Combined patient information is helping connect the dots to improve survival rates even three years after a cardiac arrest.
When Buffalo Bills player Damar Hamlin fell to the ground after a tackle during an NFL football game, it seemed inconceivable that the athletic 24-year-old suffered a cardiac arrest. Hamlin is one of around 400,000 North Americans affected by cardiac arrests that happen outside of a hospital setting each year. While Hamlin later received treatment for his condition and recovered, too many others do not survive.
“In B.C., we previously had little information about how pre- and in-hospital factors affect the long-term survival of patients, as well as whether they are readmitted to hospital or access health care services, such as residential or home care,” says Vancouver Coastal Health Research Institute researcher Dr. Christopher Fordyce.
“This significant information gap makes it hard to know what improvements to cardiac care provision may be needed.”
Fordyce’s study, published in the Canadian Journal of Cardiology, is the first to provide longitudinal information on the complete journey of cardiac arrest patients.
Also known as sudden cardiac arrest, the condition occurs when a person’s heart stops beating, causing a loss of blood flow to the brain and other organs. This emergency situation requires immediate medical attention.
In British Columbia, the survival to hospital discharge rate of cardiac arrest is only 15 per cent. However, Fordyce’s research is helping to explain how actions taken before and after a patient is admitted to hospital can have a lasting impact on their short- and long-term health and survival.
Cardiopulmonary resuscitation can save a life now and into the future
Fordyce and his team drew from the BC Cardiac Arrest Registry, which accounts for around 75 to 80 per cent of patients treated at major health care centres in the province between 2009 and 2016, including detailed information on pre-hospital patient care and patient survival outcomes.
They combined this data with administrative data from other medical sources in collaboration with Population Data BC to create a randomized registry that can be applied to future studies.
“The combined resource we established in this study represents one of the most complete and detailed longitudinal data sets in North America for out-of-hospital cardiac arrest.”
Fordyce’ study included 10,188 adult out-of-hospital cardiac arrest patients, 3,230 (31.7 per cent) of whom survived to hospital admission and 1,325 (13 per cent) of whom survived to hospital discharge.
Notably, Fordyce and his team found that the sooner cardiopulmonary resuscitation (CPR) was provided to a cardiac arrest patient by a bystander, family member, friend or paramedic, the better the long-term patient outcomes.
“Every minute makes a difference,” says Fordyce. “In the prehospital setting, we found that someone who received CPR from a bystander or paramedic following their cardiac arrest was around 35 to 40 per cent more likely to survive even three years after being discharged from hospital than someone who did not.”
“This research enabled us to make linkages in care provision and outcomes that were not possible beforehand.”
Hospital readmission and death within three years were also significantly reduced when one of two in-hospital procedures were given to patients. Those who received either revascularization — a procedure used to widen coronary arteries to increase blood flow through the heart — or an implantable cardioverter-defibrillator — a device that regulates heartbeats — had around a 50 per cent less chance of death three years after their cardiac arrest.
Fordyce and his team also found that only one in four patients who left the hospital required residential or home care within a year after hospital discharge.
“This is good news,” says Fordyce. “It means that 75 per cent of people who leave hospital are likely doing well enough that they do not require post-hospital home care, implying generally good functional outcomes if patients can survive to hospital discharge.”
The results from Fordyce’s study are only a starting point, he notes. “With this information, we can begin to inform efforts to improve care processes and increase survival to hospital discharge.”
The process the team used to create the linked cardiac arrest registry has potential to be implemented in the study of other diseases, as well.
“We have shown that it is possible to generate valuable research from our methods,” says Fordyce. “The dream now is to fund the uploading of data to a registry like this in a timely fashion and on an ongoing basis to conduct further research and to continuously improve patient care.”
For more information on cardiac arrest care and research, visit bcresurect.med.ubc.ca.