Hopeful prognosis for in-hospital cardiac arrest survivors
medwireNews: Long-term survival rates among elderly survivors of in-hospital cardiac arrest are better than generally assumed, report researchers in The New England Journal of Medicine.
In all, 58.5% of patients remained alive 1 year later, and 3-year survival rates were similar to those of patients hospitalized with heart failure, say Paul Chan (Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA) and team.
Furthermore, 34.4% of the patients did not require readmission to hospital during the year after cardiac arrest, report Chan et al. These findings, they say, "provide new insights into this population and challenge earlier assumptions."
They add that the previous lack of data "has prevented patients and clinicians from understanding what they may expect after recovery and has potentially contributed to nihilistic attitudes toward resuscitation efforts, especially for older patients."
The 6972 patients in the study were aged at least 65 years, and were identified in the Get with the Guidelines-Resuscitation registry. As anticipated, the risk adjusted 1-year survival rates fell in line with patient age, at 63.7%, 58.6%, and 49.7% for patients aged 65-74, 75-84, and at least 85 years, respectively.
Chan and team stress that, even among patients aged 85 years or older, almost half remained alive 1 year after cardiac arrest. "Although in-hospital resuscitation efforts in patients of advanced age may be perceived as futile, the relatively high survival rate among these patients suggests that discussions about advance directives should be individualized and informed by patients' preferences and health status."
The likelihood for surviving to 1 year also depended on patients' discharge neurologic status, according to their cerebral-performance category. Survival rates were 72.8%, 61.1%, and 42.2% among patients with no/mild, moderate, and severe neurologic disability, respectively, and just 10.2% among those who remained in hospital in a coma or vegetative state.
"This finding suggests that renewed efforts are needed to minimize neurologic injury during resuscitation care," says the team.
Also this week, a consensus statement released by the American Heart Association draws attention to the poor initial survival rate after in-hospital cardiac arrest, saying that just 24.2% of patients, on average, survive to discharge. The statement calls for more training for hospital staff and implementation of best-care practices, among other recommendations. It also advises mandatory reporting of in-hospital cardiac arrest rates, and of do-not-resuscitate orders, noting that the presence and implementation of these orders can "dramatically skew data about patient outcomes."
By Eleanor McDermid, Senior medwireNews Reporter