Temporal trends and hospital-level variation of inhospital cardiac arrest incidence and outcomes in the Veterans Health Administration

Bradley, Steven M; Kaboli, Peter J.; Kamphuis, Lee A.; Chan, Paul S.; Iwashyna, Theodore J.; Nallamothu, Brahmajee K.

doi:10.1016/j.ahj.2017.05.018

Cited by 21 publications

(15 citation statements)

References 26 publications

(44 reference statements)

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“…For example, studies of in-hospital cardiac arrest in VA populations have estimated event rates of 4 per 1000 hospital admissions. 17 Prior research has sought to inform the optimal treatment of patients who experience in-hospital cardiac arrest. 18 , 19 , 20 , 21 In addition, significant clinical resources are dedicated to in-hospital cardiac arrest, with estimates exceeding $300 million nationally to equip, train, and accredit clinicians and hospitals in resuscitation care.…”

Section: Discussionmentioning

confidence: 99%

Incidence, Risk Factors, and Outcomes Associated With In-Hospital Acute Myocardial Infarction

et al. 2019

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Key Points Question What are the incidence, risk factors, and outcomes associated with in-hospital acute myocardial infarction (AMI)? Findings This cohort study of 1.3 million patients hospitalized in US Veterans Health Administration facilities found an incidence of in-hospital AMI of 4.27 per 1000 admissions, and risk factors associated with in-hospital AMI included history of coronary artery disease, elevated heart rate, low hemoglobin level, and elevated white blood cell count. Compared with a matched control group, mortality was significantly higher for in-hospital AMI. Meaning In-hospital AMI is common and is associated with prior cardiovascular disease, physiological disturbances, and poor survival.

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Section: Discussionmentioning

confidence: 99%

Incidence, Risk Factors, and Outcomes Associated With In-Hospital Acute Myocardial Infarction

et al. 2019

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“…A meta-analysis yielded a 1-year survival rate of 13.4% but showed substantial heterogeneity between studied cohorts [4]. A US study also showed heterogeneity in incidence and outcomes after IHCA between centres [5]. This observed heterogeneity may be attributed in part to differences in case-mix or to differences in improvable facets of care (quality of care) at the provider and hospital level.…”

Section: Introductionmentioning

confidence: 99%

Between-centre differences in care for in-hospital cardiac arrest: a prospective cohort study

et al. 2021

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Background Survival after in-hospital cardiac arrest is poor, but current literature shows substantial heterogeneity in reported survival rates. This study aims to evaluate care for patients suffering in-hospital cardiac arrest (IHCA) in the Netherlands by assessing between-hospital heterogeneity in outcomes and to explain this heterogeneity stemming from differences in case-mix or differences in quality of care. Methods A prospective multicentre study was conducted comprising 14 centres. All IHCA patients were included. The adjusted variation in structure and process indicators of quality of care and outcomes (in-hospital mortality and cerebral performance category [CPC] scale) was assessed with mixed effects regression with centre as random intercept. Variation was quantified using the median odds ratio (MOR), representing the expected odds ratio for poor outcome between two randomly picked centres. Results After excluding centres with less than 10 inclusions (2 centres), 701 patients were included of whom, 218 (32%) survived to hospital discharge. The unadjusted and case-mix adjusted MOR for mortality was 1.19 and 1.05, respectively. The unadjusted and adjusted MOR for CPC score was 1.24 and 1.19, respectively. In hospitals where personnel received cardiopulmonary resuscitation (CPR) training twice per year, 183 (64.7%) versus 290 (71.4%) patients died or were in a vegetative state, and 59 (20.8%) versus 68 (16.7%) patients showed full recovery (p < 0.001). Conclusion In the Netherlands, survival after IHCA is relatively high and between-centre differences in outcomes are small. The existing differences in survival are mainly attributable to differences in case-mix. Variation in neurological outcome is less attributable to case-mix.

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“…Prior to the COVID-19 pandemic, large variations in hospital-wide incidence rates of adult IHCA have been reported, ranging from 3.8 to 13.1 per 1,000 admissions, along with a variation in survival to discharge rate, ranging from 10% to 20% [ 8 , 9 ]. Recent studies have reported poor outcomes after IHCA in patients with COVID-19 infection [ 3 , 6 , 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…They reported a survival rate of 3% during the COVID-19 pandemic compared to a 13% survival rate (P = 0.007) in the pre-COVID-19 period, where PEA was the most common initial rhythm (67/125, 54%) [ 7 ]. Among 136 patients with IHCA in a study from Wuhan, China, 18 patients (13.2%) achieved ROSC, four (2.9%) patients survived at least 30 days, and one patient had a favorable neurological outcome at 30 days; the most common initial rhythm was asystole (122/136, 89.1%) [ 3 , 9 ]. Mortality in patients with COVID-19 infection has varied across the world and is higher in men, older patients, and those with comorbid illnesses [ 2 , 10 , 11 ].…”

Section: Discussionmentioning

confidence: 99%

In-Hospital Cardiac Arrest (IHCA) and Outcomes in Patients Admitted With COVID-19 Infection

Khosla¹,

Delio²,

Glass³

et al. 2021

Cureus

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Temporal trends and hospital-level variation of inhospital cardiac arrest incidence and outcomes in the Veterans Health Administration

Cited by 21 publications

References 26 publications

Incidence, Risk Factors, and Outcomes Associated With In-Hospital Acute Myocardial Infarction

Incidence, Risk Factors, and Outcomes Associated With In-Hospital Acute Myocardial Infarction

Between-centre differences in care for in-hospital cardiac arrest: a prospective cohort study

In-Hospital Cardiac Arrest (IHCA) and Outcomes in Patients Admitted With COVID-19 Infection

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