Key Takeaways
- In 2023, approximately 350,000 to 450,000 adults experience out-of-hospital cardiac arrest (OHCA) annually in the United States, with survival rates varying by region
- Globally, sudden cardiac arrest (SCA) accounts for 15-20% of all deaths, equating to over 7 million cases yearly according to WHO estimates adjusted for underreporting
- In Europe, the incidence of OHCA is 67-84 per 100,000 person-years, with higher rates in Northern countries like Sweden at 86 per 100,000
- In the US, EMS-assessed OHCA incidence 110.8 per 100,000 in 2019, up 3.4% from prior years
- In 2022, American Heart Association reports 356,000 OHCA in US, with 10.4% survival to hospital discharge
- CARES registry 2021: 70% of US OHCA public vs home, but public has 2.5x better survival
- In US, coronary heart disease causes 75% of SCA
- Smoking doubles SCA risk within 2 hours of last cigarette
- Diabetes increases SCA risk by 2-4x, independent of CAD
- Bystander-witnessed OHCA survival to discharge 32.6% if shockable rhythm
- US OHCA 1-year survival 8.8% overall, drops to 5.5% at 5 years
- With bystander AED before EMS, survival 67% for VF OHCA
- US SCA annual cost $30.8 billion in direct medical + indirect
- OHCA survivor lifetime cost $1.2-5 million per patient
- AED public program cost-effectiveness $29,000/QALY at $2,000/device
Sudden cardiac arrest is a leading global killer but survival rates vary widely.
Economic Impact
- US SCA annual cost $30.8 billion in direct medical + indirect
- OHCA survivor lifetime cost $1.2-5 million per patient
- AED public program cost-effectiveness $29,000/QALY at $2,000/device
- CPR training US costs $500 million yearly, saves 1,000 lives
- ICD implantation $30,000-50,000, prevents 1 SCA per 50 patient-years
- EMS OHCA transport $25,000 average per case US
- Post-SCA ICU stay $100,000+ per survivor
- Lost productivity SCA $15 billion US yearly
Economic Impact Interpretation
Epidemiology
- In 2023, approximately 350,000 to 450,000 adults experience out-of-hospital cardiac arrest (OHCA) annually in the United States, with survival rates varying by region
- Globally, sudden cardiac arrest (SCA) accounts for 15-20% of all deaths, equating to over 7 million cases yearly according to WHO estimates adjusted for underreporting
- In Europe, the incidence of OHCA is 67-84 per 100,000 person-years, with higher rates in Northern countries like Sweden at 86 per 100,000
- SCA occurs in about 1 in 1,000 people over age 35 annually in high-income countries, with 50% of cases unwitnessed
- In Japan, the annual OHCA incidence is 118 per 100,000 population, with 60% occurring at home
- In Australia, SCA incidence is 51-102 per 100,000, with public place arrests having 2x higher bystander CPR rates
- In the UK, around 30,000 OHCA cases occur yearly, with only 8% surviving to hospital discharge
- In Canada, OHCA incidence is 40-140 per 100,000, varying by urban vs rural settings
- In India, estimated SCA cases exceed 1 million annually due to population size, though underreported by 70%
- In Brazil, urban SCA incidence is 48 per 100,000, with shockable rhythms in only 20% of cases
- In South Africa, SCA incidence is 100-200 per 100,000 in urban areas, limited by EMS response times averaging 25 minutes
- In China, over 544,000 SCA events yearly, with bystander CPR at 3-5% nationally
- In Germany, OHCA rate is 50-70 per 100,000, with 25% VF/VT initial rhythms
- In France, 40,000-50,000 SCA cases per year, with 1-year survival at 5-10%
- In Italy, SCA incidence 70-100 per 100,000, higher in males by 2:1 ratio
- In Spain, approximately 30,000 OHCA annually, with AED availability in 10% of public arrests
- In the Netherlands, OHCA incidence 54 per 100,000, with 80% AED coverage in public
- In Denmark, 61 per 100,000 OHCA rate, bystander CPR in 72% of cases
- In Sweden, 47 per 100,000 SCA, with national registry covering 99% of cases
- In Norway, OHCA 52 per 100,000, survival to discharge 10.6%
- In Finland, 69 per 100,000, with cold weather increasing incidence by 15%
- In Belgium, 45-60 per 100,000 OHCA, urban higher than rural by 30%
- In Switzerland, 78 per 100,000, with high AED use at 18%
- In Austria, SCA around 50 per 100,000, with 60% occurring between 8am-6pm
- In Portugal, estimated 10,000 SCA yearly, bystander intervention low at 15%
- In Greece, OHCA 37 per 100,000, with only 5% AED accessibility
- In Turkey, urban SCA 90 per 100,000, rural lower by 40%
- In Russia, estimated 200,000 SCA annually, survival <2% due to EMS delays
- In Poland, OHCA 65 per 100,000, bystander CPR 35%
Epidemiology Interpretation
Risk Factors
- In US, coronary heart disease causes 75% of SCA
- Smoking doubles SCA risk within 2 hours of last cigarette
- Diabetes increases SCA risk by 2-4x, independent of CAD
- Obesity (BMI>30) raises SCA odds by 1.5x, visceral fat strongest predictor
- Hypertension present in 60% of SCA victims, risk up 1.8x uncontrolled
- Family history of SCA triples risk under age 50
- Chronic kidney disease stage 4-5 SCA risk 5-10x higher
- Alcohol binge drinking (>5 drinks) increases SCA risk 3x acutely
- Sleep apnea untreated raises SCA risk 2.3x
- Illicit cocaine use multiplies SCA risk 6x via arrhythmias
- Hypercholesterolemia LDL>160 mg/dL SCA risk 1.7x
- Physical inactivity <500 MET-min/week doubles SCA risk
- Prior myocardial infarction increases SCA risk 4-6x in first year
- Heart failure ejection fraction <35% SCA risk 5x annual
- Long QT syndrome genetic mutations confer 1% annual SCA risk
- Brugada syndrome SCA risk 0.5-1% yearly untreated
- ARVC annual SCA risk 2.3% in probands
- Hypertrophic cardiomyopathy SCA risk 1% per year in adults
- Electrolyte imbalance (hypokalemia <3.5 mEq/L) SCA risk 2x
- COPD severe FEV1<50% predicted SCA risk 1.8x
- Depression treated with TCAs increases SCA 3.5x
- HIV infection SCA risk 4.5x adjusted for comorbidities
- Radiation therapy to chest SCA risk up 7.4x long-term
- Stimulant medications ADHD SCA risk 1.8x in youth
- Hypothermia <35C doubles VF SCA risk
Risk Factors Interpretation
Survival Rates
- Bystander-witnessed OHCA survival to discharge 32.6% if shockable rhythm
- US OHCA 1-year survival 8.8% overall, drops to 5.5% at 5 years
- With bystander AED before EMS, survival 67% for VF OHCA
- EMS-treated OHCA neurologically intact survival 8.2%
- IHCA survival to discharge 25.8% in 2022 US, up from 18.4% in 2000
- Pediatric OHCA survival 6.7% to discharge, 4.2% good neuro outcome
- Public OHCA vs home: 34% vs 9% survival if bystander CPR+AED
- Post-arrest PCI improves 1-year survival to 57% vs 33% no PCI
- ECPR for refractory OHCA survival 28% at 30 days
- TTM 33C vs 36C survival no difference, but neuro intact 33% both
- Unwitnessed OHCA survival <2%, witnessed 15-20%
- Nighttime OHCA survival 10% lower than daytime
- Asystole initial rhythm survival 1-2%, PEA 5-10%
- Female OHCA survival 7.5% vs male 9.1%
- Rural OHCA survival 6% vs urban 10%
- Black patients OHCA survival 6.7% vs white 9.8%
- >80yo OHCA survival 5.4%, <50yo 15.2%
- Opioid overdose OHCA survival 12.5% with naloxone
- Workplace IHCA survival 64%
- Sports SCA survival 89% with AED on field
- Airport SCA survival 37.4%
- Nursing home OHCA survival 2.7%
- Casino SCA survival 53.1%
Survival Rates Interpretation
US Statistics
- In the US, EMS-assessed OHCA incidence 110.8 per 100,000 in 2019, up 3.4% from prior years
- In 2022, American Heart Association reports 356,000 OHCA in US, with 10.4% survival to hospital discharge
- CARES registry 2021: 70% of US OHCA public vs home, but public has 2.5x better survival
- US ventricular fibrillation SCA 25-50% initial rhythm in witnessed cases
- In US adults >35, SCA risk 1 per 1,000 yearly, higher in blacks by 1.5x
- US pediatric SCA 15,000 yearly, 88% non-shockable rhythms
- In US, 90% of SCA fatal if not treated immediately
- ROC data: US bystander CPR rose to 41.8% in 2021 from 35.7% in 2017
- US AED use in public OHCA increased to 11.5% in 2021
- In US, average EMS response time for OHCA 7-8 minutes
- US OHCA survival 9.1% overall in 2019, 36.3% for bystander-witnessed shockable
- In 45 US states, OHCA incidence 96.6 per 100,000 treated by EMS
- US workplace SCA 10,000 yearly, survival 57% due to rapid response
- In US nursing homes, SCA incidence 20x higher than community
- US air travel SCA 1 per 604,000 passengers, defibrillators on 90% flights
- In US sports, SCA 1 per 50,000-200,000 participant hours, mostly males
- US fire stations OHCA 1,300 yearly, bystander AED use 40%
- In US casinos, SCA survival 53% with on-site AEDs
- US residential SCA 70% of total, survival 6.4%
- In US, SCA peak hours 6am-10am and 4pm-8pm
- US male OHCA incidence 1.5x female
- In US >65yo, SCA accounts for 60% of cases
- US black population OHCA incidence 20% higher, survival 20% lower
- In US urban areas, OHCA 110 per 100,000 vs 80 rural
- US Hispanic OHCA bystander CPR 30% less than non-Hispanic white
- In US, 45% OHCA shockable rhythm decline over 10 years
- US pediatric non-traumatic SCA survival 2.2%
- In US airports, AED-equipped, SCA survival 39%
- US opioid-related SCA increased 9.2-fold from 2010-2020
US Statistics Interpretation
Sources & References
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