Post–Cardiac Arrest Mortality Is Declining

Fugate, Jennifer E.; Brinjikji, Waleed; Mandrekar, Jay; Cloft, Harry J.; White, Roger D.; Wijdicks, Eelco F. M.; Rabinstein, Alejandro A.

doi:10.1161/circulationaha.111.088807

Cited by 127 publications

(74 citation statements)

References 16 publications

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“…Large administrative databases such as the NIS are lacking readmission status and cause of death and are prone to coding errors. There can be misinterpretation of procedure volumes and underreporting of comorbid conditions 23, 35. We have identified prevalence of cardiovascular manifestations in sarcoidosis by presence of concurrent diagnosis codes.…”

Section: Discussionmentioning

confidence: 99%

“…Comorbidities used in our study were derived from Elixhauser method for quantification of comorbidities 14. A cardiac arrest ( ICD‐9‐CM diagnosis code 427.5) was identified from the disease class of arrhythmias 23. We identified all discharges who came or required new ICD implantation or replacement while hospitalized ( ICD‐9‐CM procedure codes‐37.94, 37.95, and 37.96), CRT implantation or replacement ( ICD‐9‐CM procedural code‐00.50, 00.51), or PPM implantation ( ICD‐9‐CM procedural code‐37.7, 37.8) by using primary and secondary procedural fields.…”

Section: Methodsmentioning

confidence: 99%

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Hospitalization Rates, Prevalence of Cardiovascular Manifestations, and Outcomes Associated With Sarcoidosis in the United States

Patel

Kalra

Doshi

et al. 2018

JAHA

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BackgroundRecent trends of hospitalizations and in‐hospital mortality are not well defined in sarcoidosis. We examined aforementioned trends and prevalence of cardiovascular manifestations and explored rates of implantable cardioverter‐defibrillator implantation in hospitalizations with sarcoidosis.Methods and ResultsUsing data from the National Inpatient Sample, a retrospective population cohort from 2005 to 2014 was studied. To identify sarcoidosis, an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM) diagnosis code was used. We excluded hospitalizations with myocardial infarction, coronary artery disease, and ischemic cardiomyopathy. Cardiovascular manifestations were defined by the presence of diagnosis codes for conduction disorders, arrhythmias, heart failure, nonischemic cardiomyopathy, and pulmonary hypertension. A total of 609 051 sarcoidosis hospitalizations were identified, with an age of 55±14 years, 67% women, and 50% black. The number of sarcoidosis hospitalizations increased from 2005 through 2014 (138 versus 175 per 100 000, P trend<0.001). We observed declining trends of unadjusted in‐hospital mortality (6.5 to 4.9 per 100 sarcoidosis hospitalizations, P trend<0.001). Overall ≈31% (n=188 438) of sarcoidosis hospitalizations had coexistent cardiovascular manifestations of one or more type. Heart failure (≈16%) and arrhythmias (≈15%) were the most prevalent cardiovascular manifestations. Rates of implantable cardioverter‐defibrillator placement were ≈7.5 per 1000 sarcoidosis hospitalizations (P trend=0.95) during the study period. Black race was associated with 21% increased risk of in‐hospital mortality (odds ratio, 1.21; 95% confidence interval, 1.16–1.27 [P<0.001]).ConclusionsSarcoidosis hospitalizations have increased over the past decade with a myriad of coexistent cardiovascular manifestations. Black race is a significant predictor of in‐hospital mortality, which is declining. Further efforts are needed to improve care in view of low implantable cardioverter‐defibrillator rates in sarcoidosis.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Hospitalization Rates, Prevalence of Cardiovascular Manifestations, and Outcomes Associated With Sarcoidosis in the United States

Patel

Kalra

Doshi

et al. 2018

JAHA

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“…The survival rate of OHCA victims remained low until the early 2000s. 4 However, the past 10 years have witnessed the advancement of OHCA studies using large data, which have shown drastic improvement in OHCA survival rates in locations globally, including the USA, 5 Europe, 6,7 and Asia. [8][9][10][11] Large-scale studies have suggested that two factors are key to achieving improvement: bystanders' actions in prehospital settings, 3,[6][7][8][9]12,13 and postresuscitation care following hospital arrival.…”

mentioning

confidence: 99%

“…[8][9][10][11] Large-scale studies have suggested that two factors are key to achieving improvement: bystanders' actions in prehospital settings, 3,[6][7][8][9]12,13 and postresuscitation care following hospital arrival. 5,10,14 However, the majority of the evidence presented in these studies was derived from either pre-or in-hospital databases. Therefore, simultaneously assessing both the bystanders' actions in prehospital settings and postresuscitation care in hospital was infeasible.…”

mentioning

confidence: 99%

Changes in pre‐ and in‐hospital management and outcomes for out‐of‐hospital cardiac arrest between 2002 and 2012 in Kanto, Japan: the SOS‐KANTO 2012 Study

2015

Acute Medicine & Surgery

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Methods: We compared the data collected for the SOS-KANTO study project in 2002 and 2012. We included adult patients (aged >18 years) who experienced bystander-witnessed out-of-hospital cardiac arrest of cardiac etiology. The outcomes were as follows: proportion of favorable neurological outcomes at 1 month, bystander cardiopulmonary resuscitation provision, and pre-and postresuscitation treatment administration. Conclusions: Proportions of bystander cardiopulmonary resuscitation, layperson use of automated external defibrillator, provision of prehospital adrenaline and postresuscitation treatment, and favorable neurological outcomes at 1 month increased significantly over 10 years in the Kanto region of Japan. Results:

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“…Approximately half of the patients in the TTM trial survived, the large majority with a good neurological outcome at 180 days, evaluated with rather crude but established outcome measures during a face-to face follow-up. In-hospital mortality among patients admitted alive after out-of-hospital cardiac arrest thus remains high, although a doubling of in-hospital survival has been described in the last decade [9] thanks to the introduction of post-cardiac arrest care bundles including controlled temperature, angiography, improved ICU-care in general and possibly increased enthusiasm for the patient group.…”

mentioning

confidence: 99%

Therapeutic hypothermia and coronary angiography are mandatory after out-of-hospital cardiac arrest: No

Friberg

Nielsen

2014

Intensive Care Med

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Sudden out-of-hospital cardiac arrest is a major health problem throughout the world and in spite of increased awareness in society and improved pre-hospital and hospital care, overall survival remains around 10 % [1,2]. An impressive effort to create a prospective populationbased registry covering all out-of-hospital cardiac arrest patients in greater Paris was made and the results from the first 2 years are published in this issue of the journal [3]. The high quality registry study excluded cardiac arrest of obvious non-cardiac aetiology resulting in 3,816 patients in whom a resuscitation attempt was made, which translates into a yearly incidence of 0.6 % per inhabitant, similar to what has previously been reported [4]. Admission rate to hospital was impressively high, 35 %, while 8 % were discharged alive. The size and quality of this registry make it unique, including the systematic collection of pre-hospital and in-hospital background and treatment data. A retrospective control was performed in a sample of intensive care units (ICUs) indicating that an outstanding 99 % of all cardiac arrest patients admitted alive were identified during the study period [3], which is notably higher than in previous reports [5]. It is encouraging that the pre-hospital factors strongly associated with survival to discharge remain the same as earlier identified-initial shockable rhythm, younger age, bystander CPR and cardiac arrest in a public place-suggesting ways to improve pre-hospital performance by educating more lay people, deployment of defibrillators and by engaging fire-fighters, police, taxi drivers etc.The recently published target temperature management after cardiac arrest trial (TTM trial) included basically the same patient group as captured in the present French study [6]. The TTM trial randomly assigned 950 out-ofhospital cardiac arrest patients of cardiac aetiology to a target temperature of either 33 or 36°C with no difference in survival (Fig. 1) or neurological outcome between groups. Compared to the present registry study, patients in the TTM trial had an early angiography performed approximately as often (63 % versus 58 %) while the use of temperature control differed (100 % versus 58 %). In the present study, 22 % of patients admitted alive to hospital were eventually discharged alive; almost all (96 %) with a good neurological outcome. Haemodynamic failure was considered to be the cause of death in a majority of patients (55 %) with neurological cause as the runner-up (43 %). These results differ from other published studies [7,8] including those from the TTM trial, where a majority of deaths were considered to be of a neurological cause [6].

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Post–Cardiac Arrest Mortality Is Declining

Cited by 127 publications

References 16 publications

Hospitalization Rates, Prevalence of Cardiovascular Manifestations, and Outcomes Associated With Sarcoidosis in the United States

Hospitalization Rates, Prevalence of Cardiovascular Manifestations, and Outcomes Associated With Sarcoidosis in the United States

Changes in pre‐ and in‐hospital management and outcomes for out‐of‐hospital cardiac arrest between 2002 and 2012 in Kanto, Japan: the SOS‐KANTO 2012 Study

Therapeutic hypothermia and coronary angiography are mandatory after out-of-hospital cardiac arrest: No

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