Clinical characteristics and survival in patients with heart failure experiencing in hospital cardiac arrest

Abstract

In patients with heart failure (HF) who suffered in-hospital cardiac arrest (IHCA), little is known about the characteristics, survival and neurological outcome. We used the Swedish Registry of Cardiopulmonary Resuscitation to study this, including patients aged ≥ 18 years suffering IHCA (2008-2019), categorised as HF alone, HF with acute myocardial infarction (AMI), AMI alone, or other. Odds ratios (OR) for 30-day survival, trends in 30-day survival, and the implication of HF phenotype was studied. 6378 patients had HF alone, 2111 had HF with AMI, 4210 had AMI alone. Crude 5-year survival was 9.6% for HF alone, 12.9% for HF with AMI and 34.6% for AMI alone. The 5-year survival was 7.9% for patients with HF and left ventricular ejection fraction (LVEF) ≥ 50%, 15.4% for LVEF < 40% and 12.3% for LVEF 40-49%. Compared with AMI alone, adjusted OR (95% CI) for 30-day survival was 0.66 (0.60-0.74) for HF alone, and 0.49 (0.43-0.57) for HF with AMI. OR for 30-day survival in 2017-2019 compared with 2008-2010 were 1.55 (1.24-1.93) for AMI alone, 1.37 (1.00-1.87) for HF with AMI and 1.30 (1.07-1.58) for HF alone. Survivors with HF had good neurological outcome in 92% of cases.

Figure 1

Neurological deficits measured as cerebral performance category in patients discharged alive. CPC scores among patients who were discharged alive. HF = heart failure; MI = myocardial infarction.

Figure 2

Adjusted odds ratios for 30-day survival. Odds ratios for 30-days survival, with covariate adjustment for age, sex, time from arrest to cardiopulmonary resuscitation (CPR), initial rhythm and witnessed status. Subgroup analyses were performed in relation to sex, age-group (18–49 years, 50–69 years and 70 years or older) and diabetes status. HF = heart failure; LVEF = left ventricular ejection fraction; MI = myocardial infarction.

Figure 3

Association between LVEF and 30-days survival in patients with HF alone. Modelling the association between LVEF and 30-days survival using logistic regression. LVEF was expanded into a restricted cubic spline with 4 knots, and covariate adjustment was made for age, sex, time from arrest to start of cardiopulmonary resuscitation (CPR), initial rhythm and witnessed status. CI = confidence interval; LVEF = left ventricular ejection fraction; OR = odds ratio.

Figure 4

Trends in survival. Trends in 30-days survival during 2008 to 2019, in relation to HF and acute MI status. Adjustment was made for age and sex. Odds ratios (OR) were calculated by comparing cases during 2017–2019 with 2008–2010. The absolute change equals the difference between year 2008 and year 2019. HF = heart failure; MI = myocardial infarction.

Figure 5

Long-term survival in relation to heart failure and acute MI status and LVEF. Kaplan–Meier estimates stratified by heart failure and acute MI status, as well as LVEF category. All figures are unadjusted. IHCA = in-hospital cardiac arrest; LVEF = left ventricular ejection fraction; MI = myocardial infarction.