The quality of care and long-term mortality of out of hospital cardiac arrest survivors after acute myocardial infarction: a nationwide cohort study

Abstract

Aims The long-term outcomes of out of hospital cardiac arrest (OHCA) survivors are not well known. Methods and Using the Myocardial Ischaemia National Audit Project (MINAP) registry, linked to Office for National Statistics mortality results data, we analysed 661 326 England, Wales, and Northern Ireland acute myocardial infarction (AMI) patients; 14 127 (2%) suffered OHCA and survived beyond 30 days of hospitalization. Patients dying within 30 days of admission were excluded. Mean follow-up for the patients included was 1500 days. Cox regression models were fitted, adjusting for demographics and management strategy. OHCA survivors were younger (in years) {64 [interquartile range (IQR) 54–72] vs. 70 (IQR 59–80), P < 0.001}, more often underwent invasive coronary angiography (88% vs. 71%, P < 0.001) and percutaneous coronary intervention (72% vs. 45%, P < 0.001). Overall, the risk of mortality for OHCA patients that survived past 30 days was lower than patients that did not suffer cardiac arrest [adjusted hazard ratio (HR) 0.91; 95% CI; 0.87–0.95, P < 0.001]. ‘Excellent care’ according to the mean opportunity-based quality indicator (OBQI) score compared to ‘Poor care’, predicted a reduced risk of long-term mortality post-OHCA for all patients (HR: 0.77, CI; 0.76–0.78, P < 0.001), more for STEMI patients (HR: 0.73, CI; 0.71–0.75, P < 0.001), but less significantly in NSTEMI patients (HR: 0.79, CI; 0.78–0.81, P < 0.001). Conclusion OHCA patients remain at significant risk of mortality in-hospital. However, if surviving over 30 days post-arrest, OHCA survivors have good longer-term survival up to 10 years compared to the general AMI population. Higher-quality inpatient care appears to improve long-term survival in all OHCA patients, more so in STEMI.