Methods: We used the 1995 to 2013 Nationwide Inpatient Sample database to identify adults ≥ 18 years old hospitalized after OHCA (ICD-9-CM principal diagnosis codes 427.41, 427.5). Age and gender adjusted survival rates were studied in the overall sample and by initial rhythm. Temporal trends in survival, hospital charges and cost were examined with year as a continuous variable (1995-2013) added to the multivariable regression model. All charges and costs were adjusted using the consumer price index with 2015 as the index year.
Results: Of 247,684 hospitalized OHCA patients, 126,690 (51.1%) presented with ventricular fibrillation [VF], and 123,098 (49.3%) survived to hospital discharge. Mean age was 66.7±14 years. Although overall survival to discharge increased from 49.9% (95% CI 39.8%‒60.0%) in 1995 to 54.0% (95% CI 46.3%‒61.8%) in 2013, this trend was not statistically significant (Ptrend = 0.56). However, subgroup analyses showed that survival to discharge significantly increased in VF patients from 73.1% (95% CI 60.8%‒85.5%) in 1995 to 79.0% (95% CI 70.9%‒87.2%) in 2013 (Ptrend < 0.001). Concomitantly, a significant decrease in survival to discharge was noted in non-VF rhythm patients from 28.2% (95% CI 15.4%‒41.0%) in 1995 to 19.9% (95% CI 10.0%‒29.8%) in 2013 (Ptrend<0.001). The overall mean (SE) cost of hospitalization per patient was $19,800 ($226) with cost increasing from $18,287 ($683) in 2001 to $21,092 ($514) in 2013 at an average annual rate of $261 (Ptrend< 0.001).
Conclusions: In the United States between 1995 and 2013, survival to discharge following out-of-hospital cardiac arrest improved for VF-arrests but not for non-VF-arrests. In addition, cost of care delivery increased over the same period. Renewed national efforts are needed to warrant better knowledge translation, wider implementation of the best available science and use of high-value care in the hope of improving such trends.
To cite this abstract:Eid, SM; Albaeni, A; Akinyele, B; RaghavaKurup, L; Chandra-Strobos, DN . OUTCOME TRENDS FOLLOWING OUT-OF-HOSPITAL CARDIAC ARREST IN THE UNITED STATES: 1995-2013. Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev. Abstract 75. Journal of Hospital Medicine. 2017; 12 (suppl 2). https://www.shmabstracts.com/abstract/outcome-trends-following-out-of-hospital-cardiac-arrest-in-the-united-states-1995-2013/. Accessed November 18, 2019.