Abstract 18080: Survival Trends and Healthcare Cost Following Out-of-Hospital Cardiac Arrest in the United States: Is the Price Tag Worth It?
Introduction: The international resuscitation community has put forward multiple strategies to optimize health care delivery following cardiac arrest.
Hypothesis: We sought to identify national trends in survival and consequent healthcare cost after out-of-hospital cardiac arrest (OHCA).
Methods: We used the 1995 to 2013 Nationwide Inpatient Sample database to identify adults ≥ 18 years old hospitalized after OHCA (ICD-9-CM principal diagnosis codes 427.41, 427.5). Age and gender adjusted survival rates were studied in the overall sample and by initial rhythm. Temporal trends in survival, hospital charges and cost were examined with year as a continuous variable (1995-2013) added to the multivariable regression model. All charges and costs were adjusted using the consumer price index with 2015 as the index year.
Results: Of 247,684 hospitalized OHCA patients, 126,690 (51.1%) presented with ventricular fibrillation [VF], and 123,098 (49.3%) survived to hospital discharge. Mean age was 66.7±14 years. Although overall survival to discharge increased from 49.9% (95% CI 39.8%–60.0%) in 1995 to 54.0% (95% CI 46.3%–61.8%) in 2013, this trend was not statistically significant (Ptrend = 0.56). However, subgroup analyses showed that survival to discharge significantly increased in VF patients from 73.1% (95% CI 60.8%–85.5%) in 1995 to 79.0% (95% CI 70.9%–87.2%) in 2013 (Ptrend < 0.001). Concomitantly, a significant decrease in survival to discharge was noted in non-VF rhythm patients from 28.2% (95% CI 15.4%–41.0%) in 1995 to 19.9% (95% CI 10.0%–29.8%) in 2013 (Ptrend<0.001). The overall mean (SE) cost of hospitalization per patient was $19,800 ($226) with cost increasing from $18,287 ($683) in 2001 to $21,092 ($514) in 2013 at an average annual rate of $261 (Ptrend < 0.001).
Conclusions: The national experience confirms that while cost of care delivery for post-arrest patients has increased, this has not resulted in better clinical survival. A detailed examination of such high-value care is essential to minimize fruitless spending and better utilize precious national health care dollars.
Author Disclosures: S. Eid: None. A. Albaeni: None. B. Akinyele: None. L. Raghavakurup: None. N. Chandra-Strobos: None.
- © 2016 by American Heart Association, Inc.