Abstract 6: A 15-Year Spectrum of Resuscitation Outcomes: A Story of Success or Failure?
Background: Care strategies including automated defibrillators, improved emergency response systems, hypothermia and early revascularization have individually been shown to improve non-traumatic out-of-hospital cardiac arrest (OHCA) survival. We examined a national database to assess the cumulative impact of care change on outcomes in OHCA over a period of 15 years.
Methods: We used the Nationwide Inpatient Sample, the largest nationally representative inpatient database, to calculate outcomes every 5 years from 1995 to 2010. Patients with an ICD-9 CM code for a principle diagnosis of cardiac arrest were included. Patients with any diagnosis of trauma were excluded. Admission rate was calculated using the July 1 population census estimate for each year. In-hospital mortality rate was adjusted for age, sex and Charlson comorbidity index taking year 2010 as a reference. All charges were adjusted for inflation using the consumer price index.
Results: From 1995 to 2010, adjusted in-hospital mortality for OHCA has worsened. On subgroup analysis, mortality has improved when the coded presenting rhythm was Ventricular fibrillation (VF) and worsened when it was non-VF. The rate of poor neurologic outcome has increased with time. These changes have occurred despite the increasing use of hypothermia, coronary catheterization and stenting in all patients. Both the adjusted median hospitalization charges and the total OHCA economic burden have increased, especially after the year 2000.
Conclusions: Comorbidity, age and gender adjusted in-hospital mortality from non-traumatic out-of-hospital cardiac arrest has increased over the past 15 years. Escalating resource utilization has yielded no improvement in survival for the majority of patients but has resulted in increased hospitalization costs, reaching a staggering annual economic burden of ~$1 billion in 2010. More in-depth review of care strategies is needed to improve survival and healthcare expenditure.
- © 2013 by American Heart Association, Inc.