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Canadian Journal of Cardiology

Linking Data Through the Chain of Survival: The Potential for Better Population-Based Out-of-Hospital Cardiac Arrest Epidemiology, Process of Care, Risk Prediction, and Outcomes

  • Sean van Diepen
    Correspondence
    Corresponding author: Dr Sean van Diepen, 2C2 Cardiology Walter MacKenzie Centre, University of Alberta Hospital, 8440 11 St, Edmonton, Alberta T6G 2B7, Canada. Tel.: +1-587-990-9746.
    Affiliations
    Department of Critical Care Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada

    Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada

    Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
    Search for articles by this author
  • Jacob C. Jentzer
    Affiliations
    Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Published:September 19, 2022DOI:https://doi.org/10.1016/j.cjca.2022.09.012
      Survival after out-of-hospital cardiac arrest (OHCA) is poor, with marked regional variability.
      • Garcia R.A.
      • Girotra S.
      • Jones P.G.
      • et al.
      Variation in out-of-hospital cardiac arrest survival across emergency medical service agencies.
      • Gräsner J.T.
      • Wnent J.
      • Herlitz J.
      • et al.
      Survival after out-of-hospital cardiac arrest in Europe—results of the EuReCa TWO study.
      • Nehme Z.
      • Bernard S.
      • Cameron P.
      • et al.
      Using a cardiac arrest registry to measure the quality of emergency medical service care: decade of findings from the Victorian Ambulance Cardiac Arrest Registry.
      • Zive D.M.
      • Schmicker R.
      • Daya M.
      • et al.
      Survival and variability over time from out of hospital cardiac arrest across large geographically diverse communities participating in the Resuscitation Outcomes Consortium.
      • May T.L.
      • Lary C.W.
      • Riker R.R.
      • et al.
      Variability in functional outcome and treatment practices by treatment center after out-of-hospital cardiac arrest: analysis of International Cardiac Arrest Registry.
      To understand the epidemiology and outcomes of OHCA, several prospective multicentre and multinational OHCA registries have been established, including the Cardiac Arrest Registry to Enhance Survival (CARES), Resuscitation Outcomes Consortium (ROC), European Registry of Cardiac Arrest (EuReCa), Pan-Asian Resuscitation Outcomes Study (PAROS), and International Cardiac Arrest Registry (INTCAR), along with nationwide registries.
      • Jensen T.W.
      • Blomberg S.N.
      • Folke F.
      • et al.
      The National Danish Cardiac Arrest Registry for Out-of-Hospital Cardiac Arrest—a registry in transformation.
      ,
      • Ong M.E.
      • Shin S.D.
      • De Souza N.N.
      • et al.
      Outcomes for out-of-hospital cardiac arrests across 7 countries in Asia: the Pan Asian Resuscitation Outcomes Study (PAROS).
      These efforts have collectively yielded insights into outcome disparities along with survival association with case volume and post-OHCA care.
      • Girotra S.
      • van Diepen S.
      • Nallamothu B.K.
      Regional variation in out-of-hospital cardiac arrest survival in the United States.
      ,
      • van Diepen S.
      • Abella B.S.
      • Bobrow B.J.
      • et al.
      Multistate implementation of guideline-based cardiac resuscitation systems of care: description of the HeartRescue Project.
      In addition, findings gleaned from these registry populations can potentially be generalised to the broader OHCA population, and these networks (eg, ROC) can serve as a platform for performing randomised clinical trials. Despite the strengths, registries can provide an imperfect view of OHCA epidemiology owing to limitations in available data, and they may not include functional status at discharge or other relevant details about neurologic recovery. Participation in most of these registries by individual sites is voluntary, with institutions motivated to contribute patients potentially resulting in differences in outcomes compared with nonparticipating centres. This effect can be mitigated in nationwide registries with linked population outcomes data, which can provide long-term survival data not available in most registries that focus on in-hospital outcomes, but they may offer little information on pre-hospital and hospital-based OHCA care. Every OHCA data set has unique strengths along with limitations that may be partially overcome which individual patient information that can be linked between registries through phases of care. In this issue of the Canadian Journal of Cardiology, Fordyce et al. linked all patients in the British Columbia Cardiac Arrest Registry who experienced a nontraumatic emergency medical services (EMS)–treated OHCA patients from January 2009 to December 2016 to 7 provincial population datasets.
      • Fordyce C.B.
      • Grunau B.E.
      • Guan M.
      • et al.
      Long-term mortality, readmission, and resource utilization among hospital survivors of out-of-hospital cardiac arrest.
      The Cardiac Arrest Registry contains very detailed pre-hospital care data, including time-stamped events, processes of care (eg, bystander cardiopulmonary resuscitation, automated external fibrillation use, medications, shocks), and survival to hospital discharge. The novel linkage to the provincial population health data set facilitates 2 important additions. First, it provides a more comprehensive understanding of each patient’s pre-arrest cardiovascular history and risk factors with the use of data from previous hospitalisations, cardiovascular procedures, physician services, and recent outpatient medications dispensed from pharmacies. Second, among patients who survive to hospital discharge and who are likely to have significant medical needs after a complex inpatient stay and rehabilitation, the linked hospitalisation information, community care data, and vital statistics provide a longitudinal window into the intermediate-term rehospitalisation, nursing home admission, and mortality rates.
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