Regional Variation in Outcomes of Hospitalized Patients Having Out-of-Hospital Cardiac Arrest

Abstract

To investigate patient outcomes following hospitalization for out-of-hospital cardiac arrest (OHCA) in the United States. We used the 2002 to 2013 Nationwide Inpatient Sample database to identify adults ≥ 18 years old with an ICD-9-CM principal diagnosis code of cardio-respiratory arrest (427.5) or ventricular fibrillation (VF) (427.41). In 4 pre-defined federal geographic regions: Northeast, Midwest, South and West, means and proportions of survival, survival stratified by initial rhythm, hospital charges and cost were estimated. Multiple linear and logistic regression models were conducted. Of 154,177 OHCA patients hospitalized in the U.S, 25,873 (16.8%) were in the Northeast, 38,296 (24.8%) in the Midwest, 57,305 (37.2%) in the South, and 32,703 (21.2%) in the West. Variability in survival was noted in VF arrests; compared to the Northeast, survival was higher in the Midwest and South [AOR 1.16, 95% CI (1.02–1.32) and AOR 1.24, 95% CI (1.09–1.40) respectively], with no difference detected in the West [AOR 0.93, 95% CI (0.82–1.06)]. No variability in survival was noted following non-VF arrests (p > 0.05). Hospital charges rose significantly across all regions of the United States (P-trend < 0.001), and were higher in the West as compared with the Northeast [(Hospital charges >$109,000/admission, AOR 1.76; 95% CI (1.50–2.06)]. In conclusion, Nationwide, we observed significant regional variability in survival of hospitalized patients following out of hospital VF cardiac arrest, no survival variability following non-VF arrests and a steady increase in hospital charges.

Heart Disease and Stroke Statistics—2023 Update: A Report From the American Heart Association

“…Survival to hospital discharge varied between regions of the United States, being higher in the Midwest (aOR, 1.16 [95% CI, 1.02–1.32]) and the South (aOR, 1.24 [95% CI, 1.09–1.40]) relative to the Northeast, in 154 177 patients hospitalized after OHCA in the NIS (2002–2013). 200…”

Predictors of survival and neurologic outcome for adults with extracorporeal cardiopulmonary resuscitation

“…Just as considered a major favorable predictor for patient with conventional CPR, [36,37] initial shockable rhythm was reported significant trends in our meta-analysis towards survival and good neurologic outcome for patients with ECPR. Though the patients with initial nonshockable rhythm may have a poorer outcome compared with those with initial shockable rhythm, these patients at the time of ECPR could survive.…”

ROSC rates and live discharge rates after cardiopulmonary resuscitation by different CPR teams - a retrospective cohort study

“…Second, when interpreting our findings, it is important to note that the EM team has been primarily responsible for CPR for out-of-hospital cardiac arrests. In general, out-of-hospital cardiopulmonary arrests are known to be worse than in-hospital cardiopulmonary arrests [ 13 , 14 ]. Furthermore, the initial CPR was likely to be provided by the Public EMS team rather than the EM team from the hospital.…”