Regional Variation in Incidence and Outcomes of In-Hospital Cardiac Arrest in the United States
Background—Regional variation in incidence and outcomes of in-hospital cardiac arrest (IHCA) is not well studied and may have important health and policy implications.
Methods and Results—We used the 2003-2011 Nationwide Inpatient Sample databases to identify patients aged ≥18 years who underwent cardiopulmonary resuscitation (ICD-9-CM procedure codes 99.60 and 99.63) for IHCA. Regional differences in IHCA incidence, survival to hospital discharge, and resource utilization (total hospital cost, and discharge disposition among survivors) were analyzed. Of 838,465 patients with IHCA, 162,270 (19.4%) were in Northeast, 159,581 (19.0%) in Midwest, 316,201 (37.7%) in South, and 200,413 (23.9%) in West. Overall IHCA incidence in the U.S. was 2.85 per 1,000 hospital admissions. IHCA incidence was lowest in Midwest and highest in West (2.33 and 3.73 per 1,000 hospital admissions, respectively). Compared to Northeast, risk-adjusted survival to discharge was significantly higher in Midwest (OR 1.33, 95% CI 1.31-1.36), South (OR 1.21, 95% CI 1.19-1.23), and West (OR 1.25, 95% CI 1.23-1.27). IHCA survival increased significantly from 2003 to 2011 in the U.S. and in all regions (all Ptrend<0.001). Total hospital cost was highest in West, whereas discharge to skilled nursing facility and utilization of home health care among survivors was highest in Northeast.
Conclusions—We observed significant regional variation in IHCA incidence, survival, and resource utilization in the U.S. This variation was only partially explained by differences in patient and hospital characteristics. Further studies are needed to identify other potential factors responsible for these regional differences in order to improve outcomes after IHCA.
- Received November 26, 2014.
- Revision received January 31, 2015.
- Accepted February 13, 2015.