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. 2014 Jun 10;3(3):e000871.
doi: 10.1161/JAHA.114.000871.

Hospital variation in survival trends for in-hospital cardiac arrest

Saket Girotra  1 , Peter Cram  2 , John A Spertus  3 , Brahmajee K Nallamothu  4 , Yan Li  5 , Philip G Jones  5 , Paul S Chan  3 ; American Heart Association's Get With the Guidelines®‐Resuscitation Investigators
Collaborators, Affiliations

Hospital variation in survival trends for in-hospital cardiac arrest

Saket Girotra et al. J Am Heart Assoc. .

Abstract

Background: During the past decade, survival after in-hospital cardiac arrest has improved markedly. It remains unknown whether the improvement in survival has occurred uniformly at all hospitals or was driven by large improvements at only a few hospitals.

Methods and results: We identified 93 342 adults with an in-hospital cardiac arrest at 231 hospitals in the Get With The Guidelines(®)-Resuscitation registry during 2000-2010. Using hierarchical regression models, we evaluated hospital-level trends in survival to discharge. Mean age was 66 years, 59% were men, and 21% were black. Between 2000 and 2010, there was a significant decrease in age, prevalence of heart failure and myocardial infarction, and cardiac arrests due to shockable rhythms (P<0.001 for all) and an increase in prevalence of sepsis, respiratory insufficiency, renal insufficiency, intensive care unit location, and mechanical ventilation before arrest (P<0.001 for all). After adjustment for temporal trends in baseline characteristics, hospital rates of in-hospital cardiac arrest survival improved by 7% per year (odds ratio [OR] 1.07, 95% CI 1.06 to 1.08, P<0.001). Improvement in survival varied markedly and ranged from 3% in the bottom hospital quartile to 11% in the top hospital quartile. Compared with minor teaching hospitals (OR 1.04, 95% CI 1.02 to 1.06), hospital rate of survival improvement was greater at major teaching (OR 1.08, 95% CI 1.06 to 1.10) and nonteaching hospitals (OR 1.07, 95% CI 1.05 to 1.09, P value for interaction=0.03).

Conclusion: Although in-hospital cardiac arrest survival has improved during the past decade, the magnitude of improvement varied across hospitals. Future studies are needed to identify hospital processes that have led to the largest improvement in survival.

Keywords: cardiac arrest; cardiopulmonary resuscitation; health services research; survival.

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Figures

Figure 1.
Figure 1.
Study cohort.
Figure 2.
Figure 2.
Distribution of (A) unadjusted and (B) adjusted hospital‐level survival trends. The odds ratio (OR) represents the rate of change in survival year‐over‐year. Hospitals with OR>1.00 had an improvement in survival over time.
Figure 3.
Figure 3.
Change in in‐hospital cardiac arrest survival rates from 2000–2003 to 2007–2010. The mean adjusted hospital survival rate increased from 18.1% in 2000–2003 (range 9.1% to 29.8%) to 21.4% in 2007–2010 (range 13.9% to 32.2%).
See this image and copyright information in PMC

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