Abstract 14368: Variation in Survival Trends for In-hospital Cardiac Arrest
Background: Survival after in-hospital cardiac arrest has improved over the past decade. However, it remains unknown whether improvement in cardiac arrest survival has been uniformly distributed across all hospitals or driven by large improvements in a small number of hospitals.
Methods & Results: We identified 93,342 adult patients (>/= 18 years) with an in-hospital cardiac arrest between 2000 and 2010 at 231 hospitals with at least 5 years of participation and at least 10 cardiac arrests reported annually to the Get With The Guidelines-Resuscitation registry. We used hierarchical multivariable regression models to evaluate hospital-level trends in survival to discharge. From these models, we derived the relative change in survival per year at each hospital. After adjusting for patient and hospital characteristics, the overall mean annual improvement in survival was 7% (OR 1.07; 95% CI [1.06-1.08], P for trend < 0.001). However, there was marked variation in survival improvement across hospitals (Figure). Hospitals in the top-quartile had mean year-over-year survival improvement of 13% (range 11% to 18%) while the second and third quartiles had mean year-over-year survival improvement of 8% (range 7% to 10%) and 5% (range 3% to 7%), respectively. In contrast, mean improvement in survival at hospitals in the lowest quartile was 1% (range -3% to 3%), suggesting little or no improvement in survival. Conventional hospital characteristics (except academic status) were not associated with the magnitude of survival improvement.
Conclusion: Survival for in-hospital cardiac arrest has improved at nearly all hospitals. However, survival at some hospitals has improved substantially more than at others. Future studies are needed to identify best practices and factors at hospitals that have achieved the largest improvements in survival.
Figure. Distribution of hospital-specific odds ratios per calendar year for survival improvement
- © 2013 by American Heart Association, Inc.