Changing incidence,of out-of-hospital ventricular fibrillation. 1980-2000
Changing incidence,of out-of-hospital ventricular fibrillation. 1980-2000
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DOI：
10.1001/jama.288.23.3008
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发表时间：
2002-12-18
影响因子：
120.7
通讯作者：
Copass, MK
中科院分区：
文献类型：
--
作者：
Cobb, LA;Fahrenbruch, CE;Copass, MK
背景：来自2个欧洲城市的近期报告以及华盛顿州西雅图的一项早期观察表明，院外心室颤动（VF）患者的治疗数量有所下降。
目的：分析西雅图心脏骤停的发生率，并研究其发生率与性别、种族、年龄以及首次确定的心律之间的关系。
设计、地点和患者：对1979年至2000年特定时间段内西雅图消防部门急救医疗服务提供高级生命支持的所有假定为心脏病因的心脏骤停病例进行基于人群的研究。利用1980年、1990年和2000年西雅图的美国人口普查数据，对年龄和性别进行调整后确定心脏骤停治疗的发生率。
主要观察指标：心脏骤停发生率以及首次记录的心律变化。
结果：从1980年到2000年，以VF作为首次确定心律的心脏骤停调整后年发生率下降了约56%（从每1000人0.85例降至0.38例；相对危险度[RR]为0.44；95%置信区间[CI]为0.37 - 0.53）。黑人（54%；RR为0.45；95%CI为0.26 - 0.79）和白人（53%；RR为0.47；95%CI为0.38 - 0.58）也出现了类似的下降，在男性中最为明显（57%；RR为0.43；95%CI为0.35 - 0.53），男性的基线发生率相对较高。当考虑所有假定为心脏病因的治疗性心脏骤停时，男性的发生率下降了43%（RR为0.58；95%CI为0.49 - 0.67），而女性的下降幅度可忽略不计，女性的VF发生率相对较低且也有所下降，但被更多的心脏停搏或无脉性电活动病例所抵消。
结论：我们观察到西雅图院外VF发生率以及所有假定因心脏病治疗的心脏骤停病例发生率大幅下降。这些变化可能反映了全国冠心病死亡率的下降。
Context Recent reports from 2 European cities and an earlier observation from Seattle, Wash, suggest that the number of patients treated for out-of-hospital ventricular fibrillation (VF) has declined.Objective To analyze the incidence of cardiac arrest and to examine relationships among incidence, sex, race, age, and first identified cardiac rhythm in Seattle.Design, Setting, and Patients Population-based study of all cardiac arrest cases with presumed cardiac etiology who received advanced life support from Seattle Fire Department emergency medical services during specified periods between 1979 and 2000 . United States Census data for Seattle in 1980, 1990, and 2000 were used to determine incidence rates for treated cardiac arrest with adjustments for age and sex.Main Outcome Measures Changes in incidence of cardiac arrest and initial recorded cardiac rhythm.Results The adjusted annual incidence of cardiac arrest with VF as the first identified rhythm decreased by about 56% from 1980 to 2000 (from 0.85 to 0.38 per 1000; relative risk [RR], 0.44; 95% confidence/interval [CI], 0.37-0.53). Similar reductions occurred in blacks (54%; RR, 0.45; 95% Cl, 0.26-0.79) and whites (53%; RR, 0.47; 95% Cl, 0.38-0.58) and was most evident in men (57%; RR, 0.43; 95% Cl, 0.35-0.53), in whom the baseline incidence was relatively high. When all treated arrests with presumed cardiac etiology were considered, that incidence decreased by 43% (RR, 0.58; 95 % Cl, 0.49-0.67) in men but negligibly in women, for whom a relatively low incidence of VF also declined but was offset by more cases with asystole or pulseless electrical activity.Conclusion We observed a major decline in the incidence of out-of-hospital VF and in all cases of treated cardiac arrest presumably due to heart disease in Seattle. These changes likely reflect the national decline in coronary heart disease mortality.