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Is it worth resuscitating octogenarians with out-of-hospital cardiac arrest?

Too young to die?

Sudden Cardiac Death and Resuscitation


Barcelona, Spain – Sunday 31 August 2014: It is worth resuscitating older people with out-of-hospital cardiac arrest, concludes research presented at ESC Congress today by Dr Helle Søholm from Denmark. The nine- year study in 4 000 people shows that most of the patients who survive go on to live active lives.
Dr Søholm said:

“People over 80 years of age, also called octogenarians, do not survive quite as often as younger people after a cardiac arrest in the streets. But the findings of our study from the Copenhagen area show that most octogenarians who do survive are able to live an active life after the incident.”


She added:

“Therefore the conclusion for the public and the medical profession is that refraining from resuscitating older people in general is wrong. You may still be able to live a full life as an old person, despite having a cardiac arrest.”


Nearly 60 out of 100 000 people suffer from cardiac arrest outside the hospital each year. Only  one out of ten survive. Survival and outcome greatly depend on an immediate response with an early call for help, a bystander resuscitation attempt and the fast use of defibrillators.
Dr Søholm said:

“All physicians swear the Hippocratic Oath that we will ‘never do harm to anyone’. All people have the right to a natural end of life which means that ethical dilemmas often arise when cardiac arrests occur in the very old. Our study therefore investigated the survival and, at least as important, the functional status after out-of-hospital cardiac arrest in octogenarians.”


Over a nine-year period (2002 – 2011) the study included all patients with out-of-hospital cardiac arrest in Copenhagen who were treated by the physician-based emergency medical systems. Close to 4 000 people suffered from a cardiac arrest during the study period and a quarter of those were octogenarians.
The researchers found that resuscitation attempts were more often successful in younger cardiac arrest patients, with 40% admitted alive to the hospital compared with 25% of octogenarians. In the octogenarians, most patients were female and the cardiac arrest more often occurred in a private setting.
Dr Søholm said:

“Women tend to live longer, which explains why many of the octogenarians in our study were female. Cardiac arrests in the older group were less likely to happen in a public place as octogenarians stay home more than younger people.”


In patients who were successfully resuscitated and alive at hospital admission, 19% of octogenarians were alive 30 days later compared to 45% of younger patients. The majority of patients had sufficient function for carrying out independent daily activities, with 75% of octogenarians and 85% of younger patients discharged with a high functional status.
Dr Søholm said:

“Being an octogenarian is undoubtedly associated with a lower survival rate after out-of-hospital cardiac arrest, but the majority of the older survivors were discharged with a high functional status and were able to carry out daily activities independently.”

She concluded:

“Refraining from resuscitating older people in general does not seem justified.”


END

Notes to editor

About the European Society of Cardiology
The European Society of Cardiology (ESC) represents more than 80 000 cardiology professionals across Europe and the Mediterranean. Its mission is to reduce the burden of cardiovascular disease in Europe.
About ESC Congress 2014
The ESC Congress is currently the world's largest international congress in cardiovascular medicine.  The spotlight of this year's event is “innovation and the heart”.  ESC Congress 2014 takes place from 30 August to 3 September at the Fira Gran Via in Barcelona, Spain. For more information on ESC Congress 2014 contact the ESC Press Office.
To access all the scientific resources from the sessions during the congress, visit ESC Congress 365
This press release accompanies both a presentation and an ESC press conference at the ESC Congress 2014. Edited by the ESC from material supplied by the investigators themselves, this press release does not necessarily reflect the opinion of the European Society of Cardiology. The content of the press release has been approved by the presenter.