The contribution of comorbidity and medication use to poor outcome from out-of-hospital cardiac arrest at home locations

Introduction: Out-of-hospital cardiac arrest (OHCA) at home is associated with lower rates of shockable initial rhythm and survival than OHCA in a public location. We determined whether medical history and medication use explain the association between OHCA location and presence of shockable initial rhythm and survival rate. Methods: Data from ARREST, an OHCA registry in the Netherlands, were used (January 2009-December 2012). We assessed if OHCA location remained associated with a) presence of shockable initial rhythm and b) survival when taking medical history, medication use, resuscitation characteristics and demographics into account in a multivariable regression analysis. The relative contributions of the above mentioned variables to variance in both outcome measures was estimated using the Nagelkerke test. Results: We included 1404 patients (1034 [73.6%] home OHCA, 370 [26.4%] public OHCA). OHCA location remained significantly associated with shockable initial rhythm (home 42.7%, public 78.1%; P < 0.01) and survival to hospital discharge (home 14.0%, public 45.7%; P < 0.01). Adding resuscitation characteristics to models of shockable initial rhythm and survival rate resulted in an increase in explained variance (13.0%-23.6%), whereas adding medical history or medication use to these models resulted in only a limited increase in explained variance (medical history to 27.6%, medication use to 30.0%). Conclusions: Comorbidity and medication use do not substantially contribute in explaining the poor outcome from out-of-hospital cardiac arrest occurring at home. Even when adjusted for medical history, medication use, resuscitation characteristics, and demographics, a large gap of unexplained variance in shockable initial rhythm and survival remains.