In-Hospital Cardiac Arrest Burden Climbed in Last Decade, for Adults and Kids

Megan Brooks

July 12, 2019

Far more patients experience cardiac arrest in hospitals in the United States each year than older statistics would suggest, say researchers based on registry data collected during the past decade.

About 292,000 adults experience in-hospital cardiac arrest requiring cardiopulmonary resuscitation annually in the United States, suggest estimates based on American Heart Association (AHA) Get With The Guidelines–Resuscitation registry (GWTG-R) collected between 2008 and 2017.

The corresponding annual estimate for pulseless in-hospital arrest for children (age < 18 years) is about 7100.

Those figures contrast with GWTG-R data collected between 2003 and 2007 suggesting that about 211,000 adults and 6000 children experienced in-hospital cardiac arrest each year in the United States, the new report notes.

This suggests that the public health burden of adult in-hospital cardiac arrest has risen about 38% and by 18% in children, say the researchers, led by Mathias J. Holmberg, MD, MPH, Aarhus University Hospital, Denmark, in their report published July 9 in Circulation: Cardiovascular Quality and Outcomes.

When both index and recurrent in-hospital cardiac arrests were included in the analysis, the average annual incidence was estimated at 357,900 adult and 19,900 pediatric cardiac arrests.

"Unfortunately, in-hospital cardiac arrest still carries a very high mortality with approximately 75% of adults and 60% of children dying before hospital discharge," senior author Lars Andersen, MD, PhD, told theheart.org | Medscape Cardiology.

"We hope that our study, along with others, will help increase focus on in-hospital cardiac arrest," said Andersen, of Aarhus University and visiting researcher at Beth Israel Deaconess Medical Center, Boston.

Whereas their updated estimates "may signal a concerning trend, they are not able to offer an explanation for the rise in numbers beyond expected values," commented Prashant Vaishnava, MD, a cardiologist at The Mount Sinai Hospital in New York City, for theheart.org | Medscape Cardiology.

The data also do not provide the crude data to determine whether survival also changed throughout the period despite an increasing burden of hospital arrest, said Vaishnava, who is not associated with the report.

"Our findings illustrate a concerning trend in US hospitals, and show that cardiac arrest is a major public health problem," Andersen said in a press release issued by the AHA. "Previous incidence estimates may no longer reflect the current public health burden of cardiac arrest in hospitalized patients across the US."

"Unfortunately," added Andersen, "the data does not provide an explanation for the increase in adult in-hospital cardiac arrest, but it is likely due to many factors and may reflect an increase in actual events or in the reporting of cases over time."

Basic life-support resources and advanced cardiac life-support training programs, which traditionally have focused on out-of-hospital resuscitation, may need to be expanded to include more potential in-hospital responders, propose Holmberg and associates.

But Vaishnava cautioned that "such shuffling of resources may be premature without knowing actual survival from a growing burden of in-hospital arrest. It could be that patients are even faring better than expected."

"While speculative," added Vaishnava, "these data may point to the need for more deliberate and systematic discussion of advanced directives among hospitalized patients, as some patients may choose to not be resuscitated."

Andersen is a compensated statistical reviewer for JAMA. The other study coauthors and Vaishnava have disclosed no relevant financial relationships.

Circ Cardiovasc Qual Outcomes. Published online July 9, 2019. Abstract

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