Opportunities to prevent sudden out-of-hospital death due to coronary heart disease in a community

• Published in: Resuscitation 2003, Vol.56 (1), p.55-58
• Main Authors: Wu, Lambert A, Kottke, Thomas E, Brekke, Lee N, Brekke, Mark J, Grill, Diane E, Goraya, Tauqir Y, Roger, Veronique L, Belau, Paul G, White, Roger D
• Format: Article
• Language: English
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Automated external defibrillator; Biological and medical sciences; Cardiac arrest; Cardiology. Vascular system; Cause of Death; Coronary Disease - mortality; Coronary heart disease; Death, Sudden, Cardiac - prevention & control; Desbrilhação automática externa; Desfibrilador automático externo; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Heart; Humans; Intensive care medicine; Medical Records; Medical sciences; Minnesota; Morte súbita cardı́aca; Muerte súbita de orı́gen cardı́aco; Out-of-hospital CPR; Paragem cardı́aca; Paro cardı́aco; RCP pré-hospitalar; Reanimación cardiopulmonar (RCP) extrahospitalaria; Sudden cardiac death
• ISSN: 0300-9572; 1873-1570
• DOI: 10.1016/S0300-9572(02)00295-2

Background: Intervening successfully to reduce the burden of sudden out-of-hospital death due to coronary heart disease (OHCD) requires knowledge of where these deaths occur and whether they are observed by bystanders. Methods: To establish the proportion of OHCDs that were witnessed and where they occurred, we reviewed the coroner's notes and medical records of a previously-described sample of OHCD cases among residents of Olmsted County, Minnesota. This cohort ( n=113) consisted of a 10% random sample of all Olmsted County residents who died out-of-hospital between 1981 and 1994 and whose deaths were attributed to coronary heart disease. Results: Excluding deaths in nursing homes ( n=27), 71 (83%) of the deaths occurred in private homes and 15 (17%) occurred in public places. The event was not witnessed in 59% of deaths occurring in private homes and in 20% of deaths occurring in public places. The presence or absence of a bystander could not be established for 10% of deaths in private homes and 7% of deaths in public areas. Conclusions: A significant proportion of OHCDs occur in private homes and are not witnessed. Prevention of unwitnessed deaths will require programs that result in primary prevention and/or calls to first responders at the time of impending cardiac arrest. Tese: Para intervir com sucesso na redução do peso de mortes súbitas pré-hospitalares por doença cardı́aca coronária (OHCD) é necessário saber onde ocorrem e se são testemunhadas. Métodos: Para determinar a proporção de OHCDs que são testemunhadas e onde ocorrem, revimos as notas do delegado de saúde e os registos médicos duma amostra previamente descrita de casos de OHCDs em residentes de Olmsted County, Minnesota. Esta coorte ( n=113) consistia numa amostra aleatória de 10% de todos os residentes em Olmsted County que morreram fora do hospital entre 1981 e 1994 e cujas mortes foram atribuı́das a doença coronária. Resultados: Excluı́ndo as mortes em lares de enfermagem ( n=27), 71 (83%) das mortes ocorreram em casas particulares e 15 (17%) ocorreram em locais públicos. O evento não foi testemunhado em 59% das mortes que ocorreram em casas particulares e em 20% das que ocorreram em locais públicos. Não pode ser estabelecida a presença ou ausência de uma testemunha em 10% das mortes em casas particulares e 7% das mortes em locais públicos. Conclusões: Uma proporção significativa de OHCDs ocorrem em casas particulares e não é testemunhada. A prevenção de mortes não testemunhadas reque