Saeed Alqahtani1, Ziad Nehme2, Brett Williams3, Stephen Bernard4, Karen Smith5. 1. Department of Paramedicine, Monash University, Frankston, Victoria, Australia; Department of Emergency Medical Care, Prince Sultan Military College of Health Sciences, Al-Dhahran, Saudi Arabia. Electronic address: saeed.alqahtani@monash.edu. 2. Department of Paramedicine, Monash University, Frankston, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Centre for Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia. 3. Department of Paramedicine, Monash University, Frankston, Victoria, Australia. 4. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Centre for Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia; Alfred Hospital, Prahran, Victoria, Australia. 5. Department of Paramedicine, Monash University, Frankston, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Centre for Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia; Discipline of Emergency Medicine, University of Western Australia, Crawley, Western Australia, Australia.
Abstract
AIM: We aimed to assess temporal changes in the incidence of OHCAs of presumed cardiac and non-cardiac aetiologies. METHODS: We conducted a retrospective cohort study of OHCAs in Victoria, Australia between 2000-2017. Annual adjusted incidence rates in presumed cardiac and non-cardiac OHCA were calculated with 95% confidence intervals (95% CI), assuming a Poisson distribution. Annual percent changes in the adjusted rates were calculated from Poisson regression models. RESULTS: During an 18-year period, 90,688 emergency medical service (EMS)-attended OHCAs were included. Of those, 64,422 (71.0%) were of presumed cardiac and 26,266 (29.0%) were of non-cardiac aetiology. Over the 18-year period, there was a 12.6% (95% CI: 10.8%, 14.4%) relative decline in presumed cardiac events and this was driven largely by a reduction in cases with an initial shockable rhythm (23.4%; 95% CI: 19.8%, 27.0%) and cases in patients aged 65-79 years (48.6%; 95% CI: 45.0%, 50.4%). Conversely, there was a 28.8% (95% CI: 27.0%, 32.4%) relative increase in non-cardiac events over the 18-year period, and this was driven by an increase in initial pulseless electrical activity events (93.6%; 95% CI: 86.4%, 100.8%) and cases in patients aged ≥80 years (93.6%; 95% CI: 86.4%, 100.8%). Precipitating events with the largest 18-year increase in incidence were non-traumatic exsanguination (115.2%; 95% CI: 95.4%, 133.2%), respiratory (66.6%; 95% CI: 59.4%, 73.8%), and neurological (63.0%; 95% CI: 50.4%, 77.4%). CONCLUSION: Our data indicates that by 2052, non-cardiac aetiologies could be the leading cause of OHCA in our region. These findings have important EMS-system and public health implications.
AIM: We aimed to assess temporal changes in the incidence of OHCAs of presumed cardiac and non-cardiac aetiologies. METHODS: We conducted a retrospective cohort study of OHCAs in Victoria, Australia between 2000-2017. Annual adjusted incidence rates in presumed cardiac and non-cardiac OHCA were calculated with 95% confidence intervals (95% CI), assuming a Poisson distribution. Annual percent changes in the adjusted rates were calculated from Poisson regression models. RESULTS: During an 18-year period, 90,688 emergency medical service (EMS)-attended OHCAs were included. Of those, 64,422 (71.0%) were of presumed cardiac and 26,266 (29.0%) were of non-cardiac aetiology. Over the 18-year period, there was a 12.6% (95% CI: 10.8%, 14.4%) relative decline in presumed cardiac events and this was driven largely by a reduction in cases with an initial shockable rhythm (23.4%; 95% CI: 19.8%, 27.0%) and cases in patients aged 65-79 years (48.6%; 95% CI: 45.0%, 50.4%). Conversely, there was a 28.8% (95% CI: 27.0%, 32.4%) relative increase in non-cardiac events over the 18-year period, and this was driven by an increase in initial pulseless electrical activity events (93.6%; 95% CI: 86.4%, 100.8%) and cases in patients aged ≥80 years (93.6%; 95% CI: 86.4%, 100.8%). Precipitating events with the largest 18-year increase in incidence were non-traumatic exsanguination (115.2%; 95% CI: 95.4%, 133.2%), respiratory (66.6%; 95% CI: 59.4%, 73.8%), and neurological (63.0%; 95% CI: 50.4%, 77.4%). CONCLUSION: Our data indicates that by 2052, non-cardiac aetiologies could be the leading cause of OHCA in our region. These findings have important EMS-system and public health implications.
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