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. 2015 Apr 15;10(4):e0122675.
doi: 10.1371/journal.pone.0122675. eCollection 2015.

The secular trends in the incidence rate and outcomes of out-of-hospital cardiac arrest in Taiwan--a nationwide population-based study

Cheng-Yi Wang  1 , Jen-Yu Wang  1 , Nai-Chi Teng  2 , Ting-Ting Chao  3 , Shu-Ling Tsai  4 , Chi-Liang Chen  5 , Jeng-Yuan Hsu  6 , Chin-Pyng Wu  7 , Chih-Cheng Lai  8 , Likwang Chen  2
Affiliations

The secular trends in the incidence rate and outcomes of out-of-hospital cardiac arrest in Taiwan--a nationwide population-based study

Cheng-Yi Wang et al. PLoS One. .

Abstract

Objective: This study investigated the trends in incidence and mortality of out-of-hospital cardiac arrest (OHCA), as well as factors associated with OHCA outcomes in Taiwan.

Methods: Our study included OHCA patients requiring cardiopulmonary resuscitation (CPR) upon arrival at the hospital. We used national time-series data on annual OHCA incidence rates and mortality rates from 2000 to 2012, and individual demographic and clinical data for all OHCA patients requiring mechanical ventilation (MV) care from March of 2010 to September of 2011. Analytic techniques included the time-series regression and the logistic regression.

Results: There were 117,787 OHCAs in total. The overall incidence rate during the 13 years was 51.1 per 100,000 persons, and the secular trend indicates a sharp increase in the early 2000s and a decrease afterwards. The trend in mortality was also curvilinear, revealing a substantial increase in the early 2000s, a subsequent steep decline and finally a modest increase. Both the 30-day and 180-day mortality rates had a long-term decreasing trend over the period (p<0.01). For both incidence and mortality rates, a significant second-order autoregressive effect emerged. Among OHCA patients with MV, 1-day, 30-day and 180-day mortality rates were 31.3%, 75.8%, and 86.0%, respectively. In this cohort, older age, the female gender, and a Charlson comorbidity index score ≥ 2 were associated with higher 180-day mortality; patients delivered to regional hospitals and those residing in non-metropolitan areas had higher death risk.

Conclusions: Overall, both the 30-day and the 180-day mortality rates after OHCA had a long-term decreasing trend, while the 1-day mortality had no long-term decline. Among OHCA patients requiring MV, those delivered to regional hospitals and those residing in non-metropolitan areas tended to have higher mortality, suggesting a need for effort to further standardize and improve in-hospital care across hospitals and to advance pre-hospital care in non-metropolitan areas.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. The selection process of study subjects with out-of-hospital cardiac arrest requiring cardiopulmonary resuscitation upon arrival.
Fig 2
Fig 2. Selection of study subjects with out-of-hospital cardiac arrest requiring cardiopulmonary resuscitation and mechanical ventilation.
Fig 3
Fig 3. Total numbers of incidents with out-of-hospital cardiac arrest and incident rates, for both genders combined.
Fig 4
Fig 4. Total numbers of incidents with out-of-hospital cardiac arrest and incident rates, for men.
Fig 5
Fig 5. Total numbers of incidents with out-of-hospital cardiac arrest and incident rates, for women.
Fig 6
Fig 6. 1-day mortality rates of out-of-hospital cardiac arrest, for both genders combined and by gender.
Fig 7
Fig 7. 30-day mortality rates of out-of-hospital cardiac arrest, for both genders combined and by gender.
Fig 8
Fig 8. 180-day mortality rates of out-of-hospital cardiac arrest, for both genders combined and by gender.
See this image and copyright information in PMC

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