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Canadian Journal of Cardiology

Long-term Mortality, Readmission, and Resource Utilization Among Hospital Survivors of Out-of-Hospital Cardiac Arrest

  • Christopher B. Fordyce
    Correspondence
    Corresponding author: Dr Christopher Fordyce, 2775 Laurel St—9th Floor, Vancouver, British Columbia V5Z 1M9, Canada. Tel.: +1-604-875-5230; fax: 1-604-675-3007.
    Affiliations
    Division of Cardiology, Department of Medicine, Vancouver General Hospital and Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada

    Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada
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  • Brian E. Grunau
    Affiliations
    Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada

    Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada

    British Columbia Emergency Health Services, Vancouver, British Columbia, Canada
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  • Meijiao Guan
    Affiliations
    Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada
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  • Nathaniel M. Hawkins
    Affiliations
    Division of Cardiology, Department of Medicine, Vancouver General Hospital and Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada

    Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada
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  • May K. Lee
    Affiliations
    Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada
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  • Jennie S. Helmer
    Affiliations
    British Columbia Emergency Health Services, Vancouver, British Columbia, Canada

    School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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  • Graham C. Wong
    Affiliations
    Division of Cardiology, Department of Medicine, Vancouver General Hospital and Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
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  • Karin H. Humphries
    Affiliations
    Division of Cardiology, Department of Medicine, Vancouver General Hospital and Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada

    Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada
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  • Jim Christenson
    Affiliations
    Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada

    Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Published:August 28, 2022DOI:https://doi.org/10.1016/j.cjca.2022.08.225

      Abstract

      Background

      Among patients with out-of-hospital cardiac arrest (OHCA), the influence of pre- and in-hospital factors on long-term survival, readmission, and resource utilization is ill-defined, mainly related to challenges combining disparate data sources.

      Methods

      Adult nontraumatic OHCA from the British Columbia Cardiac Arrest Registry (January 2009 to December 2016) were linked to provincial datasets comprising comorbidities, medications, cardiac procedures, mortality, and hospital admission and discharge. Among hospital-discharge survivors, the 3-year end point of mortality or mortality and all-cause readmission was examined with the use of the Kaplan-Meier method and multivariable Cox regression model for predictors. The use of publicly funded home care and community services within 1 year after discharge also was evaluated.

      Results

      Of the 10,674 linked, emergency medical services–treated adult OHCAs, 3230 were admitted to hospital and 1325 survived to hospital discharge. At 3 years after discharge, the estimated Kaplan-Meier survival rate was 84.1% (95% CI 81.7%-86.1%) and freedom from death or all-cause readmission was 31.8% (29.0%-34.7%). After exclusions, 26.6% (n = 315/1186) accessed residential or home care services within 1 year. Independent predictors of long-term outcomes included age and comorbidities, but also favourable arrest characteristics and in-hospital factors such as revascularization or receipt of an intracardiac defibrillator before discharge.

      Conclusions

      Among OHCA hospital survivors, the long-term death or readmission risk persists and is modulated by both pre- and in-hospital factors. However, only 1 in 4 survivors required residential or home care after discharge. These results support efforts to improve care processes to increase survival to hospital discharge.

      Résumé

      Contexte

      Chez les patients qui subissent un arrêt cardiaque hors hôpital (ACHH), l’influence des facteurs préhospitaliers et des facteurs liés au séjour hospitalier sur la survie, la réadmission et l’utilisation de ressources est mal comprise, principalement en raison des difficultés à agencer des renseignements provenant de sources disparates.

      Méthodologie

      Les données au sujet des ACHH non traumatiques chez des adultes figurant au British Columbia Cardiac Arrest Registry (pour la période allant de janvier 2009 à décembre 2016) ont été associées aux ensembles de données de niveau provincial, notamment les données liées aux troubles concomitants, aux médicaments, aux interventions cardiaques, à la mortalité, à l’admission en hôpital et au congé de l’hôpital. Chez les patients ayant survécu jusqu’à leur congé, la mortalité au cours des 3 années suivant le congé ainsi que la combinaison de la mortalité et de la réadmission toutes causes confondues au cours des 3 années suivant le congé ont été analysées par la méthode de Kaplan-Meier, et les facteurs prédictifs ont été modélisés par une régression multivariée de Cox. Le recours à des soins à domicile financés par le système public et à des services de proximité dans la première année après le congé a également été évalué.

      Résultats

      Parmi les 10 674 patients qui ont subi un ACHH et pour lesquels les services d’urgence ont été requis, 3230 patients ont été admis à l’hôpital et 1325 d’entre eux ont survécu jusqu’à leur congé de l’hôpital. Trois ans après le congé, le taux de survie estimé par la méthode de Kaplan-Meier s’élevait à 84,1 % (IC à 95 % : de 81,7 % à 86,1 %) et l’absence de décès ou d’hospitalisation toutes causes confondues touchait 31,8 % des patients (29,0 % à 34,7 %). Parmi les patients inclus dans l’analyse, 26,6 % (n = 315/1186) ont eu recours à des services de soins en milieu résidentiel ou à domicile au cours de l’année suivant leur congé. Les facteurs prédictifs indépendants des résultats de santé à long terme comprenaient l’âge des patients et la présence de troubles concomitants, mais également des caractéristiques favorables relatives à l’arrêt cardiaque et des facteurs liés à l’hospitalisation comme la revascularisation ou l’implantation d’un défibrillateur cardiaque avant le congé.

      Conclusions

      Parmi les patients ayant survécu à un ACHH et ayant nécessité une hospitalisation, le risque de décès ou de réadmission hospitalière persiste à long terme, et ce risque est modulé par des facteurs préhospitaliers et des facteurs liés à l’hospitalisation. Toutefois, seulement 1 patient sur 4 requiert des soins en milieu résidentiel ou à domicile après le congé. Ces résultats viennent appuyer les efforts visant l’amélioration des processus de soins permettant d’accroître la survie jusqu’au congé de l’hôpital.

      Graphical abstract

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