.03).

Conclusion: Survival following cardiopulmonary arrest has improved after adjusting for changes in case-mix. Better clinical management has contributed to this improvement.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Cohort Studies
  • Coronary Disease / complications*
  • Coronary Disease / mortality
  • Deinstitutionalization / statistics & numerical data
  • Emergency Medical Services / statistics & numerical data
  • Female
  • Heart Arrest / mortality*
  • Humans
  • Male
  • Middle Aged
  • Mortality / trends
  • Myocardial Revascularization
  • Proportional Hazards Models
  • Registries
  • Retrospective Studies
  • Scotland / epidemiology
  • Socioeconomic Factors
  • Survival Analysis