Long-Term Outcomes in Elderly Survivors of In-Hospital Cardiac Arrest

Mar 14, 2013
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Authors:
Chan PS, Nallamothu BK, Krumholz HM, et al., on behalf of the American Heart Association Get with the Guidelines–Resuscitation Investigators.
Citation:
N Engl J Med 2013;368:1019-1026.
Summary By:
Fred Morady, MD, FACC

Study Questions:

What is the long-term survival of elderly patients who are successfully resuscitated from in-hospital cardiac arrest (IHCA)?

Methods:

In this retrospective study, a resuscitation registry was queried to identify 6,972 IHCA survivors ≥65 years old (mean age 76 years). The primary outcomes were survival and freedom from readmission at 1 year.

Results:

At the time of discharge, 52% of patients had moderate-to-severe neurologic disability or were comatose. The overall risk-adjusted 1-year survival rate was 58.5%. One-year survival was higher in patients ages 65-74 years (63.7%) than in patients ages 75-84 years (58.6%) or ≥85 years. One-year survival correlated inversely with the degree of neurologic disability, ranging from 72.8% in patients with mild or no disability to 10.2% in comatose patients. The 1-year freedom from readmission rate was 65.6%. Independent predictors or rehospitalization were female gender, black race, and severe neurologic disability after the index hospitalization.

Conclusions:

Approximately 60% of elderly patients who are successfully resuscitated from IHCA are still alive 1 year later.

Perspective:

It is surprising that the study did not include a control group of patients under the age of 65 years. There was an inverse relationship between age and survival in patients in this study, but the degree to which this relationship can be extrapolated to ages <65 years is unclear.

Keywords: Survivors, Coma, Disabled Persons, Survival Rate, Cardiology, Cardiopulmonary Resuscitation, Heart Arrest, Patient Discharge, Hospitalization


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