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CLINICAL STUDIES

In-hospital versus out-of-hospital presentation of life-threatening ventricular arrhythmias predicts survival

Results from the AVID registry

Andrew E. Epstein, MD, FACC^a, Judy Powell, RN^*, Qing Yao, PhD^*, Celeste Ocampo, RN, Scott Lancaster, MS^a, Yves Rosenberg, MD, MPH, David S. Cannom, MD, FACC, John M. Herre, MD, FACC^||, H. Leon Greene, MD, FACC^* the AVID Investigators^**

^a Division of Cardiovascular Disease, Department of Medicine, the University of Alabama at Birmingham, Birmingham, Alabama, USA
^* Department of Biostatistics, the University of Washington, Seattle, Washington, USA
Department of Cardiology, the University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
Los Angeles Cardiology Associates, Los Angeles, California, USA
^|| Cardiology Consultants, Norfolk, Virginia, USA

Manuscript received November 10, 1998; revised manuscript received April 22, 1999, accepted June 10, 1999.

Reprint requests and correspondence: AVID CTC, 1107 NE 45th Street, Room 505, Seattle, Washington, 98105-4689
avidctc{at}u.washington.edu

OBJECTIVES

This study describes the outcomes of patients from the Antiarrhythmics Versus Implantable Defibrillators (AVID) Study Registry to determine how the location of ventricular arrhythmia presentation influences survival.

BACKGROUND

Most studies of cardiac arrest report outcome following out-of-hospital resuscitation. In contrast, there are minimal data on long-term outcome following in-hospital cardiac arrest.

METHODS

The AVID Study was a multicenter, randomized comparison of drug and defibrillator strategies to treat life-threatening ventricular arrhythmias. A Registry was maintained of all patients with sustained ventricular arrhythmias at each study site. The present study includes patients who had AVID-eligible arrhythmias, both randomized and not randomized. Patients with in-hospital and out-of-hospital presentations are compared. Data on long-term mortality were obtained through the National Death Index.

RESULTS

The unadjusted mortality rates at one- and two-year follow-ups were 23% and 31.1% for patients with in-hospital presentations, and 10.5% and 16.8% for those with out-of-hospital presentations (p < 0.001), respectively. The adjusted mortality rates at one- and two-year follow-ups were 14.8% and 20.9% for patients with in-hospital presentations, and 8.4% and 14.1% for those with out-of-hospital presentations (p < 0.001), respectively. The adjusted long-term relative risk for in-hospital versus out-of-hospital presentation was 1.6 (95% confidence interval [CI] 1.3–1.9).

CONCLUSIONS

Compared with patients with out-of-hospital presentations of life-threatening ventricular arrhythmias not due to a reversible cause, patients with in-hospital presentations have a worse long-term prognosis. Because location of ventricular arrhythmia presentation is an independent predictor of long-term outcome, it should be considered as an element of risk stratification and when planning clinical trials.

Abbreviations and Acronyms   AVID Study = Antiarrhythmics Versus Implantable Defibrillators Study   ICD = implantable cardioverter-defibrillator   VF = ventricular fibrillation   VT = ventricular tachycardia

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