Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Dec 28:32:100672.
doi: 10.1016/j.lanwpc.2022.100672. eCollection 2023 Mar.

Long term survival and disease burden from out-of-hospital cardiac arrest in Singapore: a population-based cohort study

Andrew Fu Wah Ho  1   2   3   4 , Mervyn Jun Rui Lim  5 , Arul Earnest  6   7 , Audrey Blewer  8   9   10 , Nicholas Graves  11 , Jun Wei Yeo  12 , Pin Pin Pek  2 , Ling Tiah  13 , Marcus Eng Hock Ong  1   11 ; Singapore PAROS Investigators
Collaborators, Affiliations

Long term survival and disease burden from out-of-hospital cardiac arrest in Singapore: a population-based cohort study

Andrew Fu Wah Ho et al. Lancet Reg Health West Pac. .

Abstract

Background: Understanding the long-term outcomes and disability-adjusted life years (DALY) after out-of-hospital cardiac arrest (OHCA) is important to understand the overall health and disease burden of OHCA respectively, but data in Asia remains limited. We aimed to quantify long-term survival and the annual disease burden of OHCA within a national multi-ethnic Asian cohort.

Methods: We conducted an open cohort study linking the Singapore Pan-Asian Resuscitation Outcomes Study (PAROS) and the Singapore Registry of Births and Deaths from 2010 to 2019. We performed Cox regression, constructed Kaplan-Meier curves, and calculated DALYs and standardised mortality ratios (SMR) for each year of follow-up.

Results: We analysed 802 cases. The mean age was 56.0 (SD 17.8). Most were male (631 cases, 78,7%) and of Chinese ethnicity (552 cases, 68.8%). At one year, the SMR was 14.9 (95% CI:12.5-17.8), decreasing to 1.2 (95% CI:0.7-1.8) at three years, and 0.4 (95% CI:0.2-0.8) at five years. Age at arrest (HR:1.03, 95% CI:1.02-1.04, p < 0.001), shockable presenting rhythm (HR:0.75, 95% CI:0.52-0.93, p = 0.015) and CPC category (HR:4.62, 95% CI:3.17-6.75, p < 0.001) were independently associated with mortality. Annual DALYs due to OHCA varied from 304.1 in 2010 to 849.7 in 2015, then 547.1 in 2018. Mean DALYs decreased from 12.162 in 2010 to 3.599 in 2018.

Conclusions: OHCA survivors had an increased mortality rate for the first three years which subsequently normalised compared to that of the general population. Annual OHCA disease burden in DALY trended downwards from 2010 to 2018. Improved surveillance and OHCA treatment strategies may improve long-term survivorship and decrease its global burden.

Funding: National Medical Research Council, Singapore, under the Clinician Scientist Award (NMRC/CSA-SI/0014/2017) and the Singapore Translational Research Investigator Award (MOH-000982-01).

Keywords: Cardiac arrest; Disease burden; Long-term survival; Mortality; Out-of-hospital cardiac arrest.

PubMed Disclaimer

Conflict of interest statement

MEH Ong reports funding from the Zoll Medical Corporation for a study involving mechanical cardiopulmonary resuscitation devices; grants from the 10.13039/501100004102Laerdal Foundation, Laerdal Medical, and Ramsey Social Justice Foundation for funding of the Pan-Asian Resuscitation Outcomes Study; an advisory relationship with Global Healthcare SG, a commercial entity that manufactures cooling devices; and funding from Laerdal Medical on an observation program to their Community CPR Training Centre Research Program in Norway. PP Pek reports previous accommodation for participation in Research Masterclass Laerdal. A Blewer reports previous involvement with the National Heart, Lung, and Blood Institute and Eunice Kennedy Shriver National Institute of Child Health and Human Development and Laerdal Foundation.

Figures

Fig. 1
Fig. 1
Overall survival of out-of-hospital cardiac arrest patients in Singapore, in total (A), by shockable rhythm (B), and by Cerebral Performance Category (C).
Fig. 2
Fig. 2
Yearly standardised mortality ratios (95% confidence interval) of out-of-hospital cardiac arrest patients in relation to the standard Singapore population in 2019.
Supplementary Fig. S1
Supplementary Fig. S1
See this image and copyright information in PMC

References

    1. Myat A., Song K.J., Rea T. Out-of-hospital cardiac arrest: current concepts. Lancet. 2018;391(10124):970–979. - PubMed
    1. Yan S., Gan Y., Jiang N., et al. The global survival rate among adult out-of-hospital cardiac arrest patients who received cardiopulmonary resuscitation: a systematic review and meta-analysis. Crit Care. 2020;24(1):61. - PMC - PubMed
    1. Empana J.P., Lerner I., Valentin E., et al. Incidence of sudden cardiac death in the European union. J Am Coll Cardiol. 2022;79(18):1818–1827. - PubMed
    1. Lim S.L., Smith K., Dyson K., et al. Incidence and outcomes of out-of-hospital cardiac arrest in Singapore and Victoria: a collaborative study. J Am Heart Assoc. 2020;9(21) - PMC - PubMed
    1. Berdowski J., Berg R.A., Tijssen J.G., Koster R.W. Global incidences of out-of-hospital cardiac arrest and survival rates: systematic review of 67 prospective studies. Resuscitation. 2010;81(11):1479–1487. - PubMed