Vol 27, No 1 (2020)
Original articles — Clinical cardiology
Published online: 2018-03-26

open access

Page views 5655
Article views/downloads 1037
Get Citation

Connect on Social Media

Connect on Social Media

Epidemiology and chronobiology of out-of-hospital cardiac arrest in a subpopulation of southern Poland: A two-year observation

Stanislaw Szczerbinski1, Jakub Ratajczak2, Piotr Lach2, Jakub Rzeszuto2, Przemyslaw Paciorek2, Joanna Karlowska-Pik3, Bartosz Ziemkiewicz3, Malgorzata Jasiewicz2, Aldona Kubica4
Pubmed: 29611174
Cardiol J 2020;27(1):16-24.


Background: Although recent studies indicate temporal variations in the incidence of out-of-hospital cardiac arrest (OHCA), the Polish experience in this research is scarce to date. We evaluated the epidemiology of OHCA and circadian, weekly and seasonal variations of OHCA frequency among the adult population of the Opole district, Poland.

Methods: The retrospective analysis of 815 OHCA cases with presumed cardiac etiology was made based on dispatch cards from the Emergency Medical Center in Opole registered during a 2 year period (2006–2007).

Results: The incidence of OHCA in the studied population was 1.56/1000 inhabitants per year. Mean age of the group was 69.2 ± 14.2 years, with the majority of men (63%), younger than women (66.1 vs. 74 years, p = 0.0001). The OHCA occurrence increased with age reaching a peak between 71 and 75 years. The incidence of OHCA stayed at stable low levels between 22:00 and 4:59 and started to increase at 5:00, with trimodal peaks: 8:00–10:59, 14:00–15:59 and 18.00–21.59. The lowest number of OHCA occurred from 00:00 to 5:59, the highest from 6:00 to 11:59 (13% vs. 32.4%, p < 0.001). The day with the lowest occurrence of OHCA was Friday, the highest Saturday (10.9% vs. 16%, p = 0.01). Summer was the season of the lowest incidence of OHCA, while winter — the highest (22.6% vs. 26%, p = 0.04). These seasons were the warmest and the coldest one, respectively (average temperature 18.5°C vs. 0°C, p < 0.001).

Conclusions: Circadian and less marked, weekly variability in OHCA occurrence were confirmed. Existing seasonal differences may be affected by temperature. This is the first Polish analysis of a large subpopulation, which also includes seasonal temperature data.

Article available in PDF format

View PDF Download PDF file


  1. Bossaert LL, Perkins GD, Askitopoulou H, et al. ethics of resuscitation and end-of-life decisions section Collaborators. European Resuscitation Council Guidelines for Resuscitation 2015: Section 11. The ethics of resuscitation and end-of-life decisions. Resuscitation. 2015; 95: 302–311.
  2. Gach D, Nowak JU, Krzych ŁJ. Epidemiology of out-of-hospital cardiac arrest in the Bielsko-Biala district: a 12-month analysis. Kardiol Pol. 2016; 74(10): 1180–1187.
  3. Engdahl J, Holmberg M, Karlson BW, et al. The epidemiology of out-of-hospital ‘sudden’ cardiac arrest. Resuscitation. 2002; 52(3): 235–245.
  4. Hermida RC, Ayala DE, Portaluppi F. Circadian variation of blood pressure: the basis for the chronotherapy of hypertension. Adv Drug Deliv Rev. 2007; 59(9-10): 904–922.
  5. Rudic RD. Time is of the essence: vascular implications of the circadian clock. Circulation. 2009; 120(17): 1714–1721.
  6. Nicolau GY, Haus E, Popescu M, et al. Circadian, weekly, and seasonal variations in cardiac mortality, blood pressure, and catecholamine excretion. Chronobiol Int. 1991; 8(2): 149–159.
  7. Kanabrocki EL, Sothern RB, Bremner WF, et al. Weekly and yearly rhythms in plasma fibrinogen in hospitalized male military veterans. Am J Cardiol. 1995; 76(8): 628–631.
  8. Kubica A, Szczerbiński S, Kieszkowska M, et al. Wpływ czynników klimatycznych i chronologicznych na występowanie ostrych incydentów chorobowych. [The influence of climatic and chronological factors on the occurrence of acute disease events] Folia Cardiologica. 2014; 9: 263–266.
  9. Herlitz J, Eek M, Holmberg M, et al. Diurnal, weekly and seasonal rhythm of out of hospital cardiac arrest in Sweden. Resuscitation. 2002; 54(2): 133–138.
  10. Ekelund U, Akbarzadeh M, Khoshnood A, et al. Likelihood of acute coronary syndrome in emergency department chest pain patients varies with time of presentation. BMC Res Notes. 2012; 5: 420.
  11. Li Yi, Du T, Lewin MR, et al. The seasonality of acute coronary syndrome and its relations with climatic parameters. Am J Emerg Med. 2011; 29(7): 768–774.
  12. Phillips DP, Jarvinen JR, Abramson IS, et al. Cardiac mortality is higher around Christmas and New Year's than at any other time: the holidays as a risk factor for death. Circulation. 2004; 110(25): 3781–3788.
  13. Nakanishi N, Nishizawa S, Kitamura Y, et al. Circadian, weekly, and seasonal mortality variations in out-of-hospital cardiac arrest in Japan: analysis from AMI-Kyoto Multicenter Risk Study database. Am J Emerg Med. 2011; 29(9): 1037–1043.
  14. Ong MEh, Ng FSp, Yap S, et al. Temporal variation of out-of-hospital cardiac arrests in an equatorial climate. Open Access Emerg Med. 2010; 2: 37–43.
  15. Brooks SC, Schmicker RH, Rea TD, et al. ROC Investigators. Out-of-hospital cardiac arrest frequency and survival: evidence for temporal variability. Resuscitation. 2010; 81(2): 175–181.
  16. Boczar D, Molodowicz M, et al. Ludność, ruch naturalny i migracje w województwie opolskim w 2006r. [Population, vital statistics and migration of population in opolskie voivodship in 2006]. Urząd Statystyczny we Wrocławiu Wydział Poligrafii w Legnicy. Polisch. 2017: 7–20.
  17. Molodowicz M, et al. Ludność, ruch naturalny i migracje w województwie opolskim w 2007r. [Poulation, vital statistics and migration of poulation in opolskie voivodship in 2007]. Urząd Statystyczny we Wrocławiu Wydział Poligrafii w Legnicy. Polish. 2008: 7–22.
  18. Karlsson LIM, Wissenberg M, Fosbøl EL, et al. Diurnal variations in incidence and outcome of out-of-hospital cardiac arrest including prior comorbidity and pharmacotherapy: a nationwide study in Denmark. Resuscitation. 2014; 85(9): 1161–1168.
  19. Lateef F, Ong MEH, Alfred T, et al. Circadian rhythm in cardiac arrest: the Singapore experience. Singapore Med J. 2008; 49(9): 719–723.
  20. Peckova M, Fahrenbruch CE, Cobb LA, et al. Circadian variations in the occurrence of cardiac arrests: initial and repeat episodes. Circulation. 1998; 98(1): 31–39.
  21. Soo LH, Gray D, Young T, et al. Circadian variation in witnessed out of hospital cardiac arrest. Heart. 2000; 84(4): 370–376.
  22. Tofler GH, Brezinski D, Schafer AI, et al. Concurrent morning increase in platelet aggregability and the risk of myocardial infarction and sudden cardiac death. N Engl J Med. 1987; 316(24): 1514–1518.
  23. Allegra JR, Cochrane DG, Allegra EM, et al. Calendar patterns in the occurrence of cardiac arrest. Am J Emerg Med. 2002; 20(6): 513–517.
  24. Peckova M, Fahrenbruch C, Cobb L, et al. Weekly and seasonal variation in the incidence of cardiac arrests. Am Heart J. 1999; 137(3): 512–515.
  25. Arntz HR, Willich SN, Schreiber C, et al. Diurnal, weekly and seasonal variation of sudden death. Population-based analysis of 24,061 consecutive cases. Eur Heart J. 2000; 21(4): 315–320.