Friday, 9 October 2015

Mapping better survival: SPHPM research identifies out-of-hospital cardiac arrests and CPR rates in Victoria

Shrunken estimate of OHCA incidence rate (per 100,000 person years)
for Victorian Local Government Areas 2008-2013
SPHPM’s Dr Lahn Straney today had his research on regional variation in the rates of out-of-hospital cardiac arrest and bystander Cardio Pulmonary Resuscitation (CPR) published online at PLoS One.

Dr Straney is an Aus-ROC  (Australian Resuscitation Outcomes Consortium) Research Fellow and was recently the recipient of an Early Career Researcher Publication Prize in the Public Health Research category of the 2015 Faculty of Medicine, Nursing and Health Sciences awards.

He and his colleagues have co-authored the study to identify regions of high out-of-hospital cardiac arrest (OHCA) incidence and low bystander CPR rates in Victoria using Victorian Ambulance Cardiac Arrest Registry (VACAR) data and ambulance dispatch coordinates.

OHCA remains a major public health issue and carries a high case fatality rate in most communities. According to Dr Straney’s findings, interventions to improve CPR rates should be targeted at communities where current rates are low and the incidence of OHCA is high.

“Efforts to improve out-of-hospital cardiac arrest outcomes focus on improving the chain of survival, this includes: early recognition of cardiac arrest symptoms, early CPR, early defibrillation and early advanced post-resuscitation care,” he said.

“Of the interventions associated with survival, the provision of CPR is one of the most important modifiable factors”.

Overall, the study revealed that the rate of bystander CPR increased between 2008 and 2013, however there was significant regional variation in the rates of bystander CPR being undertaken.

State-wide, there was a 12 per cent increase in the rate of bystander CPR between the first and second half of the study period. Dr Straney said these improvements were particularly encouraging given that the largest improvements were seen in those regions that were performing most poorly at the beginning of the study period.

The research also found considerable regional variation in the incidence of OHCA throughout Victoria. Neighbouring rural areas Loddon and Central Goldfields had the highest OHCA incidence rates in Victoria, while the Shire of Nillumbik had the lowest. Significant variation between these communities was detected, with a 3-fold difference in the incidence rate between the lowest and highest OHCA areas.

Importantly, the study period includes the introduction of new resuscitation guidelines handed down from the International Liaison Committee on Resuscitation (ILCOR) in 2010.

Therefore the study was able to track how new simplified CPR guidelines impacted on bystander CPR in the 2011-2013 period against the 2008-2010 period.

“To our knowledge, ours is the first study of its kind to include rural regions with low and very low density populations, some of which had the highest incidence rates across the state,” Dr Straney said.

The study demonstrated that community-based interventions aimed at those regions with high incidence and low bystander CPR rates could improve future survival outcomes, particularly in regions where a high-risk status persists.

“The next phase of our study intends to explore the demographic factors seen in our high risk regions and to determine the extent to which these factors explain the variation observed” Dr Straney said.

Learn more about this research using interactive maps on bystander CPR rates and OHCA incidence rates.

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