Urban-Rural Differences in Cardiac Arrest Outcomes: A Retrospective Population-Based Cohort Study

被引：17

作者：

Connolly, Michael S. ^{[1
]}

Goldstein, Judah P. ^{[2
,3
,4
]}

Currie, Margaret ^{[1
]}

Carter, Alix J. E. ^{[2
,3
,4
]}

Doucette, Steve P. ^{[5
]}

Giddens, Karen ^{[5
]}

Allan, Katherine S. ^{[6
]}

Travers, Andrew H. ^{[2
,3
,4
]}

Ahrens, Beau ^{[7
]}

Rainham, Daniel ^{[8
]}

Sapp, John L. ^{[1
,4
]}

机构：

[1] Dalhousie Univ, Dept Med, Halifax, NS, Canada

[2] Dalhousie Univ, Div EMS, Dept Emergency Med, Halifax, NS, Canada

[3] EHS Nova Scotia, Halifax, NS, Canada

[4] Nova Scotia Hlth, Halifax, NS, Canada

[5] Dalhousie Univ, Dept Community Hlth & Epidemiol, Halifax, NS, Canada

[6] St Michaels Hosp, Div Cardiol, Halifax, NS, Canada

[7] Dalhousie Univ, Interdisciplinary PhD Program, Halifax, NS, Canada

[8] Dalhousie Univ, Sch Hlth & Human Performance, Halifax, NS, Canada

来源：

CJC OPEN | 2022年 / 4卷 / 04期

关键词：

SURVIVAL; RESUSCITATION; CARE; ASSOCIATION; DENSITY;

D O I：

10.1016/j.cjco.2021.12.010

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: Approximately 10% of people who suffer an out-of-hospital cardiac arrest (OHCA) treated by paramedics survive to hospital discharge. Survival differs by up to 19.2% between urban centres and rural areas. Our goal was to investigate the differences in OHCA survival between urban centres and rural areas. Methods: This was a retrospective cohort study of OHCA patients treated by Nova Scotia Emergency Medical Services (EMS) in 2017. Cases of traumatic, expected, and noncardiac OHCA were excluded. Data were collected from the Emergency Health Service electronic patient care record system and the discharge abstract database. Geographic information system analysis classified cases as being in urban centres (population > 1000 people) or rural areas, using 2016 Canadian Census boundaries. The primary outcome was survival to hospital discharge. Multivariable logistic regression covariates were age, sex, bystander resuscitation, whether the arrest was witnessed, public location, and preceding symptoms. Results: A total of 510 OHCAs treated by Nova Scotia Emergency Medical Services were included for analysis. A total of 12% (n = 62) survived to discharge. Patients with OHCAs in urban centres were 107% more likely to survive than those with OHCAs in rural areas (adjusted odds ratio = 2.1; 95% confidence interval = 1.1 to 3.8; P = 0.028). OHCAs in urban centres had a significantly shorter mean time to defibrillation of shockable rhythm (11.2 minutes +/- 6.2) vs those in rural areas (17.5 minutes +/- 17.3). Conclusions: Nova Scotia has an urban vs rural disparity in OHCA care that is also seen in densely populated OHCA centres. Survival is improved in urban centres. Further improvements in overall survival, especially in rural areas, may arise from community engagement in OHCA recognition and optimized healthcare delivery.

引用

页码：383 / 389

页数：7