Key Points
Question
Do the characteristics and outcomes of out-of-hospital cardiac arrest among patients aged 65 years or older differ by the location where the arrest occurs (public, residential, or nursing home) in Japan?
Findings
In this Japanese nationwide, population-based cohort study of 233 511 persons 65 years or older, the incidence of and the demographic and clinical characteristics of the patients and their outcomes following out-of-hospital cardiac arrest differed according to the location of the arrest. However, the differences in outcomes among patients based on location decreased with age.
Meaning
These results support implementing improved resuscitation strategies for persons experiencing out-of-hospital cardiac arrest in other industrialized countries.
Background: This study assessed whether the dissemination of public-access defibrillation (PAD) at the population level is associated with an increase in neurologically favorable outcomes among patients experiencing ventricular fibrillation (VF) in public vs. residential locations in Japan. Methods and Results: We enrolled adult patients with bystander-witnessed VF between 2013 and 2015. The primary outcome measure was 1-month neurologically favorable outcome defined by cerebral performance category 1 or 2. The number of survivors with neurologically favorable outcome attributed to PAD after VF arrest was estimated by location of arrest. A total of 16,252 adult patients with bystander-witnessed VF arrest were analyzed. In public locations, 29.3% (2,334/7,973) of out-of-hospital cardiac arrest (OHCA) patients received PAD, whereas 1.1% (89/8,279) of OHCA patients received PAD in residential locations. OHCA patients with PAD had significantly better neurological outcomes compared with those without PAD in public locations (51.8% vs. 25.5%, P<0.001), whereas there were no significant differences in neurologically favorable outcome between patients with or without PAD in residential locations (22.5% vs. 18.6%, P=0.357). The total number of patients with neurologically favorable outcomes attributed to PAD was estimated at 615 in public locations, but only 3 in residential locations. Conclusions: In Japan, when compared with residential locations, PAD works more successfully in public locations for adults with bystander-witnessed VF arrest.
BackgroundTo clarify the role of physical activity in preventing disability in Japan, we investigated the association between amount of leisure-time physical activity and incidence of disability among the young elderly.MethodsIn the New Integrated Suburban Seniority Investigation (NISSIN) project conducted from 1996 to 2013, we followed 2888 community-dwelling adults aged 64–65 years with no history of cerebrovascular disease for a median follow-up of 11.6 years. Disabilities were defined as follows based on the classifications of the Japanese long-term care insurance system: 1) support or care levels (support levels 1–2 or care levels 1–5); 2) care levels 2–5; 3) support or care levels with dementia; and 4) care levels 2–5 or death. In addition, we also assessed 5) all-cause mortality.ResultsAfter controlling for sociodemographic, lifestyle, and medical factors, male participants reporting an activity level of 18.1 metabolic equivalent (MET)-hours/week (the median among those with activities) or more had 52% less risk of being classified as support or care levels with dementia compared with the no activity group (hazard ratio 0.48; 95% confidence interval, 0.25–0.94). No significant association was found among women between amount of leisure-time physical activity and incidence of disability.ConclusionWe identified an inverse dose–response relationship between the amount of leisure-time physical activity and the risk of disability with dementia in men. Therefore, a higher level of physical activity should be recommended to young elderly men to prevent disability with dementia.
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