Temporal trends and hospital-level variation of inhospital cardiac arrest incidence and outcomes in the Veterans Health Administration

Bradley, Steven M; Kaboli, Peter J.; Kamphuis, Lee A.; Chan, Paul S.; Iwashyna, Theodore J.; Nallamothu, Brahmajee K.

doi:10.1016/j.ahj.2017.05.018

Cited by 22 publications

(18 citation statements)

References 26 publications

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“…For example, studies of in-hospital cardiac arrest in VA populations have estimated event rates of 4 per 1000 hospital admissions. 17 Prior research has sought to inform the optimal treatment of patients who experience in-hospital cardiac arrest. 18 , 19 , 20 , 21 In addition, significant clinical resources are dedicated to in-hospital cardiac arrest, with estimates exceeding $300 million nationally to equip, train, and accredit clinicians and hospitals in resuscitation care.…”

Section: Discussionmentioning

confidence: 99%

Incidence, Risk Factors, and Outcomes Associated With In-Hospital Acute Myocardial Infarction

et al. 2019

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Key Points Question What are the incidence, risk factors, and outcomes associated with in-hospital acute myocardial infarction (AMI)? Findings This cohort study of 1.3 million patients hospitalized in US Veterans Health Administration facilities found an incidence of in-hospital AMI of 4.27 per 1000 admissions, and risk factors associated with in-hospital AMI included history of coronary artery disease, elevated heart rate, low hemoglobin level, and elevated white blood cell count. Compared with a matched control group, mortality was significantly higher for in-hospital AMI. Meaning In-hospital AMI is common and is associated with prior cardiovascular disease, physiological disturbances, and poor survival.

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Section: Discussionmentioning

confidence: 99%

Incidence, Risk Factors, and Outcomes Associated With In-Hospital Acute Myocardial Infarction

et al. 2019

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“…Our findings of variations across hospitals indicate that there is more at play than the individual patient factor-related proposed mechanisms. Other studies have shown that hospital variation exists in the VA, such as in hospital cardiac arrest incidence and outcomes [34] and practices around non-formulary medication use. [35] Additional research is needed to characterize individual hospital practices, such as systematic medication reconciliation practices around each care transition, at discharge, and at first primary care visit; variation in health professional staffing; or local quality improvement initiatives, which may be influencing these medication use outcome differences across the VA system.…”

Section: Plos Onementioning

confidence: 99%

Statin discontinuation and new antipsychotic use after an acute hospital stay vary by hospital

Coe

Vincent²,

Iwashyna

2020

PLoS ONE

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Introduction Patients are at risk for medication problems after hospital admissions, particularly those with critical illness. Medication problems include continuation of acute medications and discontinuation of chronic medications after discharge. Little is known across a national integrated health care system about the extent of these two medication problems. Objective To examine the extent of statin medication discontinuation and new antipsychotic medication use after hospital discharge. Design Retrospective cohort study. Setting Veterans Affairs healthcare system.

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“…A meta-analysis yielded a 1-year survival rate of 13.4% but showed substantial heterogeneity between studied cohorts [4]. A US study also showed heterogeneity in incidence and outcomes after IHCA between centres [5]. This observed heterogeneity may be attributed in part to differences in case-mix or to differences in improvable facets of care (quality of care) at the provider and hospital level.…”

Section: Introductionmentioning

confidence: 99%

Between-centre differences in care for in-hospital cardiac arrest: a prospective cohort study

et al. 2021

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Background Survival after in-hospital cardiac arrest is poor, but current literature shows substantial heterogeneity in reported survival rates. This study aims to evaluate care for patients suffering in-hospital cardiac arrest (IHCA) in the Netherlands by assessing between-hospital heterogeneity in outcomes and to explain this heterogeneity stemming from differences in case-mix or differences in quality of care. Methods A prospective multicentre study was conducted comprising 14 centres. All IHCA patients were included. The adjusted variation in structure and process indicators of quality of care and outcomes (in-hospital mortality and cerebral performance category [CPC] scale) was assessed with mixed effects regression with centre as random intercept. Variation was quantified using the median odds ratio (MOR), representing the expected odds ratio for poor outcome between two randomly picked centres. Results After excluding centres with less than 10 inclusions (2 centres), 701 patients were included of whom, 218 (32%) survived to hospital discharge. The unadjusted and case-mix adjusted MOR for mortality was 1.19 and 1.05, respectively. The unadjusted and adjusted MOR for CPC score was 1.24 and 1.19, respectively. In hospitals where personnel received cardiopulmonary resuscitation (CPR) training twice per year, 183 (64.7%) versus 290 (71.4%) patients died or were in a vegetative state, and 59 (20.8%) versus 68 (16.7%) patients showed full recovery (p < 0.001). Conclusion In the Netherlands, survival after IHCA is relatively high and between-centre differences in outcomes are small. The existing differences in survival are mainly attributable to differences in case-mix. Variation in neurological outcome is less attributable to case-mix.

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Temporal trends and hospital-level variation of inhospital cardiac arrest incidence and outcomes in the Veterans Health Administration

Cited by 22 publications

References 26 publications

Incidence, Risk Factors, and Outcomes Associated With In-Hospital Acute Myocardial Infarction

Incidence, Risk Factors, and Outcomes Associated With In-Hospital Acute Myocardial Infarction

Statin discontinuation and new antipsychotic use after an acute hospital stay vary by hospital

Between-centre differences in care for in-hospital cardiac arrest: a prospective cohort study

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