HealthDay News — A considerable proportion of deaths attributed to out-of-hospital cardiac arrest (OHCA) are actually caused by occult overdose, according to a research letter published online Aug. 11 in the Annals of Internal Medicine.

Robert M. Rodriguez, M.D., from the University of California in San Francisco, and colleagues characterized occult overdose OHCA deaths by comparing their characteristics with all other causes of OHCA deaths. Data were included from 525 autopsied OHCA deaths among persons aged 18 to 90 years from Feb. 1, 2011, to March 1, 2014, in San Francisco and 242 OHCA deaths with autopsies from March 1, 2014, to Dec. 31, 2017.

The researchers found that 15 percent of the deaths in the initial cohort and 22.3 percent in the extended cohort were adjudicated as occult overdose. Those with overdose deaths were younger than those with nonoverdose OHCA deaths, and were more often White or Black than Asian or Latino. In the initial and extended periods, the most common drug classes were opioids (68.4 and 48.1 percent, respectively), sedative-hypnotics (49.4 and 51.9 percent, respectively), and stimulants (48.1 and 51.9 percent, respectively). Most of those with overdose deaths tested positive for multiple intoxicants (75.9 and 55.6 percent in the initial and extended periods, respectively).

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“Published national mortality estimates based on recognized overdoses may be a substantial underestimate of the true burden, because occult overdose deaths masquerading as sudden cardiac deaths are missed without postmortem toxicologic analysis,” the authors write.

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