April 15, 2016 – Survivors of out-of-hospital cardiac arrest are also frequently readmitted to the hospital.
Among elderly survivors of out‐of‐hospital cardiac arrest, nearly one in three die within the first year. Those patients who do survive are frequently readmitted to the hospital.
A recent study published in the Journal of the American Heart Association examined long‐term outcomes among patients who experience cardiac arrest outside of a hospital. The DCRI’s Lesley Curtis, PhD, was senior author of the study.
Approximately 350,000 Americans experience cardiac arrest outside of a hospital each year. Earlier research has focused mostly on what happens to these patients before and during their hospitalization. The researchers in this study sought to quantify long‐term mortality and costs among survivors of out‐of‐hospital cardiac arrest and analyze outcomes in specific patient subgroups.
To do so, they used patient data from the Cardiac Arrest Registry to Enhance Survival (CARES) registry. CARES is a database that allows communities to submit information from first responders and link it with outcome data from hospitals. Linking CARES data with Medicare data, the researchers identified 16,206 adults 65 years or older who experienced out‐of‐hospital cardiac arrest between 2005 and 2010. Of these patients, 1,127 survived to hospital discharge.
Overall one‐year mortality after hospital discharge for these survivors was 31.8 percent. The researchers found that sex, race, or initial cardiac arrest rhythm did not affect mortality among survivors, but patients with worse functional status and severe neurological disability at discharge were at higher risk for death.
Compared with first responders, patients who received cardiopulmonary resuscitation (CPR) from bystanders had 23 percent lower mortality. Among patients who survived, 638 (56.6 percent) were readmitted within the first year, and 279 (24.8 percent) were readmitted three or more times.
Mean and median one‐year costs for first-year hospital readmissions for the entire study cohort were $23,765 ± $41,002 and $7,054, respectively. Sex, initial cardiac arrest rhythm, or initiator of CPR did not seem to affect costs. However, compared with whites, black patients incurred nearly twice that rate for inpatient costs during the first year. The researchers also found that patients with moderate to severe neurological disability at discharge had significantly higher one‐year inpatient costs.
Duke’s Bradley Hammill, PhD, also contributed to the study.