Abstract Body: Background: Survival after an in-hospital cardiac arrest (IHCA) varies markedly across hospitals in the U.S. Whether hospitals with IHCA survival also excel in ‘preventing’ IHCA remains unclear.

Methods: Using 2013-2019 data from the Get-With-The-Guidelines–Resuscitation (GWTG-R) registry linked with Medicare and American Hospital Association data, we identified all patients >65 years with IHCA at participating hospitals. Using two-level hierarchical multivariable regression models, we calculated hospital rates of IHCA incidence, adjusted for case-mix index, and risk-standardized survival to discharge (RSSR) for IHCA, adjusted for patient and cardiac arrest variables. We also examined the association of IHCA incidence and RSSR with hospital variables.

Results: Among >10 million admissions at 335 hospitals during 2013-2019, 77676 patients experienced an IHCA. The median hospital rate of IHCA incidence was 6.9 per 1000 admissions, and the median case-survival rate among those with IHCA was 21.9%. After case-mix adjustment, the median IHCA incidence was 7.9 per 1000 admissions with considerable variation across hospitals: IQR: 5.8-10.3 per 1000 admissions, range 1.2 to 25.4 per 1000 admissions. The median RSSR for IHCA was 22.3%, which varied from 11.5% to 35.7% across hospitals (IQR: 19.5%-24.9%). There was a weak negative correlation between risk-adjusted hospital IHCA incidence and its RSSR (rho = -0.11; p = 0.037) (Figure 1). Adjustment for hospital variables attenuated the negative association between IHCA incidence and RSSR (rho = -0.08; p = 0.13). The nurse-patient ratio was the only modifiable factor significantly associated with lower IHCA incidence (OR = 0.97; p = 0.004) and higher RSSR (OR = 1.05; p <.0001).

Conclusion: Even after case-mix adjustment, hospital IHCA incidence and survival rates varied markedly. Notably, hospitals with higher survival rates for IHCA did not have a higher incidence. Since case-survival rates for IHCA have plateaued in recent years, our findings highlight that efforts focused on reducing IHCA incidence may yield additional gains in reducing resuscitation deaths in hospitals.