Characteristics and outcomes in out-of-hospital cardiac arrest

Out-of-hospital cardiac arrest (OHCA) affects around 275.000 people in Europe each year. Although there is often an underlying cardiac cause, OHCA is still the first manifestation of cardiovascular disease in 50% of the victims. OHCA is complex and many factors influence the risk of its occurrence and the chances of surviving it. The studies in this thesis are derived from data of the Amsterdam Resuscitation Studies (ARREST), an ongoing registry of OHCA’s in North-Holland.
Part I of this thesis presents studies on OHCA risk and the importance of early recognition, with a focus on patients with type 2 diabetes (T2D). Chapter 2 presents a study early diabetes-related pathophysiological changes relevant in OHCA risk. In chapter 3 the importance to look beyond ischemic heart disease as cause of OHCA in T2D is discussed. Chapter 4 describes a study investigating temporal variation in OHCA occurrence in patients with and without diabetes. In chapter 5 the outline and design of the Recognition of Sudden Cardiac Arrest Vulnerability in Diabetes project is described.
Part II focuses patient characteristics important in OHCA outcomes. Chapter 6 presents a study on the association between a previous heart disease diagnoses and OHCA survival, as well as possible mechanisms that may underlie this association. Chapters 7 and 8 describe studies on the role of cumulative comorbidity burden in OHCA survival and initial rhythm in men and women. In chapter 9 the influence of individual level socio-economic factors on OHCA survival in men and women is described.