Aims: To determine whether survival after discharge following pre- hospital cardiopulmonary arrest has improved. Methods and results: The Heartstart Register was used to identify all 1659 patients discharged alive from Scottish hospitals during 1991- 01 following pre- hospital arrest due to cardiac aetiology. The cohort was split into tertiles using year of arrest. A Cox proportional hazards model was used to determine risk of death relative to 1991- 93. Patients who survived cardiopulmonary arrest in 1997- 01 were less likely to die from any cause(unadjusted HR 0.60, 95% CI 0.48- 0.75, P< 0.001) or cardiac disease(unadjusted HR 0.50, 95% CI 0.38- 0.65, P< 0.001). After adjustment for case- mix, there remained significant declines in all- cause(adjusted HR 0.62, 95% CI 0.50- 0.78, P< 0.001) and cardiac death(adjusted HR 0.52, 95% CI 0.39- 0.68, P< 0.001). Clinical management had improved,with increased use of thrombolysis(47- 63% , χ 2 trend, P< 0.001), beta- blockers(28- 53% , χ 2 trend, P< 0.001), ACE- inhibitors(48- 69% , χ 2 trend, P< 0.001), and anti- thrombotics(79- 88% , χ 2 trend, P< 001). Adjustment for recorded changes in management attenuated the decline in all- cause death(adjusted HR 0.77, 95% CI 0.60- 0.98, P=0.03). Conclusion: Survival following cardiopulmonary arrest has improved after adjusting for changes in case- mix. Better clinical management has contributed to this improvement.
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