Differences in health care utilization prior to cardiac arrest by shockable and non-shockable presenting rhythms: a case control study.

Abstract

Health care utilization has been shown to increase prior to out-of-hospital cardiac arrest (OHCA). However, differences between OHCA presenting with shockable and non-shockable rhythms have not been explored. We examined differences in health care utilization prior to OHCA among patients with shockable and non-shockable rhythms. This was a matched case-control study. Cardiac arrests from 2009 to 2019 were identified in the British Columbia (BC) Cardiac Arrest Registry. Age, sex and geographic population-matched controls were identified. Primary outcomes were hospital admissions or emergency department (ED) visits 3 years prior to arrest. Secondary outcomes included cardiovascular (CV) and non-CV encounters. A total of 3461 shockable and 11,470 non-shockable OHCA patients were matched 4:1 to controls. Hospitalization or ED visit in the 3 years prior was 61.2% in the shockable group (48.8% in controls, OR 1.74, 95% CI 1.60-1.88) and 74.8% in the non-shockable group (50.6% in controls, OR 3.13, 95% CI 2.99-3.29). All health care encounters (hospitalization, ED or outpatient visits) were more common in both shockable and non-shockable cardiac arrests, with a higher rate of CV encounters. Non-shockable cardiac arrests had higher relative rates of non-CV encounters. Biweekly rates of hospital and emergency visits leading up to OHCA were increased for both groups, rising at 6-24 weeks prior to arrest. Shockable and non-shockable OHCA show high rates of health care utilization prior to cardiac arrest. However, there were important differences in health care utilization between the shockable and non-shockable groups.