Fredrik Folke

IntroductionEarly defibrillation is critical for survival after out-of-hospital cardiac arrest (OHCA), yet bystander defibrillation remains uncommon despite the availability of automated external defibrillators (AEDs). We investigated whether HeartRunner community first responder activation increased the likelihood of bystander defibrillation and 30-day survival in relation to the distance to the nearest accessible AED.MethodsLinking data from the Danish Cardiac Arrest Registry, Danish AED Network, and HeartRunner application, we identified patients with OHCA eligible for HeartRunner activation during 2017–2021. Using street-network distances to the nearest accessible AED, we examined associations between HeartRunner activation, bystander defibrillation, and 30-day survival using multivariable logistic regression with interaction terms and targeted maximum likelihood estimation (TMLE).ResultsAmong 5,753 OHCAs (median age, 74 years; 64% male; 78% in private locations), HeartRunner activation (41%) was associated with higher bystander defibrillation across AED distances (p-interaction = 0.004), with no interaction for 30-day survival (p-interaction = 0.054). Predicted bystander defibrillation with versus without HeartRunner activation was 9.6% vs 5.5% at Q1 (389 m), 10.0% vs 4.3% at median (717 m), and 13.0% vs 4.8% at Q3 (1,183 m). TMLE estimated a 6.1-percentage-point higher probability of bystander defibrillation (95% CI, 4.5–7.8; p<0.001) and a modest 1.8-percentage-point increase in 30-day survival (95% CI, 0.1–3.6; p=0.038) with HeartRunner activation.ConclusionHeartRunner activation attenuated the decline in bystander defibrillation with increasing AED distance following OHCA, without a corresponding distance interaction for 30-day survival. Overall, TMLE supported higher bystander defibrillation and suggested a modest increase in 30-day survival with HeartRunner activation.

Background and Aims—Immediate Out-of-hospital cardiac arrest (OHCA) survival is time-sensitive, however, evidence linking resuscitation time to recovery is limited. We examined time from emergency call to return of spontaneous circulation (time-to-ROSC) and survivor outcomes.Methods—From the Danish Cardiac Arrest Registry, we included adults with bystander-witnessed OHCA (2016–2023) surviving ≥30 days, without prior anoxic brain damage or nursing home admission. Time-to-event and multivariable regression analyses stratified by time-to-ROSC (A:0–10, B:11–18, C:>18 minutes) assessed 11-month anoxic brain damage and nursing home admission, plus long-term survival and return-to-work through December 2024.Results—We included 2,583 patients (n=875, 869, 839; groups A–C, respectively), 78% male; median age 65; median time-to-ROSC 14 min. Anoxic brain damage increased with time-to-ROSC (A–C: 0.3%, 1.8%, 3.2%; p<0.001). Adjusted analyses showed an overall association (p=0.03); HRs: 5.58 (95% CI 1.58–19.64) for B and 9.98 (95% CI 2.93–33.96) for C versus A. Nursing home admission decreased with time-to-ROSC (A–C: 3.1%, 2.2%, 1.3%; p=0.04), but adjustments attenuated the association (p=0.3). Long-term survival was similar (5-year Kaplan–Meier estimate: 79%; 95% CI 77–81%; p = 0.80; adjusted p = 0.99). Among employed patients (n=177, 168, 179), return-to-work was similar (5-year cumulative incidence: 60%; 95% CI 56–65%; p = 0.31; adjusted p = 0.29).Conclusions—In 30-day OHCA survivors, longer time-to-ROSC was associated with anoxic brain damage but not with nursing home admission, long-term survival, or return-to-work; factors beyond time-to-ROSC should inform long-term outcomes.

Introduction Understanding whether socioeconomic and ethnic backgrounds influence help-seeking and communication with emergency medical services (EMS) is essential to mitigate disparities. Objective We explored how public housing residents seek help and communicate with EMS, focusing on barriers and enablers to out-of-hospital cardiac arrest (OHCA) recognition and swift EMS responses. Design Explorative qualitative analysis of audio recordings of emergency service calls regarding non-EMS witnessed OHCAs. Audio recordings were screened and selected to ensure call variety—then transcribed and analysed using thematic analysis inspired by the concepts of social wrongs and social orders. We also analysed the dispatch protocol, a tool for managing emergency service calls. Setting Four public housing areas with >50% ethnic minority residents in Copenhagen, Denmark. Participants Non-EMS witnessed OHCAs from 2017 to 2022. Results We included 17 calls regarding 13 OHCAs and defined two themes. The effective call aligned with the dispatch protocol, leading to swift OHCA recognition and dispatcher-assisted cardiopulmonary resuscitation (CPR). In contrast, the challenging call, which did not match the framework of the dispatch protocol, entailed one or more of the following characteristics, leading to delayed or missed OHCA recognition: (1) multiple people involved (multiple callers, third-party caller or bystanders communicating with caller), (2) language barriers, (3) emotionally unstable callers and (4) lack of emergency medical competencies. Across themes, witnesses contacted someone in their network instead of calling emergency services immediately. This was a barrier to OHCA recognition in the challenging calls, which some dispatchers managed using calm intonation and simple inquiries. Conclusions We identified two themes concerning communication in emergency service calls from public housing areas: the effective call and the challenging call, resulting in swift or delayed/missed OHCA recognition, respectively. The dispatch protocol enabled swift recognition in the effective calls but was a barrier in the challenging calls. Across themes, witnesses used network-based help-seeking before calling emergency services, delaying EMS responses and dispatcher-assisted CPR.

Background: Potassium is involved in multiple physiological processes in the body, and hyperkalemia is a common, potentially life–threatening condition. Objective: The aim of our study was to examine the association between plasma potassium levels, and 30-day mortality in patients presenting to an emergency department with normo– or hyperkalemia. Design: Retrospective Cohort study. Setting: Emergency Departments in the Capital region of Denmark Participants: Persons attending Emergency Departments in the Capital Region of Denmark from 2017—2021 with a plasma potassium level of at least 3.5 mM measured within 4 hours after arrival. Measurements: The study was based on data from Danish National Registries and electronic patient records. We performed Kaplan–Meier survival analyses and unadjusted and adjusted cox regression analyses utilizing plasma [K+] 3.5—4.4 mM as the reference group for 30-day mortality hazard ratios (HRs). Results: A total of 248,453 patients were included with a median age of 60 years (Q1;Q3 42;75), and 6,959 (2.8%) died within 30 days. Mortality was 2.2% for potassium level 3.5—4.4 mM, 6.9% for 4.5—4.9 mM, 17.1% for 5.0—5.9 mM, and 26.9% for ≥ 6.0 mM. Unadjusted 30-day HRs were 3.2 (95%CI: 3.0—3.4) for [K+] 4.5—4.9 mM, 8.6 (95%CI: 7.9—9.3) for [K+] 5.0—5.9 mM, and 14.7 (95%CI: 12.5—17.0) for [K+] ≥6.0 mM. Adjusted HRs were 1.4 (1.3—1.5), 2.10 (1.9—2.3), and 2.4 (2.0—2.8), respectively. Limitations: Risk of residual confounding. Missing data. No access to data regarding in–hospital treatment. Conclusion: Plasma potassium levels above 4.4 mM were associated with increased 30–day mortality among patients presenting to emergency departments. Primary funding source: Department of Emergency Medicine, Copenhagen University hospital, Bispebjerg and Frederiksberg Hospital.

Adults with low socioeconomic position (SEP) are often provided poorer healthcare than adults with high SEP. Parents’ SEP affects their children̵

Aims: How the pre-hospital chest pain triage contributes to inequities in cardiovascular outcomes remains poorly understood in patients with severe mental illness (SMI). We aimed to examine the association between SMI, emergency response, and cardiovascular health disparities in chest pain-related calls. Methods and results: This registry-based cohort study included first-time chest pain-related calls to the Copenhagen Emergency Medical Services (emergency number and out-of-hours service) during the study period 2014–18. We compared patients with SMI to patients without SMI (controls). We examined emergency response following telephone triage and diagnoses assigned during hospitalization by multivariable logistic regression. Of 64 937 chest pain-related calls, 4303 (7%) were from patients with SMI and 60 634 (93%) from controls. Patients with SMI more often received an acute ambulance dispatch than controls (66% vs. 63%, OR: 1.24, 95% CI: 1.16–1.32). However, patients with SMI were less likely than controls to be admitted within 24 h after the call (81% vs. 85%, OR: 0.82, 95% CI: 0.76–0.89), assigned a cardiovascular diagnosis during hospitalization following the call (16% vs. 26%, OR: 0.61, 95% CI: 0.56–0.67), or undergo revascularization within 30 days after the call (4% vs. 7%, OR: 0.65, 95% CI: 0.55–0.78). The 30-day mortality was similar in patients with SMI and controls (1% vs. 2%, OR: 1.18, 95% CI: 0.90–1.55). Conclusion: Pre-hospital triage of chest pain did not contribute substantially to inequity in cardiovascular care of patients with SMI, whereas care disparities were observed in hospitalization, diagnostics, and treatment. Further examination of the symptom presentation is needed to improve identification of the acutely ill cardiovascular patients.