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Rehospitalization common for survivors of in-hospital cardiac arrest
Patients who have survived an in-hospital cardiac arrest have high rates of hospital readmission, according to recent results.
These readmission rates, along with increased costs, are particularly high within certain subgroups, such as younger patients and blacks, the researchers wrote.
The study included data from 6,972 patients enrolled in Get With the Guidelines – Resuscitation, a large, prospective quality-improvement registry of in-hospital cardiac arrest. The data, collected from 2000 to 2008, included Medicare inpatient files from 401 acute care hospitals. Patients identified for inclusion were aged at least 65 years (mean, 75.8 years), had experienced a pulseless, in-hospital cardiac arrest and survived to hospital discharge. The mean age of the patient population was 75.8 years (56% men; 12% black).
The primary outcome was all-cause readmission and utilization of inpatient resources at 30 days and 1 year after in-hospital cardiac arrest. Adjusted cost ratios were calculated based on age, sex, race, initial rhythm of cardiac arrest, hospital discharge destination (disposition) and neurological status at hospital discharge.
There were 2,005 readmissions within 30 days of discharge (cumulative incidence rate, 35 per 100 patients) and 8,751 readmissions within 1 year (cumulative incidence rate, 185 per 100 patients). The researchers noted that nearly half of patients did not require readmission within 1 year of discharge, and 30% required multiple readmissions. The most common reason for readmission within 30 days was CVD (35.9% of cases), with other prevalent causes such as pulmonary disease (17.1%), gastrointestinal bleeding (13.2%) and infections other than pneumonia (6.7%). HF was the most common individual diagnosis requiring readmission (16.7% of cases).
Patients had a mean hospital stay of 19 ± 16 days. Overall mean inpatient costs associated with readmissions were $7,741 ± $2,323 at 30 days and $18,629 ± $9,411 at 1 year. Costs at 30 days were higher among patients of younger age: Compared with the reference cost of $6,052 for patients aged 85 years or older, those aged 75 to 84 years incurred costs of $7,444 (adjusted cost ratio=1.23; 95% CI, 1.06-1.42) and patients aged 65 to 74 years incurred costs of $8,291 (adjusted cost ratio=1.37; 95% CI, 1.19-1.59). Costs at 30 days also were significantly higher among black patients compared with white patients ($9,044 vs. $7,413; adjusted cost ratio=1.22; 95% CI, 1.05-1.42).
These discrepancies in inpatient resource use remained consistent at 1 year and were attributable to the higher readmission rates, the researchers wrote. Resource use did not differ significantly according to sex.
“Collectively, these findings provide important insights into the patterns of readmission and inpatient resource use by survivors of an in-hospital cardiac arrest,” they wrote. “As new treatment strategies become adopted in survivors of an in-hospital cardiac arrest … the specific cost estimates from this study could be used to provide more precise estimates of their cost-effectiveness.”
Disclosure: One researcher reported serving served as a consultant to the American Heart Association. Another reported receiving a research grant from Medtronic through Yale University, and serving as the chair of a cardiac scientific advisory board for United Health.