Takashi Tagami1, Hiroki Matsui2, Saori Ishinokami3, Masao Oyanagi3, Akiko Kitahashi3, Reo Fukuda3, Kyoko Unemoto3, Kiyohide Fushimi4, Hideo Yasunaga2. 1. Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Japan; Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Japan. Electronic address: t-tagami@nms.ac.jp. 2. Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Japan. 3. Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Japan. 4. Department of Health Informatics and Policy, Tokyo Medical and Dental University, Graduate School of Medicine, Japan.
Abstract
BACKGROUND: We evaluated the association between nifekalant or amiodarone on hospital admission and in-hospital mortality for cardiac arrest patients with persistent ventricular fibrillation on hospital arrival. METHODS: This was a retrospective cohort study using the Japanese Diagnosis Procedure Combination inpatient database. We identified 2961 patients who suffered cardiogenic out-of-hospital cardiac arrest and who had ventricular fibrillation on hospital arrival between July 2007 and March 2013. Patients were categorized into amiodarone (n=2353) and nifekalant (n=608) groups, from which 525 propensity score-matched pairs were generated. RESULTS: We found a significant difference in the admission rate between the nifekalant and amiodarone groups in propensity score-matched groups (75.6% vs. 69.3%, respectively; difference, 6.3%; 95% confidence interval (CI), 0.9-11.7). An analysis using the hospital nifekalant/amiodarone rate as an instrumental variable found that receiving nifekalant was associated with an improved admission rate (22.2%, 95% CI, 11.9-32.4). We found no significant difference in in-hospital mortality between the nifekalant and amiodarone groups (81.5% vs. 82.1%, respectively; difference, -0.6%; 95% CI, -5.2 to 4.1). Instrumental variable analysis showed that receiving nifekalant was not associated with reduced in-hospital mortality (6.2%, 95% CI, -2.4 to 14.8). CONCLUSIONS: This nationwide study suggested no significant in-hospital mortality association between nifekalant and amiodarone for cardiogenic out-of-hospital cardiac arrest patients with ventricular fibrillation/persistent ventricular tachycardia on hospital arrival. Although nifekalant may potentially improve hospital admission rates compared with amiodarone for these patients, further studies are required to confirm our results. Copyright Â
BACKGROUND: We evaluated the association between nifekalant or amiodarone on hospital admission and in-hospital mortality for cardiac arrestpatients with persistent ventricular fibrillation on hospital arrival. METHODS: This was a retrospective cohort study using the Japanese Diagnosis Procedure Combination inpatient database. We identified 2961 patients who suffered cardiogenic out-of-hospital cardiac arrest and who had ventricular fibrillation on hospital arrival between July 2007 and March 2013. Patients were categorized into amiodarone (n=2353) and nifekalant (n=608) groups, from which 525 propensity score-matched pairs were generated. RESULTS: We found a significant difference in the admission rate between the nifekalant and amiodarone groups in propensity score-matched groups (75.6% vs. 69.3%, respectively; difference, 6.3%; 95% confidence interval (CI), 0.9-11.7). An analysis using the hospital nifekalant/amiodarone rate as an instrumental variable found that receiving nifekalant was associated with an improved admission rate (22.2%, 95% CI, 11.9-32.4). We found no significant difference in in-hospital mortality between the nifekalant and amiodarone groups (81.5% vs. 82.1%, respectively; difference, -0.6%; 95% CI, -5.2 to 4.1). Instrumental variable analysis showed that receiving nifekalant was not associated with reduced in-hospital mortality (6.2%, 95% CI, -2.4 to 14.8). CONCLUSIONS: This nationwide study suggested no significant in-hospital mortality association between nifekalant and amiodarone for cardiogenic out-of-hospital cardiac arrestpatients with ventricular fibrillation/persistent ventricular tachycardia on hospital arrival. Although nifekalant may potentially improve hospital admission rates compared with amiodarone for these patients, further studies are required to confirm our results. Copyright Â