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Seasonal Variation in Incidence of In-Hospital Cardiac Arrest
Quick Takes
- Seasonal variations exist in the incidence of in-hospital cardiac arrest (IHCA) in both male and female hospitalized patients, middle-aged and elderly but not young patients, and across different geographic regions within the United States.
- There is a need for improved insight into factors that impact the seasonal variance of IHCA, and the findings have important implications for designing strategies for prevention and optimizing system operations to improve outcomes.
- More resources may be needed in winter months than in summer to counter factors that lead to a cardiopulmonary collapse in the hospital.
Study Questions:
What are the seasonal differences in the incidence of in-hospital cardiac arrest (IHCA) and associated mortality?
Methods:
The investigators determined the incidence of IHCA in four seasons using the National Inpatient Sample data from 2005 to 2019. The primary objective was to evaluate overall seasonal trends in the incidence of IHCA and trends stratified by sex, age, and region. The secondary aim was to determine common causes of admission that led to IHCA, differences in those with shockable versus nonshockable IHCA, independent predictors of IHCA, and seasonal variation in IHCA-related in-hospital mortality and length of stay. Multinomial logistic regression was used to evaluate the association of predictors with all seasons compared to summer in patients with IHCA, and relative risk ratios were obtained for all predictors.
Results:
A consistent winter peak was observed in the incidence of IHCA in both male and female patients over the years in all age groups except young (<45 years) and in all regions. In 2019, both unadjusted and risk-adjusted odds of IHCA were higher (odds ratio [OR], 1.13; p < 0.001; adjusted OR, 1.08; p = 0.033) in winter than in summer. Patients with shockable IHCA were mainly admitted for cardiac and those with nonshockable IHCA for noncardiac conditions. No seasonal variation was observed in in-hospital mortality after IHCA. Therefore, seasonal variation exists, with a higher IHCA event rate in winter than summer.
Conclusions:
The authors report that improving insights into factors that influence the higher IHCA event rate during winter may help with proper resource allocation, development of strategies for early recognition of patients vulnerable to IHCA, and closer monitoring and optimization of care.
Perspective:
This study reports seasonal variations exist in the incidence of IHCA in both male and female hospitalized patients, middle-aged and elderly but not young patients, and across different geographic regions within the United States. These findings underscore the need for improved insights into factors that impact the seasonal variance of IHCA. The findings also have important implications for designing strategies for prevention and optimizing system operations to improve outcomes. More resources may be needed in winter months than in summer to counter factors that lead to a cardiopulmonary collapse in the hospital. It is possible that vaccination against flu, pneumonia, and other respiratory infectious agents may reduce some of the extra burden of IHCA in winter.
Clinical Topics: Acute Coronary Syndromes, Arrhythmias and Clinical EP, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias
Keywords: Acute Coronary Syndrome, Arrhythmias, Cardiac, Arrhythmia, Sinus, Cardiopulmonary Resuscitation, Heart Arrest, Inpatients, Length of Stay, Seasons, Secondary Prevention, Shock
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