In-hospital mortality in 13,263 survivors of out-of-hospital cardiac arrest in Canada Calum Redpath, MB ChB, PhD, a Christie Sambell, BSc, b Ian Stiell, MD, c Helen Johansen, PhD, b Kathryn Williams, MS, a Rafeeq Samie, MD, a Martin Green, MD, a Michael Gollob, MD, a Robert Lemery, MD, a and David Birnie, BSc, MB ChB, MD a Ontario, Canada Background There is a substantial mortality rate in patients admitted alive after out-of-hospital cardiac arrest. The primary objective of our study was to examine trends in in-hospital survival in out-of-hospital cardiac arrest survivors in Canada between 1994 and 2004. The secondary objective was to examine predictors of in-hospital survival in these patients. Methods Data on hospital admissions from April 1, 1994, to March 31, 2004, were obtained from the Health Person- oriented Information Database, maintained by Statistics Canada. We included all patients with a primary diagnosis of cardiac arrest who survived to hospital admission. We assessed survival to hospital discharge in all patients admitted alive. Results In Canada, 13,263 patients survived community arrest between 1994 and 2004. The annual incidence of hospital admission after out-of-hospital cardiac arrest decreased by 33%, from 5.37 per 100,000 in 1994 to 3.63 per 100,000 in 2004 (P b .0001 for trend). Subsequently, 5,045 patients (38.03%) survived to hospital discharge. The survival rate did not change during the duration of the study. Invasive coronary artery disease management was associated with a greatly increased chance of survival (odds ratio 21.98, 95% CI 17.62-27.42). Also male gender, heart failure, and acute myocardial ischemia were independent positive predictors of survival to hospital discharge; greater age and comorbidities were negative predictors of survival. Finally, there were significant interprovincial variations in survival rates. Conclusions Our study, the largest of its kind, has 4 main findings. Firstly, between 1993 and 2004, there was a significant and steady decline in admission rates after community cardiac arrest. Second, there was no change in the in- hospital survival rates. Thirdly, invasive management of coronary artery disease was associated with a greatly improved chance of survival, and finally, there were important regional variations in survival rates. (Am Heart J 2010;159:577-583.e1.) It is estimated that between 236,063 and 325,007 North Americans per year have an out-of-hospital cardiac arrest (OHCA). 1 The reported survival to hospital discharge is highly variable 2,3 ; in a Canadian study of 5,638 patients, the survival rate was 5.1%. 4 Historically, most research on OHCA has focused on improving the rate of return of spontaneous circulation and significant progress has been made. 5-18 However, many interventions improve return of spontaneous circulation without improving long-term survival. 19 Emerging evidence suggests that optimized in- hospital post cardiac arrest care improves mortality and functional outcome. 19 Recently, in recognition of these issues, an international consensus statement defined “the post cardiac arrest syndrome” and highlighted a list of critical knowledge gaps related to post cardiac arrest care. 19 These include longitudinal epidemiologic data on post cardiac arrest outcomes. There is a paucity of studies that focus on in- hospital outcomes of OHCA survivors. 17,20 Hence, the primary objective of our study was to examine trends in- hospital mortality in OHCA survivors in Canada between 1994 and 2004. Another identified knowledge gap was predictors of in-hospital survival in these patients, 19 and the second objective of our study was to examine these. Methods Design and setting Data on hospital admissions (April 1, 1994, to March 31, 2004) were obtained from the Health Person-oriented Information Database, 21,22 maintained by Statistics Canada. The database tracks patients from admission until death-in-hospital or final discharge (including transfers between acute care hospitals). For each patient, one primary diagnosis and up to 16 secondary From the a University of Ottawa Heart Institute, Ottawa, Ontario, Canada, b Statistics Canada, and c Department of Emergency Medicine, University of Ottawa. Submitted July 4, 2009; accepted December 14, 2009. Reprint requests: David H. Birnie, BSc, MB ChB, MD, University of Ottawa Heart Institute, 40 Ruskin Road, Ottawa, Ontario, Canada K1Y 4W7. E-mail: dbirnie@ottawaheart.ca 0002-8703/$ - see front matter © 2010, Mosby, Inc. All rights reserved. doi:10.1016/j.ahj.2009.12.030