Reduced pre-hospital and in-hospital survival rates after out-of-hospital cardiac arrest of patients with type-2 diabetes mellitus: an observational prospective community-based study

Europace. 2015 May;17(5):753-60. doi: 10.1093/europace/euv014. Epub 2015 Mar 8.

Abstract

Aims: Out-of-hospital cardiac arrest (OHCA) remains a major cause of death. We aimed to determine whether type-2 diabetes mellitus (T2DM) is associated with reduced pre-hospital and in-hospital survival rates after OHCA.

Methods and results: An observational community-based cohort study was performed among 1549 OHCA patients with ECG-documented ventricular tachycardia/ventricular fibrillation (VT/VF). We compared pre-hospital and in-hospital survival rates between T2DM patients and non-diabetic patients. Analyses among T2DM patients were stratified according to current T2DM treatment, used as proxy for T2DM severity. Proportions of neurologically intact survival were analysed. Pre-hospital survival rates were lower in T2DM patients (n = 275) than in non-diabetic patients (n = 1274); 48.7 vs. 55.8% (univariate P = 0.032). Type-2 diabetes mellitus was associated with lower pre-hospital survival [OR 0.75 (0.58-0.98); after evaluation of the risk factors, we found no relevant confounding]. Patients treated with insulin only had lower pre-hospital survival rates than patients treated with oral glucose-lowering drugs only (37.3 vs. 53.3%, univariate P = 0.034), partially explained by location of OHCA and EMS response time [ORadj 0.62 (0.33-1.17)]. In-hospital survival rates were also lower in T2DM patients (n = 134) than in non-diabetic patients (n = 711); 40.3 vs. 57.7%, univariate P < 0.001. In those patients whose cause of OHCA was retrieved (n = 771), T2DM was significantly associated with lower in-hospital survival [ORadj 0.57 (0.37-0.87)]. Neurologically intact status at discharge was similarly high among T2DM and non-diabetic patients (94.4 vs. 94.6%, P = 0.954).

Conclusion: T2DM is associated with lower pre-hospital and in-hospital survival rates after OHCA. Neurologically intact status at hospital discharge is high both among T2DM and non-diabetic patients.

Keywords: Diabetes mellitus; Epidemiology; Out-of-hospital cardiac arrest; Sudden cardiac arrest; Survival; Ventricular fibrillation.

Publication types

  • Comparative Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Diabetes Mellitus, Type 2 / diagnosis
  • Diabetes Mellitus, Type 2 / drug therapy
  • Diabetes Mellitus, Type 2 / mortality*
  • Diabetes Mellitus, Type 2 / physiopathology
  • Electrocardiography
  • Emergency Medical Services*
  • Female
  • Hospital Mortality*
  • Humans
  • Hypoglycemic Agents / therapeutic use
  • Male
  • Middle Aged
  • Nervous System / physiopathology
  • Out-of-Hospital Cardiac Arrest / diagnosis
  • Out-of-Hospital Cardiac Arrest / mortality*
  • Out-of-Hospital Cardiac Arrest / physiopathology
  • Out-of-Hospital Cardiac Arrest / therapy
  • Patient Discharge
  • Predictive Value of Tests
  • Prognosis
  • Prospective Studies
  • Registries
  • Risk Factors
  • Severity of Illness Index
  • Survival Rate
  • Tachycardia, Ventricular / diagnosis
  • Tachycardia, Ventricular / mortality*
  • Tachycardia, Ventricular / physiopathology
  • Tachycardia, Ventricular / therapy
  • Ventricular Fibrillation / diagnosis
  • Ventricular Fibrillation / mortality*
  • Ventricular Fibrillation / physiopathology
  • Ventricular Fibrillation / therapy

Substances

  • Hypoglycemic Agents