Abstract
Introduction:
Cardiac arrest remains a major public health problem that requires study with a focus on improved outcomes and cost-effective care. The aim of this study was to examine clinical outcomes and health care cost associated with hospitalization after cardiac arrest in the United States from 2008-2012.
Methods:
Clinical outcomes, including mortality and health care cost, were examined using the US National Inpatient Sample from 2008 to 2012. The International Classification of Diseases, 9th Edition, code 427.5 was used to identify patients with cardiac arrest. Total health care cost was the primary outcome of interest. We used student-t and x2 tests for comparisons. Univariable and multivariable analyses were used to evaluate the effects of clinical characteristics and medical procedures on health care cost for patients after resuscitation from cardiac arrest.
Results:
An estimated 751, 873 patients were admitted with the diagnosis of cardiac arrest. The mean age of the study population was 67 years, 45% were female, and 68% were Caucasians. Hypertension and fluid/electrolyte disorders were observed in approximately 46% of the population. Patients with > 2 comorbidities increased overtime (2008: 51% vs. 2012: 59%, p <0.001). The inpatient procedures performed on the study group were intubation (51%), coronary angiography (16%), and PTCA (8%). The rates of therapeutic hypothermia increased steadily overtime (2008: 0.6% vs. 2012: 2.8%, p <0.001). The mean in-hospital mortality was 60%, with a mean length of stay of 9 days. In a multivariable analysis, age was negatively associated with cost (Estimate: -692, CI -708 to -550, p < 0.001). Factors that were associated with increased health cost were increasing length of stay, coronary angiography or PTCA, and therapeutic hypothermia. Adjusting for clinical variables, the health care cost increased overtime (Figure).
Conclusion:
This study found an improved post-resuscitation mortality rates compared to prior decades. Further, this survival was associated with a significant steady increase in post-arrest hospital cost, likely related to increased length of stay, medical procedures, and systems of care. The figures do not include additional post-hospital costs that continue to accrue over time.