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Diabetes decreases likelihood of in-hospital cardiac arrest survival
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Patients with diabetes were modestly less likely to survive in-hospital cardiac arrest compared with those without diabetes, according to a study published in The American Journal of Cardiology.
Justin B. Echouffo - Tcheugui, MD, PhD, clinical fellow in medicine at Brigham and Women’s Hospital, and colleagues analyzed data from 1,009,073 patients from the Nationwide Inpatient Sample who underwent CPR for in-hospital cardiac arrest from 2003 to 2013.
Covariates included in this study were primary expected payer, demographics, various comorbidities, weekday vs. weekend admission and initial cardiac arrest rhythm.
The primary outcome was survival to hospital discharge. The secondary outcome of interest was discharge disposition, categorized as home or self-care, home health care, short-term hospital skilled nursing facility and others.
Among the cohort, 30.8% had a documented diagnosis of diabetes. Those with diabetes were more likely to be older and had an increased prevalence of CV risk factors such as obesity, smoking, dyslipidemia and hypertension (P < .001 for all). These patients were also more likely to have previous MI, history of CAD, previous CABG, previous PCI, HF, previous cardiac arrest, chronic renal failure and peripheral vascular disease (P < .001 for all).
During the 11-year study period, 27% of patients with diabetes and 25.1% of patients without diabetes survived in-hospital cardiac arrest.
After multivariate adjustment, patients with diabetes had a modestly lower risk for survival to hospital discharge compared with patients without diabetes (adjusted OR = 0.96; 95% CI, 0.95-0.97). There was a lower risk for survival in patients with a primary CV diagnosis (aOR = 0.88; 95% CI, 0.86-0.89), those who were younger (aOR = 0.93; 95% CI, 0.92-0.94), and patients with ventricular fibrillation or ventricular tachycardia as the cardiac arrest rhythm (aOR = 0.88; 95% CI, 0.79-0.82). The presence of chronic kidney disease also influenced this.
Compared with patients without diabetes, those with diabetes were less likely to be discharged home or with self-care (26.4% vs. 31.6%; aOR = 0.82; 95% CI, 0.8-0.84).
“The observed estimates of association between [diabetes] and survival are modest and potentially within the range of residual confounding,” Echouffo-Tcheugui and colleagues wrote. “However, if these observations are true, in view of the low survival rate among patients with [in-hospital cardiac arrest] nationally in the United States, with approximately half of adult patients achieving return of spontaneous circulation and less than one-quarter of patients surviving to hospital discharge, even a 4% relative difference in survival between patients with and without [diabetes] would be relevant.” – by Darlene Dobkowski
Disclosures: Echouffo-Tcheugui reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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