Out-of-hospital cardiac arrest in the 1990's: a population-based study in the Maastricht area on incidence, characteristics and survival

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J Am Coll Cardiol, 1997; 30:1500-1505
© 1997 by the American College of Cardiology Foundation

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Out-of-hospital cardiac arrest in the 1990's: a population-based study in the Maastricht area on incidence, characteristics and survival

JJ de Vreede-Swagemakers, AP Gorgels, WI Dubois-Arbouw, JW van Ree, MJ Daemen, LG Houben, and HJ Wellens

Department of Cardiology, University of Limburg, Maastricht, The Netherlands.

OBJECTIVES: We sought to describe the incidence, characteristics and survival of out-of-hospital sudden cardiac arrest (SCA) in the Maastricht area of The Netherlands. BACKGROUND: Incidence and survival rates of out-of-hospital SCA in different communities are often based on the number of victims resuscitated by the emergency medical services. Our population-based study in the Maastricht area allows information on all victims of witnessed and unwitnessed SCA occurring outside the hospital. METHODS: Incidence, patient characteristics and survival rates were determined by prospectively collecting information on all cases of SCA occurring in the age group 20 to 75 years between January 1, 1991 and December 31, 1994. Survival rates were related to the site of the event (at home vs. outside the home) and the presence or absence of a witness and rhythm at the time of the resuscitation attempt in out-of-hospital SCA. RESULTS: Five hundred fifteen patients were included (72% men, 28% women). In 44% of men and 53% of women, SCA was most likely the first manifestation of heart disease. In patients known to have had a previous myocardial infarction (MI), the mean interval between the MI and SCA was 6.5 years, with >50% having a left ventricular ejection fraction >30%. The mean yearly incidence of SCA was 1 in 1,000 inhabitants. Of all deaths in the age groups studied, 18.5% were sudden. Nearly 80% of SCAs occurred at home. In 60% of all cases of SCA a witness was present. Cardiac resuscitation, which was attempted in 51% of all subjects, resulted overall in 32 (6%) of 515 patients being discharged alive from the hospital. Survival rates for witnessed SCA were 8% (16 of 208 subjects) at home and 18% (15 of 85 subjects) outside the home (95% confidence interval 1% to 18.8%). CONCLUSIONS: The majority of victims of SCA cannot be identified before the event. Sudden cardiac arrest usually occurs at home, and the survival of those with a witnessed SCA at home was low compared with that outside the home, indicating the necessity of optimizing out-of-hospital resuscitation, especially in the at-home situation.

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				S. S. Chugh, K. Reinier, and E. C. Stecker Learning From a Real-World Analysis of Implantable Cardioverter-Defibrillator Recipients: Comorbidities Matter J. Am. Coll. Cardiol., June 26, 2007; 49(25): 2416 - 2418. [Full Text] [PDF]

				J.-P. Empana, P. Duciemetiere, B. Balkau, and X. Jouven Contribution of the metabolic syndrome to sudden death risk in asymptomatic men: the Paris Prospective Study I Eur. Heart J., May 1, 2007; 28(9): 1149 - 1154. [Abstract] [Full Text] [PDF]

				K. S. Kaikkonen, M.-L. Kortelainen, E. Linna, and H. V. Huikuri Family History and the Risk of Sudden Cardiac Death as a Manifestation of an Acute Coronary Event Circulation, October 3, 2006; 114(14): 1462 - 1467. [Abstract] [Full Text] [PDF]

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				Developed in Collaboration With the European Heart, D. P. Zipes, A. J. Camm, M. Borggrefe, A. E. Buxton, B. Chaitman, M. Fromer, G. Gregoratos, G. Klein, A. J. Moss, et al. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death--Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) J. Am. Coll. Cardiol., September 5, 2006; 48(5): 1064 - 1108. [Full Text] [PDF]

				D. P. Zipes, D. P. Zipes, A. J. Camm, M. Borggrefe, A. E. Buxton, B. Chaitman, M. Fromer, G. Gregoratos, G. Klein, A. J. Moss, et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death--executive summary: A report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Eur. Heart J., September 1, 2006; 27(17): 2099 - 2140. [Full Text] [PDF]

				Writing Committee Members, D. P. Zipes, A. J. Camm, M. Borggrefe, A. E. Buxton, B. Chaitman, M. Fromer, G. Gregoratos, G. Klein, A. J. Moss, et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: A report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society Europace, September 1, 2006; 8(9): 746 - 837. [Full Text] [PDF]

				K M Nielsen, O Faergeman, M L Larsen, and A Foldspang Danish singles have a twofold risk of acute coronary syndrome: data from a cohort of 138 290 persons. J. Epidemiol. Community Health, August 1, 2006; 60(8): 721 - 728. [Abstract] [Full Text] [PDF]

				B S Rana, J I Davies, M M Band, S D Pringle, A Morris, and A D Struthers B-type natriuretic peptide can detect silent myocardial ischaemia in asymptomatic type 2 diabetes Heart, July 1, 2006; 92(7): 916 - 920. [Abstract] [Full Text] [PDF]

				M. Holzer, M. Mullner, F. Sterz, O. Robak, A. Kliegel, H. Losert, G. Sodeck, T. Uray, A. Zeiner, and A. N. Laggner Efficacy and Safety of Endovascular Cooling After Cardiac Arrest: Cohort Study and Bayesian Approach Stroke, July 1, 2006; 37(7): 1792 - 1797. [Abstract] [Full Text] [PDF]

				E. Vanoli and P. B. Adamson What does the future hold for the management of chronic heart failure? Eur. Heart J. Suppl., June 1, 2006; 8(suppl_C): C51 - C57. [Abstract] [Full Text] [PDF]

				E. C. Stecker, C. Vickers, J. Waltz, C. Socoteanu, B. T. John, R. Mariani, J. H. McAnulty, K. Gunson, J. Jui, and S. S. Chugh Population-Based Analysis of Sudden Cardiac Death With and Without Left Ventricular Systolic Dysfunction: Two-Year Findings from the Oregon Sudden Unexpected Death Study J. Am. Coll. Cardiol., March 21, 2006; 47(6): 1161 - 1166. [Abstract] [Full Text] [PDF]

				M J Moore, B M Glover, C J McCann, N A Cromie, P Ferguson, D C Catney, F Kee, and A A J Adgey Demographic and temporal trends in out of hospital sudden cardiac death in Belfast Heart, March 1, 2006; 92(3): 311 - 315. [Abstract] [Full Text] [PDF]

				Z. Goldberger and R. Lampert Implantable Cardioverter-Defibrillators: Expanding Indications and Technologies JAMA, February 15, 2006; 295(7): 809 - 818. [Abstract] [Full Text] [PDF]

				C. R. Bezzina, W. Shimizu, P. Yang, T. T. Koopmann, M. W.T. Tanck, Y. Miyamoto, S. Kamakura, D. M. Roden, and A. A.M. Wilde Common Sodium Channel Promoter Haplotype in Asian Subjects Underlies Variability in Cardiac Conduction Circulation, January 24, 2006; 113(3): 338 - 344. [Abstract] [Full Text] [PDF]

				R M Norris and on behalf of the UK Heart Attack Study (UKHAS) Col Circumstances of out of hospital cardiac arrest in patients with ischaemic heart disease Heart, December 1, 2005; 91(12): 1537 - 1540. [Abstract] [Full Text] [PDF]

				X. Jouven, R. N. Lemaitre, T. D. Rea, N. Sotoodehnia, J.-P. Empana, and D. S. Siscovick Diabetes, glucose level, and risk of sudden cardiac death Eur. Heart J., October 2, 2005; 26(20): 2142 - 2147. [Abstract] [Full Text] [PDF]

				A. A. El-Menyar The Resuscitation Outcome: Revisit the Story of the Stony Heart Chest, October 1, 2005; 128(4): 2835 - 2846. [Abstract] [Full Text] [PDF]

				S. M.J.M. Straus, M. C.J.M. Sturkenboom, G. S. Bleumink, J. P. Dieleman, J. v. d. Lei, P. A. d. Graeff, J. H. Kingma, and B. H.Ch. Stricker Non-cardiac QTc-prolonging drugs and the risk of sudden cardiac death Eur. Heart J., October 1, 2005; 26(19): 2007 - 2012. [Abstract] [Full Text] [PDF]

				I. Laurent, C. Adrie, C. Vinsonneau, A. Cariou, J.-D. Chiche, A. Ohanessian, C. Spaulding, P. Carli, J.-F. Dhainaut, and M. Monchi High-Volume Hemofiltration After Out-of-Hospital Cardiac Arrest: A Randomized Study J. Am. Coll. Cardiol., August 2, 2005; 46(3): 432 - 437. [Abstract] [Full Text] [PDF]

				G. Thorgeirsson, G. Thorgeirsson, H. Sigvaldason, and J. Witteman Risk factors for out-of-hospital cardiac arrest: the Reykjavik Study Eur. Heart J., August 1, 2005; 26(15): 1499 - 1505. [Abstract] [Full Text] [PDF]

				A. E. Buxton, A. J. Moss, A. E. Buxton, and A. J. Moss Should everyone with an ejection fraction less than or equal to 30% receive an implantable cardioverter-defibrillator? Circulation, May 17, 2005; 111(19): 2537 - 2549. [Full Text] [PDF]

				X. Jouven, J.-P. Empana, P. J. Schwartz, M. Desnos, D. Courbon, and P. Ducimetiere Heart-Rate Profile during Exercise as a Predictor of Sudden Death N. Engl. J. Med., May 12, 2005; 352(19): 1951 - 1958. [Abstract] [Full Text] [PDF]