Data of "Epidemiology of Out-of-Hospital Cardiac Arrests,Knowledge of Cardiovascular disease and Risk Factors in a regional setting in India: The Warangal Area out-of -hospital Cardiac Arrest Registry (WACAR)

Published: 30-10-2020| Version 1 | DOI: 10.17632/cwc9v4p56s.1
Contributors:
Srinivas Ramaka,
Noreen T Nazir ,
Vemuri Murthy,
Terry Vanden Hoek ,
Bellur Prabhakar,
Ravikumar Chodavarapu,
Sundaresh Peri,
Anveshini Uppuleti,
Rakesh Jatoth,
Vasudeva Murthy S,
ADIL SARVAR MOHAMMED,
Stevan Weine

Description

Out-of-Hospital Cardiac Arrest (OHCA) is a global public health problem.While several OHCA registries are developed based on the Utstein template, there is limited data on OHCA from India.The Warangal Area out-of-hospital Cardiac Arrest Registry (WACAR) was designed to gain a better understanding of OHCA in a regional setting in India. The WACAR is a prospective one-year observational study of OHCA in Warangal area in the State of Telangana, India.OHCA cases were obtained from a regional Government Hospital, Mahatma Gandhi Memorial Hospital, a secondary care District Headquarters Hospital. Study subjects included all those above 18 years brought to the hospital with a history of non-traumatic OHCA of presumed cardiac origin from January 1, 2018 - December 31, 2018. A total of 814 individuals were included in the study for data analysis. The data are collected on a standard collection form designed with Utstein variables with additional data on clinical characteristics (modified Utstein template). It includes information on demographics, patient characteristics, risk factors, history of heart disease, comorbidities, prior symptoms, resuscitation characteristics, event timing, utilization of Emergency Medical Services (EMS) and outcomes. Study data were obtained from a review of hospital records. Medical staff involved in the care of OHCA were given data collection forms that were filled out in the emergency room setting. Information not obtained during initial emergency room evaluation was obtained from bystanders (including victim’s relatives and attendants) through telephone interviews. Results: A total of 1106 subjects of OHCA attended MGM Hospital during January 2018 and December 2018. After excluding those due to trauma, hanging, and burns, the sample size of OHCA was sized down to 926 subjects and 814 subjects with Presumed Cardiac etiology were included in the study for analysis. The results are tabulated into demographics, patient characteristics and resuscitation characteristics. Majority of subjects were male, with a median age of 60 years. The majority occurred in residential locations and sustained OHCA within one hour of symptom onset. Individuals with knowledge of CVD risk factors were more likely to report symptoms before OHCA. Data on resuscitation characteristics were inadequate. Conclusions: WACAR gives insight into the epidemiology of OHCA in India.The results of WACAR highlight that OHCA of cardiac etiology is a significant public health problem in India.The study demonstrated barriers involving patient knowledge of CVD ,risk factors, data collection, and access to health care. The study results also convey that the knowledge level of CVD risk factors and personal CVD disease have a significant impact on OHCA outcomes. The information from the WACAR registry, the first registry on OHCA in this setting points to the need for a Indian National OHCA Registry and might help to guide future steps to improve care OHCA in India.

Steps to reproduce

OHCA cases in WACAR were obtained from a regional Government Hospital, Mahatma Gandhi Memorial Hospital, which is a secondary care District Headquarters Hospital. The study population included all those above 18 years brought to the hospital with a history of non-traumatic OHCA of presumed cardiac origin from January 1, 2018 - December 31, 2018. A total of 1106 subjects of OHCA attended MGM Hospital during January 2018 and December 2018. After excluding those due to trauma, hanging and burns, the sample size of OHCA was sized down to 926 individuals and 814 subjects with Presumed Cardiac etiology were included in the study for analysis A total of 814 individuals were included in the study for data analysis during this one year. The geographical area was chosen as a representative of communities in India with similar health care knowledge and access to healthcare seen in most parts of India. Data collection and Variables: The Utstein checklist for standardized reporting of OHCA was followed in the study. The data form is based on the ILCOR consensus statement and other registries (CARES, PAROS). Apart from the standard Utstein variables, a modified Utstein template containing other variables of clinical characteristics was followed in the study. It includes information on demographics, patient characteristics, risk factors, history of heart disease, comorbidities, prior symptoms, resuscitation characteristics, event timing, utilization of Emergency Medical Services (EMS), and outcomes. Study data were obtained from the review of hospital records. Medical staff involved in the care of OHCA were given data collection forms that were filled out in the emergency room setting. Information not obtained during initial emergency room evaluation was obtained from bystanders (including victim’s relatives and attendants) through telephone interviews. A few OHCA individuals had neither address nor phone number available to collect information. Data entered into Excel forms.Institutional Ethics Committee approval was taken. Individual age was categorized into age category for Premature CAD versus characteristic age for CVD as to delineate differences associated with premature CVD risk. Age cutoffs for premature CVD risk were under 55 years for Males and under 65 years for Females. For the second age-category, 55 years and higher for males and 65 years and higher for females were used. Traditional CVD risk factors evaluated were : hypertension, hyperlipidemia, diabetes, smoking, and family history of cardiovascular disease. Risk Factors(RF) were weighted similarly with 1 point assigned to risk factors with higher points assigned for more RF burden. Symptom duration was classified as less than 1 hour versus greater than 1 hour before the onset of OHCA. Symptoms were evaluated, and individuals were categorized by those who had symptoms preceding OHCA event versus those without known symptoms. Statistical analysis was done by Medcalc and Epi info of CDC.