April 1, 2013 – The DCRI’s Lesley Curtis, PhD, and other researchers used data from the Get With the Guidelines–Resuscitation registry matched with Medicare patient records to chart long-term outcomes.
Nearly 60 percent of elderly survivors of in-hospital cardiac arrest were still alive after one year, according to a new study by DCRI researchers.
The study by Lesley Curtis, PhD; Bradley Hammill, MS; and colleagues from other institutions was published in the March 14 issue of the New England Journal of Medicine.
Although previous studies have focused on in-hospital survival rates of elderly cardiac arrest patients, there has been little research to date on long-term survival rates. For this study, Curtis, Hammill, and their colleagues linked data from the Get With The Guidelines–Resuscitation registry, a large national registry of in-hospital cardiac arrests, with Medicare claims files. In total, they examined data from more than 19,000 patients at 523 hospitals across the country. All of these patients experienced in-hospital cardiac arrest between 2000 and 2008 and survived until discharge. After excluding patients younger than 65 years of age and patients whose data could not be linked to Medicare files, the researchers had a final study population of 6,972 patients at 401 hospitals. Of these patients, 55.5 percent were men and 11.8 percent were African-American. The mean age of the patients was 75.8 years.
With a primary outcome defined as survival at one year, the researchers conducted a statistical analysis of the study population. They found that ventricular fibrillation and pulseless electrical activity were the most common causes of cardiac arrest. Approximately one-fourth of the patients had a diagnosis of heart failure, heart attack, or impaired kidney function. At discharge, 48.1 percent of patients had mild or no neurological disability; the remainder had moderate-to-severe disability or were vegetative or in a coma. At discharge, 55.3 percent were transferred to a nursing or rehabilitative facility; 40 percent were sent home; and 4.8 percent went into hospice care.
The overall rate of survival after hospital discharge was 82 percent at 30 days, 72 percent at three months, 58.5 percent at one year, and 49.6 percent at two years. “The rates of one-year survival were significantly lower among patients who were older, men, and black (versus patients who were younger, women, and white, respectivily) and among patients with moderate or more severe neurologic disability at discharge (versus mild or no neurologic disability).More than one-third of the patients were not readmitted to the hospital within one year after discharge, and many of the patient characteristics associated with lower rates of one-year survival were also associated with higher rates of readmission.