TY - JOUR
T1 - Association of non-cardiac depolarization-blocking drugs with first-registered heart rhythm and survival in out-of-hospital cardiac arrest
AU - Hindborg, Mathias
AU - Coronel, Ruben
AU - Arulmurugananthavadivel, Anojhaan
AU - Parveen, Saaima
AU - Yonis, Harman
AU - Andersen, Mikkel Porsborg
AU - Sørensen, Kathrine Kold
AU - Christensen, Helle Collatz
AU - Torp-Pedersen, Christian
AU - Gislason, Gunnar
AU - Eroglu, Talip Emre
N1 - Copyright © 2025 The Author(s). Published by Elsevier B.V. All rights reserved.
PY - 2025/12
Y1 - 2025/12
N2 - OBJECTIVE: Out-of-hospital cardiac arrest (OHCA) is one of the leading causes of mortality worldwide. Survival following OHCA largely depends on whether the initial heart rhythm is shockable or non-shockable. Previous research has suggested that drugs with an off-target effect of blocking cardiac depolarization (non-cardiac depolarization-blocking (DB) drugs) may be associated with a higher likelihood of having a non-shockable rhythm. In this study, we examined whether the use of non-cardiac DB-drugs affects the initial rhythm and survival in OHCA.METHODS: We identified all patients with OHCA of medical causes from the nationwide Danish Cardiac Arrest Registry (2001-2020). Non-cardiac DB-drug use was defined by prescriptions within 90 days prior to OHCA. Multiple logistic regression models with adjustments for relevant confounders were employed to estimate the odds ratio (OR) for the association between non-cardiac DB-drugs and initial heart rhythm and 30-day survival following OHCA. Additionally, stratified analyses were performed based on sex, age, cardiovascular and psychiatric comorbidities, and the year of OHCA occurrence.RESULTS: We included 54,370 OHCA patients (63.1 % male, median age 74 years). Non-cardiac DB-drugs was used by 6284 (11.6 %) OHCA patients and was associated with increased odds of non-shockable rhythm compared with non-users after adjustment for relevant confounders (OR 1.62, 95 % CI: 1.48-1.79). This increased odds of non-shockable rhythm was consistent in men and women (ORmen: 1.72, 95 % CI: 1.53-1.95, ORwomen 1.46, 95 % CI: 1.26-1.70), in all age categories (OR<60 years 1.91, 95 % CI: 1.54-2.39, OR>60 years 1.57, 95 % CI: 1.41-1.74), in the absence of pre-existing psychiatric or non-cardiovascular disease, or when stratified by the year of OHCA occurrence. Finally, we found that users of non-cardiac DB-drugs had lower 30-day survival chances following OHCA when compared to non-users (OR 0.81, 95 % CI: 0.69-0.95).CONCLUSION: Use of non-cardiac DB-drugs was associated with increased odds of non-shockable rhythm in OHCA and with lower 30-day survival following OHCA.
AB - OBJECTIVE: Out-of-hospital cardiac arrest (OHCA) is one of the leading causes of mortality worldwide. Survival following OHCA largely depends on whether the initial heart rhythm is shockable or non-shockable. Previous research has suggested that drugs with an off-target effect of blocking cardiac depolarization (non-cardiac depolarization-blocking (DB) drugs) may be associated with a higher likelihood of having a non-shockable rhythm. In this study, we examined whether the use of non-cardiac DB-drugs affects the initial rhythm and survival in OHCA.METHODS: We identified all patients with OHCA of medical causes from the nationwide Danish Cardiac Arrest Registry (2001-2020). Non-cardiac DB-drug use was defined by prescriptions within 90 days prior to OHCA. Multiple logistic regression models with adjustments for relevant confounders were employed to estimate the odds ratio (OR) for the association between non-cardiac DB-drugs and initial heart rhythm and 30-day survival following OHCA. Additionally, stratified analyses were performed based on sex, age, cardiovascular and psychiatric comorbidities, and the year of OHCA occurrence.RESULTS: We included 54,370 OHCA patients (63.1 % male, median age 74 years). Non-cardiac DB-drugs was used by 6284 (11.6 %) OHCA patients and was associated with increased odds of non-shockable rhythm compared with non-users after adjustment for relevant confounders (OR 1.62, 95 % CI: 1.48-1.79). This increased odds of non-shockable rhythm was consistent in men and women (ORmen: 1.72, 95 % CI: 1.53-1.95, ORwomen 1.46, 95 % CI: 1.26-1.70), in all age categories (OR<60 years 1.91, 95 % CI: 1.54-2.39, OR>60 years 1.57, 95 % CI: 1.41-1.74), in the absence of pre-existing psychiatric or non-cardiovascular disease, or when stratified by the year of OHCA occurrence. Finally, we found that users of non-cardiac DB-drugs had lower 30-day survival chances following OHCA when compared to non-users (OR 0.81, 95 % CI: 0.69-0.95).CONCLUSION: Use of non-cardiac DB-drugs was associated with increased odds of non-shockable rhythm in OHCA and with lower 30-day survival following OHCA.
KW - Aged
KW - Aged, 80 and over
KW - Anti-Arrhythmia Agents/therapeutic use
KW - Cardiopulmonary Resuscitation/methods
KW - Denmark/epidemiology
KW - Female
KW - Heart Rate/drug effects
KW - Humans
KW - Male
KW - Middle Aged
KW - Out-of-Hospital Cardiac Arrest/mortality
KW - Registries
U2 - 10.1016/j.resuscitation.2025.110903
DO - 10.1016/j.resuscitation.2025.110903
M3 - Article
C2 - 41270993
SN - 0300-9572
VL - 217
JO - Resuscitation
JF - Resuscitation
M1 - 110903
ER -