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. 2021 Jul 28;29(1):103.
doi: 10.1186/s13049-021-00923-0.

Intensive care-treated cardiac arrest: a retrospective study on the impact of extended age on mortality, neurological outcome, received treatments and healthcare-associated costs

Ester Holmström  1 , Ilmar Efendijev  2 , Rahul Raj  3 , Pirkka T Pekkarinen  2 , Erik Litonius  2 , Markus B Skrifvars  4
Affiliations

Intensive care-treated cardiac arrest: a retrospective study on the impact of extended age on mortality, neurological outcome, received treatments and healthcare-associated costs

Ester Holmström et al. Scand J Trauma Resusc Emerg Med. .

Abstract

Background: Cardiac arrest (CA) is a leading cause of death worldwide. As population ages, the need for research focusing on CA in elderly increases. This study investigated treatment intensity, 12-month neurological outcome, mortality and healthcare-associated costs for patients aged over 75 years treated for CA in an intensive care unit (ICU) of a tertiary hospital.

Methods: This single-centre retrospective study included adult CA patients treated in a Finnish tertiary hospital's ICU between 2005 and 2013. We stratified the study population into two age groups: <75 and [Formula: see text]75 years. We compared interventions defined by the median daily therapeutic scoring system (TISS-76) between the age groups to find differences in treatment intensity. We calculated cost-effectiveness by dividing the total one-year healthcare-associated costs of all patients by the number of survivors with a favourable neurological outcome. Favourable outcome was defined as a cerebral performance category (CPC) of 1-2 at 12 months after cardiac arrest. Logistic regression analysis was used to identify independent associations between age group, mortality and neurological outcome.

Results: This study included a total of 1,285 patients, of which 212 (16 %) were [Formula: see text]75 years of age. Treatment intensity was lower for the elderly compared to the younger group, with median TISS scores of 116 and 147, respectively (p < 0.001). The effective cost in euros for patients with a good one-year neurological outcome was €168,000 for the elderly and €120,000 for the younger group. At 12 months after CA 24 % of the patients in the elderly group and 47 % of the patients in the younger group had a CPC of 1-2 (p < 0.001). Age was an independent predictor of mortality (multivariate OR = 2.90, 95 % CI: 1.94-4.31, p < 0.001) and neurological outcome (multivariate OR = 3.15, 95 % CI: 2.04-4.86, p < 0.001).

Conclusions: The elderly ICU-treated CA patients in this study had worse neurological outcomes, higher mortality and lower cost-effectiveness than younger patients. Elderly received less intense treatment. Further efforts are needed to recognize the tools for assessing which elderly patients benefit from a more aggressive treatment approach in order to improve the cost-effectiveness of post-CA management.

Keywords: Cardiac arrest; Elderly; ICUCA; IHCA; OHCA; cardiopulmonary resuscitation; critical care; intensive care unit.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Mean cost distribution among all patients in 2021 euros
Fig. 2
Fig. 2
Kaplan-Meier survival curve of all cases during the first year, Log Rank p < 0.001
See this image and copyright information in PMC

References

    1. Porzer M, et al. Out-of-hospital cardiac arrest. Biomedical papers. 2017;161(4):348–53. doi: 10.5507/bp.2017.054. - DOI - PubMed
    1. Zima E. Sudden Cardiac Death and Post Cardiac Arrest Syndrome. An Overview. J Crit Care Med (Targu Mures) 2015;1(4):167–70. doi: 10.1515/jccm-2015-0031. - DOI - PMC - PubMed
    1. Hirlekar G, et al. Survival and neurological outcome in the elderly after in-hospital cardiac arrest. Resuscitation. 2017;118:101–6. doi: 10.1016/j.resuscitation.2017.07.013. - DOI - PubMed
    1. Bielecki JM, et al. Disparities in a provision of in-hospital post-arrest interventions for out-of-hospital cardiac arrest (OHCA) in the elderly population-protocol for a systematic review. Syst Rev. 2016;5:55. doi: 10.1186/s13643-016-0234-4. - DOI - PMC - PubMed
    1. Segal N, et al. Evolution of Survival in Cardiac Arrest with Age in Elderly Patients: Is Resuscitation a Dead End? The Journal of Emergency Medicine. 2018;54(3):295–301. doi: 10.1016/j.jemermed.2017.11.018. - DOI - PubMed