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Impact of age on long-term survival and quality of life following out-of-hospital cardiac arrest*

Bunch, T. Jared MD; White, Roger D. MD; Khan, Akbar H. MD; Packer, Douglas L. MD

doi: 10.1097/01.CCM.0000119421.73520.B6
CLINICAL INVESTIGATIONS
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Objective Early defibrillation programs have improved long-term outcomes following out-of-hospital cardiac arrest from ventricular fibrillation. Although long-term collective quality of life and survival are favorable, there are subsets of these patients who may be predisposed to worse outcomes. In particular, elderly patients may present with more comorbid medical conditions affecting their outcome. However, the impact of age on mortality rate and quality of life after rapid defibrillation is unknown.

Design Observational study.

Setting Hospital.

Subjects All patients with an out-of-hospital cardiac arrest between November 1990 and January 2001 who received rapid defibrillation for ventricular fibrillation in Olmsted County, Minnesota. All patients received treatment at one hospital.

Interventions Long-term outcome and quality of life were followed. Survival was estimated using the Kaplan-Meier method. The quality of life was established by an SF-36 survey.

Measurements and Main Results Two hundred patients presented in ventricular fibrillation out-of-hospital cardiac arrest; of these, 138 (69%) survived to hospital admission, seven (4%) died in the emergency department, and 79 (39%) were discharged neurologically intact. The average age was 62 ± 16 yrs, with 51% (n = 40) of the population ≥65. The average length of follow-up was 4.8 ± 3.0 yrs. The 5-yr survival in patients <65 was 94% (confidence interval, 86–100%) and 66% (confidence interval, 52–84%) in patients ≥65 (p < .001). The observed survival in the younger group was not different from that expected in a U.S. age- and gender-matched population. However, in the older group, the expected survival was significantly lower compared with an age- and gender-matched U.S. population (p = .01) but similar to an age-, gender-, and disease-matched cohort of patients from Olmsted County not experiencing an arrest. In both age-dependent cohort populations, the quality of life scores crossed the norm in all categories with exception of vitality in patients >65 yrs old (42.6 ± 7.2). In direct comparison between the two patient groups, the older cohort reported lower levels of physical functioning (p = .002), role-emotional score (p = .03), and role-physical score (p = .007). Other SF-36 scores were not different between the groups. Sixty-five percent of patients <65 yrs returned to work compared with 56% of older patients.

Conclusions The survival rate for ventricular fibrillation out-of-hospital cardiac arrest is significantly improved by the presence of a rapid defibrillation program. In patients <65 yrs old, long-term survival is equal to that of normal individuals and quality of life is similar to the general population. The survival, although high, in older patients is less than that in age-matched healthy controls, and physical and emotional quality of life scores are decreased.

From the Department of Internal Medicine (TJB, AHK), Department of Anesthesiology (RDW), and Department of Internal Medicine, Mayo Clinic, Rochester, MN.

The ventricular fibrillation out-of-hospital cardiac arrest survival rate is significantly improved by the presence of a rapid defibrillation program.

© 2004 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins