The Impact of Emergency Interventions and Patient Characteristics on the Risk of Heart Failure in Patients with Nontraumatic OHCA

الملخص EN

Background.

Since out-of-hospital cardiac arrest- (OHCA-) related dysfunction (ischemic/reperfusion injury and inflammatory response) might result in long-term impairment, we suspect that new-onset heart failure might be common in long-term survivors.

However, these relationships had not been well addressed, and we aimed to analyze the impact of emergency interventions and patient characteristics on the risk of new-onset heart failure in patients with nontraumatic OHCA.

Methods.

The Taiwanese government healthcare database contains data for 49,101 nontraumatic OHCA adult patients from 2011-2012, which were analyzed in this study.

Nontraumatic OHCA patients who survived to the intensive care unit (ICU) were included as the study group (n = 7,321).

Matched patients (n = 21,963) were recruited as a comparison group.

Patients with any history of heart failure or cardiac arrest were not included in either group.

All patients were followed-up for 6 months for the identification of new-onset heart failure.

Adjustments were made for demographics, age, emergency interventions, and comorbidities as potential risk factors.

Results.

In all, 3.84% (n = 281) of OHCA patients suffered new-onset heart failure, while only 1.24% (n = 272) of matched patients in the comparison group suffered new-onset heart failure.

Strong risk factors for heart failure were age (60–75 years, HR: 11.4; 95% CI: 9–14.4), medical history (myocardial infarction, HR: 2.47; 95% CI: 2.05–2.98 and cardiomyopathy, HR: 2.94; 95% CI: 1.45–5.94), and comorbidities during hospitalization (ischemic heart disease, HR: 4.5; 95% CI: 3.46–5.86).

Only extracorporeal membrane oxygenation (ECMO) decreased the risk of heart failure.

Most (53.6%) heart failure events occurred within 60 days after OHCA.

Conclusion.

An age from 61 to 75 years, a history of myocardial infarction or cardiomyopathy, and ischemic heart disease or infection as comorbidities occurring during hospitalization were strong risk factors for new-onset heart failure in OHCA patients.

However, ECMO could decrease this risk.

More importantly, most heart failure events occurred within 60 days after OHCA.