Abstract 1781: Trends in Cardiac Arrest in US Hospital Population - An Analysis of NHDS Data from 1988 to 2003
Objective: To analyze the trends in the incidence, outcomes, co-morbidities and treatment among patients admitted with cardiac arrest in a nationwide database.
Methods: The study involves analysis of National Hospital Discharge survey (NHDS) data from 1988 to 2003. Using ICD-9 CM code 427.5 all discharges with the diagnosis of cardiac arrest were identified. Using independent sample T-test and Chi-square test, the continuous and categorical variables were compared respectively.
Results: During the study period, there were 1.9 million estimated admissions for cardiac arrest. The incidence of cardiac arrest related hospitalizations decreased from 69 cases per 100,000 in 1988 to 29 cases per 100,000 in 2003 (58% reduction). Similar patterns were seen in male and female populations (male 56% reduction; females 57%). The mean age was 65-yrs. [Males 65 - yrs.; Female 69.9 - yrs.; difference of 4.5-years (95% C.I. 4.49 – 4.69)]. In 1988, 68% of patients were older than 69-yrs. but the proportion of such patients declined to 50% in 2003 (26% reduction). The most prevalent co-morbidity was myocardial infarction (21.4%; 95% C.I. (21.41 – 41.99), with CHF (18.78%; 95% C.I. 18.74 – 36.75) and ventricular arrhythmias (14.58%; 95% C.I. 14.54 – 28.52) being second and third respectively. Among non-cardiac diagnoses Diabetes (14.58%; 95% C.I. 14.54 – 28.52) was most frequently present. The most common site of myocardial infarction was anterior wall (27.9% of all MI patients). The percentage of cardiac patients surviving the hospitalization increased from 25.7% in the period 1988 – 1991 to 33.99% in the period 2000 – 2003; (31.9% increase). The improvement in survival for females was 43.2% as oppose to 21.6% for males (p value = 0.04). The largest number of deaths occurred within the first 24 hours of hospitalization (36%). The most commonly performed cardiovascular procedure was coronary angiography (12.3%). Temporary pacemaker implantation (4.1%) and percutaneous coronary intervention (3.4%) were second and third most commonly coded cardiovascular procedures respectively.
Conclusion: The incidence of cardiac arrest related hospitalizations has decreased significantly over the past 16 years with considerable improvement in survival rate, especially in women.