In-hospital cardiac arrest incidence tied to survival in older patients

The incidence rates of in-hospital cardiac arrest (IHCA) show a modest association with survival in older patients, reports a recent study, noting that IHCA incidence rates may be considered an independent quality metric.

A total of 77,676 patients had an IHCA among the more than 10 million Medicare admissions at 335 hospitals between 2013 and 2019. 

After case-mix adjustment, the median IHCA incidence was 7.9 per 1,000 admissions (Q1–Q3: 5.9–10.3 per 1,000 admissions; range, 1.2–25.9 per 1,000 admissions), and the median risk-standardized rate of survival to discharge (RSSR) was 22.3 percent (Q1–Q3: 19.5 percent to 24.9 percent; range, 11.5 percent to 35.7 percent).

A modest negative association was noted between case-mix adjusted IHCA incidence and RSSR (ρ, −0.12; p=0.03). However, this negative relationship was attenuated (ρ, −0.08; p=0.13) after adjusting for hospital characteristics.

Notably, the only modifiable variable that contributed to a lower IHCA incidence and higher RSSR was the higher nurse-to-patient ratio.

“Given that IHCA survival has plateaued in recent years, efforts to reduce IHCA incidence rates, such as higher nurse-staffing, may yield additional gains in reducing IHCA deaths,” the investigators said. 

This observational cohort study identified patients aged ≥65 years with IHCA using the 2013–2019 Get With The Guidelines–Resuscitation data linked with Medicare and American Hospital Association data.

The investigators used hierarchical multivariable regression models to calculate the hospital rates of IHCA incidence adjusted for case-mix index and the RSSR for IHCA adjusted for patient variables. They also examined the relationship between IHCA incidence and RSSR and evaluated their association with hospital variables using linear regression.