Resuscitation plus · 2026
Cardiometabolic multimorbidity and survival after out-of-hospital cardiac arrest.
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Li Yue, Shahidah Nur, Pflug David, Zhao Yang, Siddiqui Fahad Javaid, Leong Benjamin Sieu-Hon, Chong Chia Michael Yih, Mao Desmond Renhao, Gan Han Nee, Ng Wei Ming, Doctor Nausheen Edwin, Ong Marcus Eh, Lim Shir Lynn, Singapore PAROS Investigators
Аннотация
OBJECTIVE: Cardiometabolic multimorbidity, defined as the coexistence of ≥2 of heart disease, diabetes, hypertension, stroke, and hyperlipidemia, is increasingly prevalent and may adversely influence outcomes after out-of-hospital cardiac arrest (OHCA). We evaluated the association between cardiometabolic multimorbidity and short-term OHCA outcomes in a national cohort.
METHODS: Using the national OHCA registry, we analyzed adult, non-traumatic OHCAs in Singapore between 2010 and 2021, excluding cases occurring in healthcare facilities or ambulances. Our primary outcome was survival to hospital discharge; secondary outcomes included pre-hospital return of spontaneous circulation (ROSC), survival to hospital admission and discharge with good neurological outcome. Multivariable logistic regression models were used to investigate the associations between cardiometabolic multimorbidity and outcomes, adjusting for prespecified Utstein covariates.
RESULTS: Among 20,475 patients (median age 70 years, 63.7% males), 60.2% had cardiometabolic multimorbidity. It was associated with lower odds of pre-hospital ROSC (adjusted odds ratio [aOR] 0.78, 95% confidence intervals [CI] 0.68-0.88) and survival to hospital discharge (aOR 0.78, 95% CI 0.64-0.96), but not survival to hospital admission (aOR 0.95, 95% CI 0.67-1.05) or discharge with good neurological outcome (aOR 0.90, 95% CI 0.68-1.19). We observed worse outcomes with increasing numbers of cardiometabolic conditions, most evident for pre-hospital ROSC (P for trend ≤ 0.001) and survival to hospital discharge (P for trend = 0.002). Among individual conditions, diabetes showed the strongest adverse associations, with survival to hospital discharge being the outcome most affected for both diabetes and hypertension.
CONCLUSION: In this national OHCA cohort, cardiometabolic multimorbidity independently predicted lower pre-hospital ROSC and survival to hospital discharge, with a graded decline in outcomes with increasing disease burden. These findings underscore the importance of upstream prevention of cardiometabolic disease to improve both OHCA incidence and survival.
METHODS: Using the national OHCA registry, we analyzed adult, non-traumatic OHCAs in Singapore between 2010 and 2021, excluding cases occurring in healthcare facilities or ambulances. Our primary outcome was survival to hospital discharge; secondary outcomes included pre-hospital return of spontaneous circulation (ROSC), survival to hospital admission and discharge with good neurological outcome. Multivariable logistic regression models were used to investigate the associations between cardiometabolic multimorbidity and outcomes, adjusting for prespecified Utstein covariates.
RESULTS: Among 20,475 patients (median age 70 years, 63.7% males), 60.2% had cardiometabolic multimorbidity. It was associated with lower odds of pre-hospital ROSC (adjusted odds ratio [aOR] 0.78, 95% confidence intervals [CI] 0.68-0.88) and survival to hospital discharge (aOR 0.78, 95% CI 0.64-0.96), but not survival to hospital admission (aOR 0.95, 95% CI 0.67-1.05) or discharge with good neurological outcome (aOR 0.90, 95% CI 0.68-1.19). We observed worse outcomes with increasing numbers of cardiometabolic conditions, most evident for pre-hospital ROSC (P for trend ≤ 0.001) and survival to hospital discharge (P for trend = 0.002). Among individual conditions, diabetes showed the strongest adverse associations, with survival to hospital discharge being the outcome most affected for both diabetes and hypertension.
CONCLUSION: In this national OHCA cohort, cardiometabolic multimorbidity independently predicted lower pre-hospital ROSC and survival to hospital discharge, with a graded decline in outcomes with increasing disease burden. These findings underscore the importance of upstream prevention of cardiometabolic disease to improve both OHCA incidence and survival.