IN ELDERLY, SURVIVAL AFTER HOSPITAL-ADMINISTERED CPR HAS NOT IMPROVED
July 6, 2009
Among elderly patients in the United States, survival after in-hospital cardiac arrest has not been improving, a 13-year study shows.
Dr. William J. Ehlenbach of Harborview Medical Center in Seattle, Washington and colleagues studied Medicare data on individuals age 65 or older who underwent cardiopulmonary resuscitation (CPR) in U.S. hospitals from 1992 through 2005.
According to their report in the July 1 issue of the New England Journal of Medicine:
- Some 433,985 elderly patients had in-hospital CPR during the study period, and 18.3 percent survived to discharge.
- The cumulative incidence of in-hospital CPR was 2.73 events per 1000 admissions.
Neither the survival rate nor the cumulative incidence changed substantially over time, the researchers said. However:
- Among all hospital deaths in the study cohort, the proportion occurring in patients who had received in-hospital CPR rose from 3.8 percent in 1992 to 5.2 percent in 2005.
- The incidence of CPR was higher in blacks and other nonwhite patients, with 4.35 deliveries of CPR per 1000 admissions in blacks versus 2.35 in whites and 3.85 among other races.
- Furthermore, adjusted odds of survival for blacks were 23.6 percent lower than for similar white patients, a finding due in part to the fact that blacks were more likely to be resuscitated in hospitals with lower rates of survival after CPR.
- Survival was also lower among men, older patients, patients with more comorbidities, and those admitted from skilled-nursing facilities.
What could explain the findings? "A static survival rate could occur if the delivery of CPR has improved and the improvements have been offset by an increase in the proportion of patients with nonsurvivable primary illness who undergo CPR," the authors write.
Also, they speculate, the increase in the proportion of in-patient deaths preceded by CPR may reflect "a trend toward the administration of CPR to patients who are poorer candidates for resuscitation."
The researchers also found that the proportion of survivors discharged to home instead of to a health care facility decreased over time.
"This study provides information useful to older patients and their clinicians in their decision about whether to choose to be resuscitated," the authors conclude.
Source: Reuters Health Stories, "In elderly, survival after hospital-administered CPR has not improved," Rehab Management: The Interdisciplinary Journal of Rehabilitation, July 1, 2009; based upon: William J. Ehlenbach et al., "Epidemiologic Study of In-Hospital Cardiopulmonary Resuscitation in the Elderly," New England Journal of Medicine, Vol. 361, No. 1, July 2, 2009.
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