Contacts With the Health Care System Before Out-of-Hospital Cardiac Arrest

Abstract

Background It remains challenging to identify patients at risk of out-of-hospital cardiac arrest (OHCA). We aimed to examine health care contacts in patients before OHCA compared with the general population that did not experience an OHCA. Methods and Results Patients with OHCA with a presumed cardiac cause were identified from the Danish Cardiac Arrest Registry (2001-2014) and their health care contacts (general practitioner [GP]/hospital) were examined up to 1 year before OHCA. In a case-control study (1:9), OHCA contacts were compared with an age- and sex-matched background population. Separately, patients with OHCA were examined by the contact type (GP/hospital/both/no contact) within 2 weeks before OHCA. We included 28 955 patients with OHCA. The weekly percentages of patient contacts with GP the year before OHCA were constant (25%) until 1 week before OHCA when they markedly increased (42%). Weekly percentages of patient contacts with hospitals the year before OHCA gradually increased during the last 6 months (3.5%-6.6%), peaking at the second week (6.8%) before OHCA; mostly attributable to cardiovascular diseases (21%). In comparison, there were fewer weekly contacts among controls with 13% for GP and 2% for hospital contacts (P<0.001). Within 2 weeks before OHCA, 57.8% of patients with OHCA had a health care contact, and these patients had more contacts with GP (odds ratio [OR], 3.17; 95% CI, 3.09-3.26) and hospital (OR, 2.32; 95% CI, 2.21-2.43) compared with controls. Conclusions The health care contacts of patients with OHCA nearly doubled leading up to the OHCA event, with more than half of patients having health care contacts within 2 weeks before arrest. This could have implications for future preventive strategies.

Keywords: ESCAPE‐NET; general practitioner; health care contact; hospital; out‐of‐hospital cardiac arrest.

Figure 1. Flowchart.

The patient selection process of the study population from the period of June 1, 2001, to December 31, 2014. GP indicates general practitioner; and OHCA, out‐of‐hospital cardiac arrest.

Figure 2. Health care contacts within 1 year before OHCA.

The weekly percentages of health care contacts within 1 year before OHCA compared with an age‐, sex‐, and index date–matched control population divided by (A) contacts to GP and (B) contacts to hospital. Number of cases=28 955; number of controls=260 595. GP indicates general practitioner; and OHCA, out‐of‐hospital cardiac arrest.

Figure 3. Hospital contacts within 1 year before OHCA divided by (A) outpatient clinic contacts and (B) ED contacts and hospital admissions.

The weekly percentages of hospital contacts are divided into (A) outpatient contacts; (B) emergency department (ED) contacts and hospital admissions within 1 year before OHCA compared with an age‐, sex‐, and index date–matched control population. Number of cases=28 955; Number of controls=260 595. OHCA indicates out‐of‐hospital cardiac arrest.

Figure 4. Types of GP contacts within 2 weeks before OHCA.

The types of GP contacts within 2 weeks before OHCA. “Other” includes laboratory exams, other examinations such as blood pressure measurements and ECGs or vaccination. The total exceeds 100% because patients could have >1 contact within the 2 weeks before OHCA. Number of patients=15 671. GP indicates general practitioner; and OHCA, out‐of‐hospital cardiac arrest.

Figure 5. The main discharge diagnosis within 2 weeks before OHCA.

The main discharge diagnosis following a hospital contact within 2 weeks before OHCA compared with an age‐, sex‐, and index date–matched control population. A, Number of cases=3495. B, Number of controls=9583. Arrythmias indicates cardiac arrhythmia; CHF, congestive heart failure; COLD, chronic obstructive lung disease; and IHD, ischemic heart disease.