Family history of cardiovascular disease and death in patients with out-of-hospital cardiac arrest

Abstract

Aim: How a family history of cardiovascular disease (CVD) or death influences the risk of out-of-hospital cardiac arrest (OHCA) is unknown. This study examined the prevalence of family histories of CVD and death in patients with OHCA and if these factors were associated with OHCA.

Methods: Patients (<70 years) with OHCA's of presumed cardiac origin and available kinship information were identified from the Danish Cardiac Arrest Register (2001-2014). Patients with OHCA were matched 1:4 (age, sex, and number of identifiable parents) with individuals from the background population (controls) to compare family histories (events in first-degree relatives before OHCA) of CVD, all-cause death, cardiovascular death, and premature death (death <60 years). In conditional multivariable logistic regressions, we examined associations between parental history and offspring OHCA risk.

Results: Of 45,293 patients with OHCA 4,994, were eligible for inclusion (median age 50 years at OHCA, 76% male). Of these 47.7% had a family history of CVD (vs. 42.1% of controls), 68.2% of all-cause death (vs. 60.9%), 23% of premature death (vs. 15.8%) and 33.3% of cardiovascular death (vs. 27%) (p < 0.001 for all). A family history of a single parent with CVD (OR: 1.13, 95%CI: 1.05,1.23), all-cause death (OR: 1.42, 95%CI: 1.29,1.56), cardiovascular death (OR: 1.35, 95%CI: 1.24, 1.47), and premature death (OR: 1.45, 95%CI: 1.32,1.59) were all associated with OHCA (p < 0.001 for all).

Conclusion: A family history of CVD and death is more common among patients with OHCA compared to a matched background population, as well as being significantly associated with OHCA.

Keywords: Epidemiology; Family History; Out-of-hospital cardiac arrest.

Fig. 1

Study setup and index dates. Footnotes: First-degree relatives of both cases and the matched background population were identified through kinship registries. For OHCA cases and matched controls, comorbidities were identified 5 years prior to the OHCA/matching date. For first-degree relatives, comorbidities were identified 5 years prior to either the OHCA/matching date or the date of their own death, whichever came first. OHCA: Out-of-hospital cardiac arrest.

Fig. 2

Proportion of patients with out-of-hospital cardiac arrest (OHCA cases) and matched controls with any parental history of premature death stratified by age at OHCA or matching.Premature death was death before the age of 60. OHCA: Out-of-hospital cardiac arrest.

Fig. 3

Proportion of patients with out-of-hospital cardiac arrest (OHCA cases) and matched controls with any sibling history of premature death stratified by age at OHCA or matching. Premature death was death before the age of 60. OHCA: Out-of-hospital cardiac arrest.

Fig. 4

Forest plot depicting conditional multivariable logistic regressions assessing parental history of either cardiovascular disease or death and association to out-of-hospital cardiac arrest in offspring. Footnotes: 0/2 is the reference, meaning that none of the parents were sick/deceased. 1/2 means that one of the parents was deceased/sick and 2/2 means that both were. All analyses were adjusted for comorbidities and the education level of the patients with OHCA or matched controls.