Article

Essential Features of Designating Out-of-Hospital Cardiac Arrest as a Reportable Event: A Scientific Statement From the American Heart Association Emergency Cardiovascular Care Committee; Council on Cardiopulmonary, Perioperative, and Critical Care; Council on Cardiovascular Nursing; Council on Clinical Cardiology; and Quality of Care and Outcomes Research Interdisciplinary Working Group

University of Washington, USA.
Circulation (Impact Factor: 14.43). 05/2008; 117(17):2299-308. DOI: 10.1161/CIRCULATIONAHA.107.189472
Source: PubMed
ABSTRACT
The 2010 impact goal of the American Heart Association is to reduce death rates from heart disease and stroke by 25% and to lower the prevalence of the leading risk factors by the same proportion. Much of the burden of acute heart disease is initially experienced out of hospital and can be reduced by timely delivery of effective prehospital emergency care. Many patients with an acute myocardial infarction die from cardiac arrest before they reach the hospital. A small proportion of those with cardiac arrest who reach the hospital survive to discharge. Current health surveillance systems cannot determine the burden of acute cardiovascular illness in the prehospital setting nor make progress toward reducing that burden without improved surveillance mechanisms. Accordingly, the goals of this article provide a brief overview of strategies for managing out-of-hospital cardiac arrest. We review existing surveillance systems for monitoring progress in reducing the burden of out-of-hospital cardiac arrest in the United States and make recommendations for filling significant gaps in these systems, including the following: 1. Out-of-hospital cardiac arrests and their outcomes through hospital discharge should be classified as reportable events as part of a heart disease and stroke surveillance system. 2. Data collected on patients' encounters with emergency medical services systems should include descriptions of the performance of cardiopulmonary resuscitation by bystanders and defibrillation by lay responders. 3. National annual reports on key indicators of progress in managing acute cardiovascular events in the out-of-hospital setting should be developed and made publicly available. Potential barriers to action on cardiac arrest include concerns about privacy, methodological challenges, and costs associated with designating cardiac arrest as a reportable event.

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Available from: Robert E O'Connor
Myron L. Weisfeldt
Hong, Robert E. O'Connor, Vincent N. Mosesso, Robert A. Berg, Barbara ''Bobbi'' Leeper and
Graham Nichol, John Rumsfeld, Brian Eigel, Benjamin S. Abella, Darwin Labarthe, Yuling
Outcomes Research Interdisciplinary Working Group
on Cardiovascular Nursing; Council on Clinical Cardiology; and Quality of Care and
Care Committee; Council on Cardiopulmonary, Perioperative, and Critical Care; Council
A Scientific Statement From the American Heart Association Emergency Cardiovascular
Essential Features of Designating Out-of-Hospital Cardiac Arrest as a Reportable Event :
Print ISSN: 0009-7322. Online ISSN: 1524-4539
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is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231Circulation
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Essential Features of Designating Out-of-Hospital Cardiac
Arrest as a Reportable Event
A Scientific Statement From the American Heart Association Emergency
Cardiovascular Care Committee; Council on Cardiopulmonary,
Perioperative, and Critical Care; Council on Cardiovascular Nursing;
Council on Clinical Cardiology; and Quality of Care and Outcomes
Research Interdisciplinary Working Group
Graham Nichol, MD, MPH, FAHA; John Rumsfeld, MD, PhD, FAHA; Brian Eigel, PhD;
Benjamin S. Abella, MD, MPhil; Darwin Labarthe, MD, MPH, PhD, FAHA;
Yuling Hong, MD, PhD, FAHA; Robert E. O’Connor, MD; Vincent N. Mosesso, MD;
Robert A. Berg, MD, FAHA; Barbara “Bobbi” Leeper, MN, RN, FAHA;
Myron L. Weisfeldt, MD, FAHA
Abstract—The 2010 impact goal of the American Heart Association is to reduce death rates from heart disease and stroke
by 25% and to lower the prevalence of the leading risk factors by the same proportion. Much of the burden of acute heart
disease is initially experienced out of hospital and can be reduced by timely delivery of effective prehospital emergency
care. Many patients with an acute myocardial infarction die from cardiac arrest before they reach the hospital. A small
proportion of those with cardiac arrest who reach the hospital survive to discharge. Current health surveillance systems
cannot determine the burden of acute cardiovascular illness in the prehospital setting nor make progress toward reducing
that burden without improved surveillance mechanisms. Accordingly, the goals of this article provide a brief overview
of strategies for managing out-of-hospital cardiac arrest. We review existing surveillance systems for monitoring
progress in reducing the burden of out-of-hospital cardiac arrest in the United States and make recommendations for
filling significant gaps in these systems, including the following: 1. Out-of-hospital cardiac arrests and their outcomes
through hospital discharge should be classified as reportable events as part of a heart disease and stroke surveillance
system. 2. Data collected on patients’ encounters with emergency medical services systems should include descriptions
of the performance of cardiopulmonary resuscitation by bystanders and defibrillation by lay responders. 3. National
annual reports on key indicators of progress in managing acute cardiovascular events in the out-of-hospital setting
should be developed and made publicly available. Potential barriers to action on cardiac arrest include concerns about
privacy, methodological challenges, and costs associated with designating cardiac arrest as a reportable event.
(Circulation. 2008;117:2299-2308.)
Key Words: AHA Scientific Statements
cardiac arrest
emergency medical services
The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and
Prevention.
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relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required
to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.
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© 2008 American Heart Association, Inc.
Circulation is available at http://circ.ahajournals.org DOI: 10.1161/CIRCULATIONAHA.107.189472
2299
AHA Scientific Statement
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Page 2
T
he 2010 impact goal of the American Heart Association
(AHA) is to reduce death rates from coronary heart
disease and stroke by 25% and risk factors for these diseases
by the same amount.
1
Healthy People 2010, a set of health
priorities promulgated by the US Department of Health and
Human Services, established national goals for prevention
and management of heart disease and stroke in the United
States, as shown in Table 1.
2
Much of the burden of acute
heart disease and stroke is initially experienced out of
hospital and can be reduced by timely delivery of effective
prehospital emergency care. The Institute of Medicine has
noted, however, that across the United States, the delivery of
such care is fragmented.
3
Many patients with an acute
myocardial infarction die from cardiac arrest before reaching
the hospital. Although there have been tremendous advances
in the treatment of acute myocardial infarction once the
patient arrives at the hospital, by comparison, out-of-hospital
cardiac arrest continues to be an important public health
problem. In selected cities where cardiac arrest has been
treated as a public health problem, gains have been made. But
in most of the United States, little progress has been achieved.
Unfortunately, contemporary health surveillance systems
cannot accurately determine the burden of acute cardiovas-
cular illness in the prehospital setting or progress toward
reducing it.
4
The AHA recently described the essential
features of a surveillance system designed to support the
prevention and management of heart disease and stroke, as
shown in Table 2.
5
The present statement describes the
burden of cardiac arrest and expands the focus on surveil-
lance to address unique aspects of designating out-of-hospital
cardiac arrest as a reportable event. Strategies for managing
acute cardiovascular events are summarized, and the role of
surveillance in monitoring the impact of efforts to treat these
events is examined. We review existing surveillance systems
for monitoring progress in reducing the burden of out-of-
hospital cardiac arrest in the United States and make recom-
mendations for filling significant gaps in the systems. Poten-
tial barriers to action on out-of-hospital cardiac arrest are also
addressed. In the present statement, out-of-hospital cardiac
arrest is the primary event of interest, but similar approaches
are applicable to acute myocardial infarction, acute coronary
syndromes, and acute stroke in the out-of-hospital setting.
Implementation of the recommendations made in the pres-
ent statement would require the commitment of resources
beyond those already devoted to surveillance. The return on
such an investment, however, could be substantial in terms of
improving emergency medical service (EMS) systems nation-
wide to prevent acute cardiovascular disease (CVD) and other
major disorders that are treated by EMS systems, which
would result in better population health as well as fewer
inflation-adjusted healthcare dollars being spent on acute
in-hospital care. Better data would also be useful for targeting
research, prevention, and treatment of acute CVD to reduce
the burden of illness.
Public Health Burden
CVD is a leading cause of disability, death, and income-
related differences in premature mortality.
6–8
Much of this
burden is attributable to sudden cardiac death and acute
myocardial infarction. Although cardiovascular mortality has
declined over the past 30 years,
9 –11
the case-fatality rate of
sudden cardiac arrest has not decreased.
10,12
The present
AHA statement refers to sudden cardiac death as out-of-
hospital cardiac arrest when it occurs in the prehospital
setting, regardless of outcome, and as out-of-hospital cardiac
death when a resuscitation attempt outside the hospital is
unsuccessful.
The true incidence of out-of-hospital cardiac arrest is an
elusive number. Data from the Framingham Heart Study
cohort suggest that the age-adjusted annual incidence of
sudden cardiac death has a much wider range, from 0.5 to 4.5
per 1000 individuals within the population.
13
Other published
estimates of deaths attributable to out-of-hospital cardiac
arrest range from 184 400 to 450 000 (0.6 to 1.5 per 1000)
Americans annually.
14 –17
Recent data suggest that there are
273 000 EMS-treated out-of-hospital cardiac arrests in the
United States annually (ie, 89.9 per 100 000 people) (unpub-
lished data, Resuscitation Outcomes Consortium Investiga-
tors, January 28, 2008), which has a population of approxi-
mately 303 295 561 individuals (www.census.gov, accessed
on January 24, 2008). The incidence of out-of-hospital
cardiac arrest appears to be increasing in some popula-
tions,
16,18
particularly in certain geographic areas.
19
Further-
Table 1. Healthy People 2010 Goals for Preventing and
Managing Heart Disease and Stroke
Prevention of cardiovascular risk factors
Detection and treatment of risk factors
Early identification and treatment of heart attacks and strokes
Prevention of recurrent cardiovascular events
Table 2. Recommendations for Comprehensive Cardiovascular
Disease Surveillance System
Establish National Heart Disease and Stroke Surveillance Unit to monitor
progress in preventing and managing heart disease and stroke
Classify cardiovascular disease as a reportable condition
Modify patient-encounter data to include lipoprotein cholesterol, blood sugar,
and glycohemoglobin concentrations
Standardize data elements
Implement oversampling in existing surveillance programs to provide better
estimates for ethnic subgroups
Enable linkage between healthcare data systems, national surveillance
programs, and electronic health records
Validate the multiple measures collected by self-reports and the reports
from providers that are used in national databases
Expand national surveys to include information on awareness of physical
inactivity, unhealthy diet, cigarette smoking, and obesity and on detecting,
treating, and controlling these problems
Develop, test, and implement indicators and systems