Abstract 227: Acute Inpatient Rehabilitation And Social Determinants Of Health Are Associated With Functional Recovery Patterns At 12 Months Relative To Hospital Discharge From Cardiac Arrest.

Abstract

Introduction: Cardiac arrest (CA) survivors have significant impairments and poor functional outcomes at hospital discharge. We assessed if discharge disposition to acute inpatient rehabilitation after CA-related hospitalization is associated with improved functional recovery at 12 months relative to alternative acute care hospital discharge dispositions. Methods: Adults with the return of spontaneous circulation after in-hospital or out-of-hospital CA between 2/1/2016- 1/31/2020 admitted to intensive care units in a single tertiary care center were enrolled in an observational, prospective cohort study. A series of logistic regressions were used to assess acute inpatient rehabilitation associations with good functional recovery patterns, defined as persistent Modified Rankin Score (mRS) 0-2, or absence of any worsening of mRS at 12 months relative to discharge mRS. The model included demographics, individual and structural-level Social Determinants of Health, and pertinent clinical characteristics. Results: Of 201 included patients (24% Hispanic and 19% Black; average age 56±16 years; 40% women), 63% (n=127) reported good functional recovery pattern. Patients who went to acute inpatient rehabilitation were significantly more likely to experience good recovery pattern (54.3% vs 37.8% with poor recovery pattern, p<0.01). In a multivariable model, acute inpatient rehabilitation was significantly associated with a good recovery pattern when compared to other discharge dispositions (home with out-patient rehabilitation services (odds ratio (OR), 0.3; CI, 0.1-0.8; p = 0.02), and skilled nursing facility (OR, 0.2; CI, 0.1-0.6; p<0.01). SDOH including minority race/ethnicity, poor insurance, premorbid unemployment, no carepartner or spouse, and patients with longer hospital length of stay had independent and significant associations with poor functional recovery patterns. Conclusions: Acute inpatient rehabilitation was associated with a good functional recovery pattern 12 months after hospital discharge from CA. Social determinants of health have an independent effect on the functional recovery patterns and should be systematically collected for future outcome-based studies.