Long-Term Survival Trends of Medicare Patients After In-Hospital Cardiac Arrest: Insights from Get With The Guidelines-Resuscitation

RESUSCITATION

卷:123

Article

Thompson, Lauren E.¹  Chan, Paul S.²  Tang, Fengming²  Nallamothu, Brahmajee K.³  Girotra, Saket⁴  Perman, Sarah M.⁵  Bose, Somnath⁶  Daugherty, Stacie L.¹  Bradley, Steven M.⁷ 

[1] Univ Colorado, Dept Cardiol, Aurora, CO USA

[2] Mid Amer Heart Inst, Kansas City, MO USA

[3] Univ Michigan, Ann Arbor, MI 48109 USA

[4] Univ Iowa, Iowa City, IA USA

[5] Univ Colorado, Dept Emergency Med, Aurora, CO USA

[6] Harvard Med Sch, Boston, MA USA

[7] Minneapolis Heart Inst, Minneapolis, MN USA

关键词: In-Hospital cardiac arrest;    Outcomes;    Survival;    Resuscitation;   

DOI  :  10.1016/j.resuscitation.2017.10.023

来源: Elsevier

【 摘 要 】

Background: Although rates of survival to hospital discharge after in-hospital cardiac arrest (IHCA) have improved over the last decade, it is unknown if these survival gains are sustained after hospital discharge. Objective: To examine 1-year survival trends overall and by rhythm after IHCA. Methods: Using Medicare beneficiaries (age >= 65 years) with IHCA occurring between 2000 and 2011 at Get With The Guidelines((R))-Resuscitation Registry participating hospitals we used multivariable regression, to examine temporal trends in risk-adjusted rates of 1-year survival. Results: Among 45,567 patients with IHCA, the unadjusted 1-year survival was 9.4%. Unadjusted 1-year survival was 21.8% among the 9,223 (20.2%) of patients with Ventricular Fibrillation or Pulseless Ventricular Tachycardia (VF/VT) and 6.2% among the 36,344 (79.8%) of patients with Pulseless Electrical Activity or asystole (PEA/asystole). After adjustment for patient and arrest characteristics, 1-year survival increased over time for all IHCA from 8.9% in 2000-2001 to 15.2% in 2011 (adjusted rate ratio [RR] per year, 1.05; 95% CI, 1.03-1.06; P < 0.001 for trend). Improvements in 1-year risk adjusted survival were also observed for VF/VT (19.4% in 2000-2001 to 25.6% in 2011 [RR per year, 1.02; 95% CI, 1.01-1.04; P 0.004 for trend]) and PEA/asystole arrests (4.7% in 2000-2001 to 10.2% in 2011 [RR per year, 1.07; 95% CI, 1.05-1.08; P < 0.001 for trend]). Conclusion: Among Medicare beneficiaries in the GWTG-Resuscitation registry, 1-year survival after IHCA has increased for over the past decade. Temporal improvements in survival were noted for both shockable and non-shockable presenting arrest rhythms. (C) 2017 Elsevier B.V. All rights reserved.

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