Regional Variation for In-Hospital Cardiac Arrest | Journal Scan

Study Questions:

What is the incidence, survival to hospital discharge, and resource utilization for in-hospital cardiac arrests (IHCAs) in the United States?


The investigators used the 2003-2011 Nationwide Inpatient Sample databases to identify patients, aged ≥18 years, who underwent cardiopulmonary resuscitation (International Classification of Diseases [ICD]-9-CM procedure codes 99.60 and 99.63) for IHCA. Regional differences in IHCA incidence, survival to hospital discharge, and resource utilization (total hospital cost, and discharge disposition among survivors) were analyzed. To examine differences in survival to hospital discharge among the four geographic regions, a multivariable logistic regression model was constructed using Generalized Estimating Equations with exchangeable working correlation matrix to account for clustering of outcomes within hospitals.


Of 838,465 patients with IHCA, 162,270 (19.4%) were in the Northeast, 159,581 (19.0%) in the Midwest, 316,201 (37.7%) in the South, and 200,413 (23.9%) in the West. Overall IHCA incidence in the United States was 2.85 per 1,000 hospital admissions. IHCA incidence was lowest in the Midwest and highest in the West (2.33 and 3.73 per 1,000 hospital admissions, respectively). Compared to the Northeast, risk-adjusted survival to discharge was significantly higher in the Midwest (odds ratio [OR], 1.33; 95% confidence interval [CI], 1.31-1.36), South (OR, 1.21; 95% CI, 1.19-1.23), and West (OR, 1.25; 95% CI, 1.23-1.27). IHCA survival increased significantly from 2003 to 2011 in the United States and in all regions (all Ptrend < 0.001). Total hospital cost was highest in the West, whereas discharge to skilled nursing facility and utilization of home health care among survivors was highest in the Northeast.


The authors concluded that there are significant regional variations in IHCA incidence, survival, and resource utilization in the United States.


This study reports significant variation in IHCA incidence, survival, and resource utilization across geographic regions within the United States. This variation was only partially explained by differences in patient case-mix or hospital characteristics. Development of a national registry to monitor and report incidence, processes of care, and outcomes may help identify additional patient- and hospital-level factors responsible for the observed geographic differences, in order to implement targeted interventions to enhance the overall quality of resuscitation and postresuscitation care and improve IHCA outcomes.

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

Keywords: Out-of-Hospital Cardiac Arrest, Cardiopulmonary Resuscitation, Survival, Incidence, Clinical Coding, Hospital Costs, International Classification of Diseases, Logistic Models, Patient Discharge, Risk, United States

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