A new study published today in the New England Journal of Medicine finds that survival in patients who experience a cardiac arrest in the hospital has increased significantly over the past decade. The study, led by cardiologists at University of Iowa Hospitals and Clinics and Saint Luke's Mid America Heart Institute and the University of Missouri in Kansas City, also shows that this improvement has been accompanied by lower rates of neurological disability among those who survive.
"If we apply our study's findings to all patients with a cardiac arrest in the United States (approximately 200,000 people every year), we estimate that an additional 17,200 patients survived in 2009 who would have died in 2000," says lead study author Saket Girotra, M.D., UI associate in internal medicine. "And, more than 13,000 cases of significant neurological disability were avoided. So we are not only seeing an improvement in quantity of life, but also quality of life among survivors at the time of discharge."
The research team examined almost 85,000 patients who experienced a cardiac arrest -- when the heart stops beating -- while hospitalized over a 10-year period from 2000 to 2009. The study found that the risk-adjusted rate of survival among these patients increased from 13.7 percent in 2000 to 22.3 percent in 2009. The team found that the increase in survival over time was due to both a greater success in reviving patients from the initial cardiac arrest event as well as an improvement in survival following successful resuscitation until discharge.
Neurological damage that occurs during a cardiac arrest can lead to significant disability and reduced quality of life. So, an important question for the study team was whether the improved survival came at a cost of increased neurological disability among the survivors. In fact, the study showed that even as survival increased, neurological disability actually decreased from 32.9 percent in 2000 to 28.1 percent in 2009.
Despite low rates of survival in 2000, the new study shows a dramatic improvement in survival with in-hospital cardiac arrest over the last decade. The magnitude of improvement (8.6 percent) is larger than seen for other cardiac conditions. For example, heart attack survival has improved by 3 to 4 percent over the same time period.
The study focused on patients at 374 hospitals participating in the "Get with the Guidelines-Resuscitation" registry -- a large national quality-improvement registry overseen by the American Heart Association. This program aims to help health care teams consistently use evidence-based, best practices to improve patient outcome. The registry is one of a number of quality improvement strategies hospitals have implemented to improve heart attack survival rates in in-patient settings.
Although the new study was not able to pinpoint which specific factors are responsible for the improvement in survival, Girotra says the findings suggest that there has been an overall improvement in quality of resuscitation care. He notes that a greater understanding of the factors behind these increased survival rates will allow the benefits to be consolidated and expanded to all hospitals.
In addition to Girotra, the study team included senior author Paul S. Chan, M.D., M.Sc. associate professor of medicine, University of Missouri-Kansas City and Saint Luke's Mid America Heart Institute, and colleagues at University of Missouri-Kansas City, University of Michigan, and Yale University School of Medicine.
The Get With The Guidelines-Resuscitation registry is funded by the American Heart Association.
- Saket Girotra, Brahmajee K. Nallamothu, John A. Spertus, Yan Li, Harlan M. Krumholz, Paul S. Chan. Trends in Survival after In-Hospital Cardiac Arrest. New England Journal of Medicine, 2012; 367 (20): 1912 DOI: 10.1056/NEJMoa1109148
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