Abstract 269: Patients >65 Years of Age Have Higher Mortality After In-hospital Cardiac Arrest With Lower Utilization of Healthcare Resources

Abstract

Background: Studies have shown that age is not an independent predictor of short-term and long-term neurological outcomes after cardiopulmonary resuscitation. These findings were reported for both in-hospital and out-of-hospital cardiac arrest. Yet, elderly patients are less aggressively treated and have higher mortality. We investigated the current outcomes and therapeutic approach in a large unselected population of patients. Methods: In a retrospective cohort study, using the 2014 Nationwide Inpatient Sample, we analyzed patients >65 years of age with in-hospital cardiac arrest. We performed univariate analysis of age, sex, race, hospital location, hospital teaching status, insurance type, hospital bed size, Charlson Comorbidity Index and other relevant comorbidities such as ventricular arrhythmias and we included variables with p<0.2 in the multivariate logistic regression model. Results: A total of 39397 patients, who underwent in-hospital cardiopulmonary resuscitation (CPR) were identified. Patients >65 years of age (55%) had mean age of 78+/_0.06, vs 50+/_0.22, p<0.001 and a higher percentage of them were female (46% vs 40%, p<0.001). They were less likely to have ESRD (9% vs 11%, p<0.001), abuse drugs (0.7% vs 10%, p<0.001) and alcohol (0.3% vs 11.5%, p<0.001) and had lower incidence of ventricular tachycardia or ventricular fibrillation (20% vs 23%, p<0.001). They were more likely to have chronic kidney disease (25% vs 11%, p<0.001), diabetes mellites (29% vs 21%, p<0.001), hypertension (69% vs 50%, p<0.001) and heart failure (26% vs 17%, p<0.001). Patients >65 years of age had higher mortality (OR=1.51, 95%CI =1.43-1.61, p<0.001) and were less likely to undergo therapeutic hypothermia (OR=0.66, 95%CI=0.56-0.79, p<0.001), receive cardioverter-defibrillator (OR=0.77, 95%CI=0.64-0.92, p=0.005) and extracorporeal membrane oxygenation (OR=0.32, 95%CI =0.23-0.45, p<0.001). There was no difference in utilization of short-term mechanical circulatory support, dialysis in the setting of acute kidney injury and blood product transfusion. There was also no difference in the incidence of ischemic stroke and placement of percutaneous endoscopic gastrostomy with lower utilization of tracheostomies (OR=0.64, 95% CI= 0.56-0.73, p<0.001) and higher utilization of palliative care consult (OR=1.44, 95% CI=1.33-1.56, p<0.001) in older patients. Patients >65 years of age had lower length of stay (Coef. =-1.46, 95% CI=-1.85- -1.08), p<0.001) and the total charges from hospital stay (Coef. =-49889$, 95% CI= -56803$- -42975, p<0.001). Conclusion: Patients >65 years of age, who underwent in-hospital CPR had higher mortality, which could be related to lower utilization of healthcare resources and contribute to a shorter hospital stay and lower total charges. Furthermore, our study unravels lower utilization of a palliative care consult in a younger population of patients.