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

Abstract

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≥65years) with IHCA occurring between 2000 and 2011 at Get With The Guidelines®-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.

Keywords: In-Hospital cardiac arrest; Outcomes; Resuscitation; Survival.

Fig. 1

Study Design Flowsheet. Abbreviations: GWTG-R = Get With The Guidelines-Resuscitation^® ; IHCA = in-hospital cardiac arrest.

Fig. 2

Unadjusted Rates of Discharge, 30-day, and 1-Year Survival after In-Hospital Cardiac Arrest Overall and By Presenting Rhythm. Figure includes 45,567 patients with In-Hospital Cardiac Arrest at 525 Get With the Guideline-Resuscitation Hospital’s between 2000 and 2011. Figure demonstrates unadjusted discharge, 30-day, and 1-year survival rates. Abbreviations: Asystole/PEA = asystole or pulseless electrical activity; VT/VF = Pulseless Ventricular Tachycardia or Ventricular Fibrillation