J Korean Med Sci.  2015 Oct;30(10):1396-1404. 10.3346/jkms.2015.30.10.1396.

Presumed Regional Incidence Rate of Out-of-Hospital Cardiac Arrest in Korea

• Ro YS
• Hwang SS
• Shin SD
• Han D
• Kang S
• Song KJ
• Cho SI

• KMID: 2344171
• DOI: http://doi.org/10.3346/jkms.2015.30.10.1396

Abstract

The regional incidence rates of out-of-hospital cardiac arrest (OHCA) were traditionally calculated with the residential population as the denominator. The aim of this study was to estimate the true incidence rate of OHCA and to investigate characteristics of regions with overestimated and underestimated OHCA incidence rates. We used the national OHCA database from 2006 to 2010. The nighttime residential and daytime transient populations were investigated from the 2010 Census. The daytime population was calculated by adding the daytime influx of population to, and subtracting the daytime outflow from, the nighttime residential population. Conventional age-standardized incidence rates (CASRs) and daytime corrected age-standardized incidence rates (DASRs) for OHCA per 100,000 person-years were calculated in each county. A total of 97,291 OHCAs were eligible. The age-standardized incidence rates of OHCAs per 100,000 person-years were 34.6 (95% CI: 34.3-35.0) in the daytime and 24.8 (95% CI: 24.5-25.1) in the nighttime among males, and 14.9 (95% CI: 14.7-15.1) in the daytime, and 10.4 (95% CI: 10.2-10.6) in the nighttime among females. The difference between the CASR and DASR ranged from 35.4 to -11.6 in males and from 6.1 to -1.0 in females. Through the Bland-Altman plot analysis, we found the difference between the CASR and DASR increased as the average CASR and DASR increased as well as with the larger daytime transient population. The conventional incidence rate was overestimated in counties with many OHCA cases and in metropolitan cities with large daytime population influx and nighttime outflow, while it was underestimated in residential counties around metropolitan cities.

Keyword

Out-of-Hospital Cardiac Arrest; Incidence; Epidemiology

MeSH Terms

Age Factors
Aged
Aged, 80 and over
Female
Geography
Humans
Incidence
Male
Middle Aged
Out-of-Hospital Cardiac Arrest/*epidemiology
Republic of Korea/epidemiology
Seasons
Survival Rate
Time Factors

Figure

• 

  Fig. 1 Time distribution of out-of-hospital cardiac arrest. OHCA, out-of-hospital cardiac arrest.

• 

  Fig. 2 Bland-Altman plots of conventional age-standardized rates and daytime corrected age-standardized rates by gender. CASR, conventional age-standardized rate per 100,000 person-years; DASR, daytime corrected age-standardized rate per 100,000 person-years.

• 

  Fig. 3 Scatter plots of the D index and the difference between the conventional age-standardized rates and daytime corrected age-standardized rates. D index = daytime population/nighttime residential population *100.

• 

  Fig. 4 Geographical maps of conventional age-standardized rates and daytime corrected age-standardized rates by gender. CASR, conventional age-standardized rate per 100,000 person-years; DASR, daytime corrected age-standardized rate per 100,000 person-years.

Reference

1. Soo L, Huff N, Gray D, Hampton JR. Geographical distribution of cardiac arrest in Nottinghamshire. Resuscitation. 2001; 48:137–147.

2. Berdowski J, Berg RA, Tijssen JG, Koster RW. Global incidences of out-of-hospital cardiac arrest and survival rates: Systematic review of 67 prospective studies. Resuscitation. 2010; 81:1479–1487.

3. Nichol G, Thomas E, Callaway CW, Hedges J, Powell JL, Aufderheide TP, Rea T, Lowe R, Brown T, Dreyer J, et al. Regional variation in out-of-hospital cardiac arrest incidence and outcome. JAMA. 2008; 300:1423–1431.

4. Galea S, Blaney S, Nandi A, Silverman R, Vlahov D, Foltin G, Kusick M, Tunik M, Richmond N. Resuscitation Outcomes Consortium Investigators. Explaining racial disparities in incidence of and survival from out-of-hospital cardiac arrest. Am J Epidemiol. 2007; 166:534–543.

5. Brooks SC, Schmicker RH, Rea TD, Aufderheide TP, Davis DP, Morrison LJ, Sahni R, Sears GK, Griffiths DE, Sopko G, et al. ROC Investigators. Out-of-hospital cardiac arrest frequency and survival: evidence for temporal variability. Resuscitation. 2010; 81:175–181.

6. Willich SN, Goldberg RJ, Maclure M, Perriello L, Muller JE. Increased onset of sudden cardiac death in the first three hours after awakening. Am J Cardiol. 1992; 70:65–68.

7. Thakur RK, Hoffmann RG, Olson DW, Joshi R, Tresch DD, Aufderheide TP, Ip JH. Circadian variation in sudden cardiac death: effects of age, sex, and initial cardiac rhythm. Ann Emerg Med. 1996; 27:29–34.

8. Ong ME, Earnest A, Shahidah N, Ng WM, Foo C, Nott DJ. Spatial variation and geographic-demographic determinants of out-of-hospital cardiac arrests in the city-state of Singapore. Ann Emerg Med. 2011; 58:343–351.

9. Yasunaga H, Miyata H, Horiguchi H, Tanabe S, Akahane M, Ogawa T, Koike S, Imamura T. Population density, call-response interval, and survival of out-of-hospital cardiac arrest. Int J Health Geogr. 2011; 10:26.

10. Lerner EB, Fairbanks RJ, Shah MN. Identification of out-of-hospital cardiac arrest clusters using a geographic information system. Acad Emerg Med. 2005; 12:81–84.

11. Sasson C, Keirns CC, Smith D, Sayre M, Macy M, Meurer W, McNally BF, Kellermann AL, Iwashyna TJ. CARES (Cardiac Arrest Registry to Enhance Survival) Study Group. Small area variations in out-of-hospital cardiac arrest: does the neighborhood matter? Ann Intern Med. 2010; 153:19–22.

12. Sasson C, Cudnik MT, Nassel A, Semple H, Magid DJ, Sayre M, Keseg D, Haukoos JS, Warden CR. Columbus Study Group. Identifying high-risk geographic areas for cardiac arrest using three methods for cluster analysis. Acad Emerg Med. 2012; 19:139–146.

13. Strömsöe A, Svensson L, Claesson A, Lindkvist J, Lundström A, Herlitz J. Association between population density and reported incidence, characteristics and outcome after out-of-hospital cardiac arrest in Sweden. Resuscitation. 2011; 82:1307–1313.

14. Peberdy MA, Ornato JP, Larkin GL, Braithwaite RS, Kashner TM, Carey SM, Meaney PA, Cen L, Nadkarni VM, Praestgaard AH, et al. National Registry of Cardiopulmonary Resuscitation Investigators. Survival from in-hospital cardiac arrest during nights and weekends. JAMA. 2008; 299:785–792.

15. Iwami T, Hiraide A, Nakanishi N, Hayashi Y, Nishiuchi T, Uejima T, Morita H, Shigemoto T, Ikeuchi H, Matsusaka M, et al. Outcome and characteristics of out-of-hospital cardiac arrest according to location of arrest: A report from a large-scale, population-based study in Osaka, Japan. Resuscitation. 2006; 69:221–228.

16. Ro YS, Shin SD, Song KJ, Lee EJ, Kim JY, Ahn KO, Chung SP, Kim YT, Hong SO, Choi JA, et al. A trend in epidemiology and outcomes of out-of-hospital cardiac arrest by urbanization level: a nationwide observational study from 2006 to 2010 in South Korea. Resuscitation. 2013; 84:547–557.

17. Na SH, Shin SD, Ro YS, Lee EJ, Song KJ, Park CB, Kim JY. Specific activity types at the time of event and outcomes of out-of-hospital cardiac arrest: a nationwide observational study. J Korean Med Sci. 2013; 28:320–327.

18. Kim TH, Shin SD, Kim YJ, Kim CH, Kim JE. The scene time interval and basic life support termination of resuscitation rule in adult out-of-hospital cardiac arrest. J Korean Med Sci. 2015; 30:104–109.

19. Ro YS, Shin SD, Song KJ, Park CB, Lee EJ, Ahn KO, Cho SI. A comparison of outcomes of out-of-hospital cardiac arrest with non-cardiac etiology between emergency departments with low- and high-resuscitation case volume. Resuscitation. 2012; 83:855–861.

20. Jacobs I, Nadkarni V, Bahr J, Berg RA, Billi JE, Bossaert L, Cassan P, Coovadia A, D'Este K, Finn J, et al. International Liaison Committee on Resuscitation. American Heart Association. European Resuscitation Council. Australian Resuscitation Council. New Zealand Resuscitation Council. Heart and Stroke Foundation of Canada. InterAmerican Heart Foundation. Resuscitation Councils of Southern Africa. ILCOR Task Force on Cardiac Arrest and Cardiopulmonary Resuscitation Outcomes. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Councils of Southern Africa). Circulation. 2004; 110:3385–3397.

21. Deo R, Albert CM. Epidemiology and genetics of sudden cardiac death. Circulation. 2012; 125:620–637.

22. Empana JP, Sauval P, Ducimetiere P, Tafflet M, Carli P, Jouven X. Increase in out-of-hospital cardiac arrest attended by the medical mobile intensive care units, but not myocardial infarction, during the 2003 heat wave in Paris, France. Crit Care Med. 2009; 37:3079–3084.

23. Arntz HR, Willich SN, Schreiber C, Brüggemann T, Stern R, Schultheiss HP. Diurnal, weekly and seasonal variation of sudden death. Population-based analysis of 24,061 consecutive cases. Eur Heart J. 2000; 21:315–320.

24. Caffrey SL, Willoughby PJ, Pepe PE, Becker LB. Public use of automated external defibrillators. N Engl J Med. 2002; 347:1242–1247.

25. Valenzuela TD, Roe DJ, Nichol G, Clark LL, Spaite DW, Hardman RG. Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos. N Engl J Med. 2000; 343:1206–1209.

26. Hallstrom AP, Ornato JP, Weisfeldt M, Travers A, Christenson J, McBurnie MA, Zalenski R, Becker LB, Schron EB, Proschan M, et al. Public Access Defibrillation Trial Investigators. Public-access defibrillation and survival after out-of-hospital cardiac arrest. N Engl J Med. 2004; 351:637–646.

27. Eisenberg MS, Mengert TJ. Cardiac resuscitation. N Engl J Med. 2001; 344:1304–1313.

28. Norris RM. UK Heart Attack Study Collaborative Group. Circumstances of out of hospital cardiac arrest in patients with ischaemic heart disease. Heart. 2005; 91:1537–1540.

29. Semple HM, Cudnik MT, Sayre M, Keseg D, Warden CR, Sasson C. Columbus Study Group. Identification of high-risk communities for unattended out-of-hospital cardiac arrests using GIS. J Community Health. 2013; 38:277–284.