Readmission Rates and Long-Term Hospital Costs Among Survivors of an In-Hospital Cardiac Arrest
Among survivors of in-hospital cardiac arrest, what are patterns of 30-day and 1-year readmission and inpatient resource use rates?
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.
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.
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.
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.
Keywords: Survivors, Hospital Costs, Resuscitation, Morbidity, Patient Readmission, Heart Arrest, Medicare, Hospitalization
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