Long-term outcomes in elderly survivors of in-hospital cardiac arrest

Abstract

Background: Little is known about the long-term outcomes in elderly survivors of in-hospital cardiac arrest. We determined rates of long-term survival and readmission among survivors of in-hospital cardiac arrest and examined whether these outcomes differed according to demographic characteristics and neurologic status at discharge.

Methods: We linked data from a national registry of inpatient cardiac arrests with Medicare files and identified 6972 adults, 65 years of age or older, who were discharged from the hospital after surviving an in-hospital cardiac arrest between 2000 and 2008. Predictors of 1-year survival and of readmission to the hospital were examined.

Results: One year after hospital discharge, 58.5% of the patients were alive, and 34.4% had not been readmitted to the hospital. The risk-adjusted rate of 1-year survival was lower among older patients than among younger patients (63.7%, 58.6%, and 49.7% among patients 65 to 74, 75 to 84, and ≥85 years of age, respectively; P<0.001), among men than among women (58.6% vs. 60.9%, P=0.03), and among black patients than among white patients (52.5% vs. 60.4%, P=0.001). The risk-adjusted rate of 1-year survival was 72.8% among patients with mild or no neurologic disability at discharge, as compared with 61.1% among patients with moderate neurologic disability, 42.2% among those with severe neurologic disability, and 10.2% among those in a coma or vegetative state (P<0.001 for all comparisons). Moreover, 1-year readmission rates were higher among patients who were black, those who were women, and those who had substantial neurologic disability (P<0.05 for all comparisons). These differences in survival and readmission rates persisted at 2 years. At 3 years, the rate of survival among survivors of in-hospital cardiac arrest was similar to that of patients who had been hospitalized with heart failure and were discharged alive (43.5% and 44.9%, respectively; risk ratio, 0.98; 95% confidence interval, 0.95 to 1.02; P=0.35).

Conclusions: Among elderly survivors of in-hospital cardiac arrest, nearly 60% were alive at 1 year, and the rate of 3-year survival was similar to that among patients with heart failure. Survival and readmission rates differed according to the demographic characteristics of the patients and neurologic status at discharge. (Funded by the American Heart Association and the National Heart, Lung, and Blood Institute.).

Figure 1. Kaplan–Meier Estimates of Rates of Survival over Time among Patients Who Have Survived an In-Hospital Cardiac Arrest

Shown below the graph are the estimated rates of survival at specific follow-up time points. The cerebral-performance category (CPC) scores are used to assess neurologic status at discharge after a cardiac arrest. Scores range from 1 to 5, with 1 indicating mild or no neurologic disability, 2 indicating mild neurologic disability, 3 indicating severe neurologic disability, 4 indicating coma or vegetative state, and 5 indicating brain death.

Figure 2. Long-Term Survival after In-Hospital Cardiac Arrest and after Hospitalization for Heart Failure

By the 3-year follow-up, the rate of survival among patients who had had an in-hospital cardiac arrest and were discharged alive was nearly identical to that of patients who had been hospitalized for heart failure and were discharged alive. The 3-year rates are Kaplan–Meier survival estimates, since patients enrolled during 2008 did not have 3 complete years of follow-up.