Association Between In-Hospital Cardiac Arrest Incidence and Survival in Older Patients

Efforts over the past two decades have gone toward improving care delivery and outcomes after in-hospital cardiac arrest (IHCA). As a result of these efforts (e.g., timely defibrillation and high-quality CPR), survival for IHCA has improved but remains dismal. Moreover, survival rates have plateaued at ~25% in recent years. In contrast, strategies to prevent IHCAs have received far less attention, primarily because data needed to calculate IHCA incidence rates are not captured in most national registries such as the Get With the Guidelines®-Resuscitation (GWTG-R). This lack of data has made it challenging to quantify IHCA incidence rates and the impact of any preventive measures.

To overcome this challenge, we linked the GWTG-R registry with Medicare data, the latter providing information on total admissions, the denominator for quantifying incidence rates, and the case mix index. As presented at #AHA24, we found that the overall incidence of IHCA was 6.9 per 1,000 admissions with >20-fold variation across hospitals (0.9 to 22.9) even after adjusting for case mix. A higher proportion of cardiac arrest victims at hospitals with high IHCA incidence were African American and had a higher burden of comorbidities. Hospital rates of cardiac arrest incidence were modestly associated with survival rates (ρ = -0.22; P value < 0.001). Among hospital variables, nurse staffing was the only modifiable factor associated with a lower IHCA incidence rate and a higher survival rate.

We believe that focusing on prevention of IHCA, the first link in the cardiac arrest chain of survival, can reduce the overall burden of cardiac arrest on hospital mortality. We also propose that future hospital performance metrics should collect data on IHCA incidence rates and incentivize efforts at prevention.