Abstract
Although survival for in-hospital cardiac arrest (IHCA) has improved substantially over the last 2 decades, survival rates have plateaued in recent years. A better understanding of hospital differences in IHCA incidence may provide important insights regarding best practices for prevention of IHCA. To determine the incidence of IHCA among Medicare beneficiaries, and evaluate hospital variation in incidence of IHCA. This observational cohort study analyzes 2014 to 2017 data from 170 hospitals participating in the Get With The Guidelines-Resuscitation registry, linked to Medicare files. Participants were adults aged 65 years and older. Statistical analysis was performed from January to December 2021. Case-mix index, teaching status, and nurse-staffing. Hospital incidence of IHCA among Medicare beneficiaries was estimated as the number of IHCA patients divided by the total number of hospital admissions. Multivariable hierarchical regression models were used to calculate hospital incidence rates adjusted for differences in patient case-mix and evaluate the association of hospital variables with IHCA incidence. Among a total of 4.5 million admissions at 170 hospitals, 38 630 patients experienced an IHCA during 2014 to 2017. Among the 38 630 patients with IHCAs, 7571 (19.6%) were non-Hispanic Black, 26 715 (69.2%) were non-Hispanic White, and 16 732 (43.3%) were female; the mean (SD) age at admission was 76.3 (7.8) years. The median risk-adjusted IHCA incidence was 8.5 per 1000 admissions (95% CI, 8.2-9.0 per 1000 admissions). After adjusting for differences in case-mix index, IHCA incidence varied markedly across hospitals ranging from 2.4 per 1000 admissions to 25.5 per 1000 admissions (IQR, 6.6-11.4; median odds ratio, 1.51 [95% CI, 1.44-1.58]). Among hospital variables, a higher case-mix index, higher nurse staffing, and teaching status were associated with a lower hospital incidence of IHCA. This cohort study found that the incidence of IHCA varies markedly across hospitals, and hospitals with higher nurse staffing and teaching status had lower IHCA incidence rates. Future studies are needed to better understand processes of care at hospitals with exceptionally low IHCA incidence to identify best practices for cardiac arrest prevention.
Highlights
In-hospital cardiac arrest (IHCA) affects nearly 290 000 hospitalized patients each year in the United States[1] and is associated with poor survival and a high risk of neurological disability among survivors.[2,3] Over the past decade, hospitals have devoted considerable effort toward improving in-hospital cardiac arrest (IHCA) survival by improving care delivery during the acute resuscitation phase[4-6] and the postresuscitation phase.[7]
After adjusting for differences in case-mix index, IHCA incidence varied markedly across hospitals ranging from 2.4 per 1000 admissions to 25.5 per 1000 admissions (IQR, 6.6-11.4; median odds ratio, 1.51 [95% CI, 1.44-1.58])
This cohort study found that the incidence of IHCA varies markedly across hospitals, and hospitals with higher nurse staffing and teaching status had lower IHCA incidence rates
Summary
In-hospital cardiac arrest (IHCA) affects nearly 290 000 hospitalized patients each year in the United States[1] and is associated with poor survival and a high risk of neurological disability among survivors.[2,3] Over the past decade, hospitals have devoted considerable effort toward improving IHCA survival by improving care delivery during the acute resuscitation phase[4-6] and the postresuscitation phase.[7]. In-hospital cardiac arrest (IHCA) affects nearly 290 000 hospitalized patients each year in the United States[1] and is associated with poor survival and a high risk of neurological disability among survivors.[2,3]. Hospitals have devoted considerable effort toward improving IHCA survival by improving care delivery during the acute resuscitation phase[4-6] and the postresuscitation phase.[7]. Despite these efforts, IHCA survival rates have plateaued in recent years, with mean survival of approximately 25%.2,8,9. Understanding the extent to which the incidence of IHCA varies across hospitals in the US and the factors associated with this variation is a critical first step toward identifying best practices for IHCA prevention
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