Readmission Rates and Long-Term Hospital Costs Among Survivors of an In-Hospital Cardiac Arrest

Study Questions:

Among survivors of in-hospital cardiac arrest, what are patterns of 30-day and 1-year readmission and inpatient resource use rates?

Methods:

This was an analysis of data from the Get With The Guidelines (GWTG)-Resuscitation in-hospital multicenter cardiac arrest registry linked with Medicare inpatient claims files. Eligible patients had pulseless in-hospital cardiac arrest and survived to discharge. Outcomes were rates of all-cause readmission and inpatient resource use at 30 days and 1 year after discharge from in-hospital cardiac arrest. The impact of demographic data, hospital disposition, and neurological status at discharge on these outcomes was determined.

Results:

The study cohort included 6,972 patients who survived in-hospital cardiac arrest from 401 hospitals. The cumulative mean incidence rates of 30-day and 1-year readmissions were 35 readmissions/100 patients (95% confidence interval [CI], 33-37) and 185 readmissions/100 patients (95% CI, 177-190), respectively. Nearly half of the cohort was not readmitted during the first year following in-hospital cardiac arrest. Among 30-day readmissions, cardiovascular disease was the predominant cause for readmission (35.9%). Mean inpatient costs were $7,741 ± $2,323 at 30 days and $18,629 ± $9,411 at 1 year. The following factors were associated with higher 30-day inpatient costs: younger age, black race, discharge with severe neurological disability, or discharge disposition to skilled nursing or rehabilitation facility.

Conclusions:

Among elderly survivors of in-hospital cardiac arrest, 30-day and 1-year readmission and inpatient resource use rates are significant and vary by age, race, discharge disposition, and neurologic status at discharge.

Perspective:

This is an important study that adds to the literature on survivors of in-hospital cardiac arrest. Previous studies have focused on in-hospital outcomes; the current analysis offers insight on readmission rates and long-term hospital costs. While both readmission and inpatient resource use rates were high among survivors of in-hospital cardiac arrest, nearly half of patients in this cohort from the GWTG registry were not readmitted. As the authors appropriately suggest, ‘[These findings] help put into context the notion that survivors of an in-hospital cardiac arrest have extraordinarily high morbidity and mortality.’ It is also important to note that cardiovascular disease accounted for only one-third of readmissions, suggesting that those readmitted may have multiple cardiovascular co-morbidities that contribute to their risk for inpatient care use.

Clinical Topics: Arrhythmias and Clinical EP, Implantable Devices, SCD/Ventricular Arrhythmias

Keywords: Survivors, Hospital Costs, Resuscitation, Morbidity, Patient Readmission, Heart Arrest, Medicare, Hospitalization


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