Abstract 133: Regional Variation in Post--Cardiac Arrest Care: A Statewide Evaluation
Introduction: There is an evolving body of literature advocating for regional post cardiac arrest systems of care. We sought to describe the variation in the provision of post cardiac arrest care in a single large state.
Methods: We used the Michigan Inpatient data base (MIBD) to evaluate care provided to post cardiac arrest patients from July 2008-June 2011. The MIDB is a comprehensive source of inpatient activity at Michigan hospitals. We included all patients admitted with ICD-9 CM diagnosis of cardiac arrest (ICD 427.5) or ventricular fibrillation (427.41). Data was collated regarding patient demographics, final diagnoses, and procedures performed: therapeutic hypothermia (TH), PCI, implantable cardiac defibrillator (ICD) placement, and coronary artery bypass grafting (CABG). We evaluated variation in care by region, using the eight state designated emergency care regions (MECR), which are designed to facilitate disaster, trauma, and cardiac care. Descriptive statistics, correlation coefficients and chi-square results are reported.
Results: During the study period, there were 21,856 cardiac arrests admitted with 9,014 (41.2%) discharged alive. Rates of TH increased by year (0.7%, 1.7%, 2.2% p<0.001). Significant regional variation in post arrest care was observed for TH, PCI, CABG, and ICD (Table 1). Patients with diagnosis VF were more likely to received TH (2.3% vs 1.2%, (OR 1.9, 95% CI 1.5, 2.3)), and TH provision varied more than eightfold region (0.6% to 5.1%, p<0.001)by region. There was no correlation between TH and other cardiac procedures.
Conclusion: Use of TH is increasing in Michigan, and significant regional variation exists for post cardiac arrest care. Provisional rate of TH post arrest did not correlate with other interventional cardiac procedures. Designation of regional cardiac arrest centers identified by their provision of invasive cardiac procedures may not result in adequate utilization of TH.
- © 2012 by American Heart Association, Inc.