Regional variation in the incidence and outcomes of in-hospital cardiac arrest in the United States

Dhaval Kolte; Sahil Khera; Wilbert S Aronow; Chandrasekar Palaniswamy; Marjan Mujib; Chul Ahn; Sei Iwai; Diwakar Jain; Sachin Sule; Ali Ahmed; Howard A Cooper; William H Frishman; Deepak L Bhatt; Julio A Panza; Gregg C Fonarow

doi:10.1161/CIRCULATIONAHA.114.014542

Regional variation in the incidence and outcomes of in-hospital cardiac arrest in the United States

Circulation. 2015 Apr 21;131(16):1415-25. doi: 10.1161/CIRCULATIONAHA.114.014542. Epub 2015 Mar 19.

Authors

Affiliations

¹ From New York Medical College, Valhalla, NY (D.K., S.K., W.S.A., M.M., S.I., D.J., S.S., H.A.C., W.H.F., J.A.P.); Icahn School of Medicine at Mount Sinai Hospital, New York, NY (C.P.); University of Texas Southwestern Medical Center, Dallas (C.A.); VA Medical Center, Washington, DC (A.A.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); and David-Geffen School of Medicine, University of California at Los Angeles (UCLA), Los Angeles (G.C.F.).
² From New York Medical College, Valhalla, NY (D.K., S.K., W.S.A., M.M., S.I., D.J., S.S., H.A.C., W.H.F., J.A.P.); Icahn School of Medicine at Mount Sinai Hospital, New York, NY (C.P.); University of Texas Southwestern Medical Center, Dallas (C.A.); VA Medical Center, Washington, DC (A.A.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); and David-Geffen School of Medicine, University of California at Los Angeles (UCLA), Los Angeles (G.C.F.). gfonarow@mednet.ucla.edu.

PMID: 25792560
DOI: 10.1161/CIRCULATIONAHA.114.014542

Abstract

Background: Regional variation in the incidence and outcomes of in-hospital cardiac arrest (IHCA) is not well studied and may have important health and policy implications.

Methods and results: We used the 2003 to 2011 Nationwide Inpatient Sample databases to identify patients≥18 years of age who underwent cardiopulmonary resuscitation (International Classification of Diseases, Ninth Edition, Clinical Modification procedure codes 99.60 and 99.63) for IHCA. Regional differences in IHCA incidence, survival to hospital discharge, and resource use (total hospital cost and discharge disposition among survivors) were analyzed. Of 838,465 patients with IHCA, 162,270 (19.4%) were in the Northeast, 159,581 (19.0%) were in the Midwest, 316,201 (37.7%) were in the South, and 200,413 (23.9%) were in the West. Overall IHCA incidence in the United States was 2.85 per 1000 hospital admissions. IHCA incidence was lowest in the Midwest and highest in the West (2.33 and 3.73 per 1000 hospital admissions, respectively). Compared with the Northeast, risk-adjusted survival to discharge was significantly higher in the Midwest (odds ratio, 1.33; 95% confidence interval, 1.31-1.36), South (odds ratio, 1.21; 95% confidence interval, 1.19-1.23), and West (odds ratio, 1.25; 95% confidence interval, 1.23-1.27). IHCA survival increased significantly from 2003 to 2011 in the United States and in all regions (all Ptrend<0.001). Total hospital cost was highest in the West, whereas discharge to skilled nursing facility and use of home health care among survivors was highest in the Northeast.

Conclusions: We observed significant regional variation in IHCA incidence, survival, and resource use in the United States. This variation was explained only partially by differences in patient and hospital characteristics. Further studies are needed to identify other potential factors responsible for these regional differences to improve outcomes after IHCA.

Keywords: cardiopulmonary resuscitation; costs and cost analysis; heart arrest; survival.

Publication types

Comparative Study

MeSH terms

Aged
Aged, 80 and over
Comorbidity
Emergency Service, Hospital / statistics & numerical data
Ethnicity / statistics & numerical data
Female
Heart Arrest / economics
Heart Arrest / epidemiology*
Heart Arrest / therapy
Home Care Services / statistics & numerical data
Hospital Costs
Hospital Mortality
Hospitals / classification
Hospitals / statistics & numerical data
Humans
Incidence
International Classification of Diseases
Male
Medicaid / statistics & numerical data
Medicare / statistics & numerical data
Middle Aged
Patient Admission / statistics & numerical data
Patient Discharge / statistics & numerical data
Skilled Nursing Facilities / statistics & numerical data
Survival Rate
Treatment Outcome
United States / epidemiology