Long-Term Outcomes Among Elderly Survivors of Out-of-Hospital Cardiac Arrest

Abstract

Background: Most studies on out-of-hospital cardiac arrest have focused on immediate survival. However, little is known about long-term outcomes and resource use among survivors.

Methods and results: Within the national CARES registry, we identified 16 206 adults 65 years or older with an out-of-hospital cardiac arrest between 2005 and 2010. Among 1127 patients who were discharged alive, we evaluated whether 1-year mortality, cumulative readmission incidence, and follow-up inpatient costs differed according to patients' race, sex, initial cardiac arrest rhythm, bystander delivery of cardiopulmonary resuscitation, discharge neurological status, and functional status (hospital discharge disposition). Overall 1-year mortality after hospital discharge was 31.8%. Among survivors, there were no long-term mortality differences by sex, race, or initial cardiac arrest rhythm, but worse functional status and severe neurological disability at discharge were associated with higher mortality. Moreover, compared with first responders, cardiopulmonary resuscitation delivered by bystanders was associated with 23% lower mortality (hazard ratio 0.77 [confidence interval 0.58-1.02]). Besides mortality, 638 (56.6%) patients were readmitted within the first year, and the cumulative readmission incidence was 197 per 100 patient-years. Mean 1-year inpatient costs were $23 765±41 002. Younger age, black race, severe neurological disability at discharge, and hospital disposition to a skilled nursing or rehabilitation facility were each associated with higher 1-year inpatient costs (P for all <0.05).

Conclusion: Among elderly survivors of out-of-hospital cardiac arrest, nearly 1 in 3 patients die within the first year. Long-term mortality and inpatient costs differed substantially by certain demographic factors, whether cardiopulmonary resuscitation was initiated by a bystander, discharge neurological status, and hospital disposition.

Keywords: cardiac arrest; cost; outcomes research; survival.

Figure 1

Definition of the study cohort.

Figure 2

Comparison of long‐term mortality with matched medicare cohorts. Survivors of out‐of‐hospital cardiac arrest had higher mortality during follow‐up than patients hospitalized for any reason but lower mortality than patients who required mechanical ventilation during the index hospitalization. CARES indicates cardiac arrest registry to enhance survival.

Figure 3

Cumulative readmission incidence and frequency of readmissions during the first year. There were 197 readmissions per 100 patient years during the first year of follow‐up, although 43% of cardiac arrest survivors were not readmitted during this time.