Correlation between hospital rates of survival to discharge and long-term survival for in-hospital cardiac arrest: Insights from Get With The Guidelines®-Resuscitation registry

• Published in: Resuscitation 2024-09, Vol.202, p.110322, Article 110322
• Main Authors: Khera, Rohan, Aminorroaya, Arya, Kennedy, Kevin F., Chan, Paul S., Grossestreuer, Anne, Moskowitz, Ari, Ornato, Joseph, Churpek, Matthew, Starks, Monique Anderson, Girotra, Saket, Perman, Sarah
• Format: Article
• Language: English
• Subjects: Advanced Cardiac Life Support; Aged; Aged, 80 and over; Cardiopulmonary Resuscitation; Cardiopulmonary Resuscitation - methods; Cardiopulmonary Resuscitation - statistics & numerical data; Female; Heart Arrest; Heart Arrest - mortality; Heart Arrest - therapy; Hospital Mortality; Humans; Male; Medicare - statistics & numerical data; Outcome and Process Assessment, Health Care; Patient Discharge - statistics & numerical data; Quality of Health Care; Registries; Survival Rate; Survival Rate - trends; United States - epidemiology
• ISSN: 0300-9572; 1873-1570; 1873-1570
• DOI: 10.1016/j.resuscitation.2024.110322

Given challenges in collecting long-term outcomes for survivors of in-hospital cardiac arrest (IHCA), most studies have focused on in-hospital survival. We evaluated the correlation between a hospital’s risk-standardized survival rate (RSSR) at hospital discharge for IHCA with its RSSR for long-term survival. We identified patients ≥65 years of age with IHCA at 472 hospitals in Get With The Guidelines®–Resuscitation registry during 2000–2012, who could be linked to Medicare files to obtain post-discharge survival data. We constructed hierarchical logistic regression models to compute RSSR at discharge, and 30-day, 1-year, and 3-year RSSRs for each hospital. The association between in-hospital and long-term RSSR was evaluated with weighted Kappa coefficients. Among 56,231 Medicare beneficiaries (age 77.2 ± 7.5 years and 25,206 [44.8%] women), 10,536 (18.7%) survived to discharge and 8,485 (15.1%) survived to 30 days after discharge. Median in-hospital, 30-day, 1-year, and 3-year RSSRs were 18.6% (IQR, 16.7–20.4%), 14.9% (13.2–16.7%), 10.3% (9.1–12.1%), and 7.6% (6.8–8.8%), respectively. The weighted Kappa coefficient for the association between a hospital’s RSSR at discharge with its 30-day, 1-year, and 3-year RSSRs were 0.72 (95% CI, 0.68–0.76), 0.56 (0.50–0.61), and 0.47 (0.41–0.53), respectively. There was a strong correlation between a hospital’s RSSR at discharge and its 30-day RSSR for IHCA, although this correlation weakens over time. Our findings suggest that a hospital’s RSSR at discharge for IHCA may be a reasonable surrogate of its 30-day post-discharge survival and could be used by Medicare to benchmark hospital performance for this condition without collecting 30-day survival data.