Association Between a Hospital’s Rate of Cardiac Arrest Incidence and Cardiac Arrest Survival

Jul 17, 2013
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Authors:
Chen LM, Nallamothu BK, Spertus JA, Li Y, Chan PS.
Citation:
JAMA Intern Med 2013;173:1186-1195.
Summary By:
Prashant Vaishnava, MD, FACC

Study Questions:

What is the association between a hospital’s cardiac arrest incidence rate and its case survival rate?

Methods:

This was a retrospective analysis of 102,153 adults with an in-hospital pulseless cardiac arrest among 358 hospitals participating in the Get With the Guidelines (GWTG)-Resuscitation registry. Patients with do-not-resuscitate (DNR) orders were excluded. The main study outcome was the correlation between a hospital’s incidence rate and case-survival rate for cardiac arrest. In the statistical analysis, the authors examined the correlation between a hospital’s risk-adjusted incidence rate and risk-adjusted case survival rate, after adjusting for patient and hospital characteristics.

Results:

Unadjusted analysis demonstrated a significant negative correlation between a hospital’s case-survival rate and incidence rate (r, -0.16; p = 0.003). After adjusting for patient factors, the negative correlation was minimally changed (r, -0.15; p = 0.004). However, adjustment for hospital and patient attributes significantly attenuated the relationship between a hospital’s cardiac arrest incidence and case-survival rate (r, -0.07; p = 0.18). The hospital’s nurse-to-bed ratio most attenuated the relationship (r, -0.12; p = 0.03).

Conclusions:

In the GWTG-Resuscitation registry, there was a negative correlation between a hospital’s incidence rate and case-survival rate for cardiac arrest, a relationship that is partly mediated by measured hospital attributes.

Perspective:

The growing numbers of studies of in-hospital cardiac arrest have generally examined case-survival and incidence rates independently of one another. The present analysis adds value by demonstrating a negative correlation between a hospital’s incidence rate and case-survival rate for cardiac arrest, suggesting that hospitals with higher rates of survival may be better at also preventing cardiac arrests. The limitations of this analysis aside, this study lends support to the practice of comparing case-survival rates across similar hospitals as a performance metric.

Keywords: Registries, Resuscitation, Survival Rate, Heart Arrest


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