Abstract EP03: 30-day Readmission Rates After Targeted Temperature Management For Cardiac Arrest

Abstract

Background: In its 2015 guidelines, the American Heart Association instituted a Class 1 recommendation for use of Targeted Temperature Management (TTM) in patients with cardiac arrest (CA) . Prior observational studies have suggested benefits using TTM in these patients, while many randomized control trials have failed to replicate these results. Regardless, there have been studies with contradictory conclusions addressing readmission rates in patients receiving TTM. Thus, we sought to ascertain this relationship further by identifying 30-day readmission rates in Out-of-Hospital Cardiac Arrest (OHCA) patients receiving TTM. Methods: We utilized the Healthcare Cost and Utilization Project (HCUP) National Readmission Database (NRD) for data collection and International Classification of Diseases, Ninth and Tenth Revision, Clinical Modification codes to identify 353,380 cardiac arrest cases and clinical variables. The primary outcome includes all-cause readmission rates within 30 days from cardiac arrest index admission discharge. We then conducted a logistic regression analysis after accounting for variables to assess odds of 30-day readmission in these patients. Results: TTM following CA was associated with a decreased likelihood of readmission at 30 days(OR: 0.822, p = 0.006, 95% CI [0.716-0.945]). Comorbidities associated with an increased risk of readmission after controlling for the other variables include congestive heart failure(OR: 1.259, p = 0.027, 95% CI [1.207-1.313]) and renal failure (OR: 1.363, p = 0.031, 95% CI [1.304- 1.425]). Of these patients receiving TTM compared to those who did not receive TTM, there was a greater proportion of cardiogenic shock (23.7% vs. 12.3%, p < 0.001), acute heart failure (20.1% vs. 17.3%, p < 0.001), coronary artery disease (53.0% vs. 46.2%, p < 0.001), ischemic cardiomyopathy (61.7% vs. 53.1%, p < 0.001), ventricular tachycardia (9.6% vs. 8.6%, p = 0.045), and ventricular fibrillation (56.6% vs. 24.1%, p<0.001). Conclusion: TTM following CA is associated with decreased odds of readmission at 30 days. Prior long-term comorbidities represented most of the covariates for readmissions in this patient population.