Abstract Body: Background
Survival after in-hospital cardiac arrest (IHCA) has improved over the past two decades, primarily resulting from higher rates of acute resuscitation survival. Post-resuscitation care is a key link in the IHCA chain-of-survival, yet post-return of spontaneous circulation (ROSC) survival rates have remained stagnant over time. We hypothesized that substantial hospital-to-hospital variation in post-resuscitation survival exists and that hospital-area social deprivation is associated with worse post-ROSC survival.
Methods
Cohort study of the prospectively collected AHA GWTG-Resuscitation database linked to the American Hospital Association survey. We included adult IHCA patients with ROSC from 2001–2023, excluding centers with <10 events. Risk-standardized post-ROSC survival was the ratio of the predicted to expected outcome, multiplied by the unadjusted outcome. Predicted outcome was the hospital average of patient-level predictions from a mixed-effects model, while incorporating fixed effects (patient, arrest, and hospital level) and the hospital’s random intercept. Expected outcome was calculated from a logistic regression model, with the same covariates (excluding hospital system). SDI was assigned by ZIP-to-ZCTA linkage and analyzed by quartile. Hospitals that could not be linked to ZCTA were excluded from SDI analyses.
Results
A total of 686,273 were present in the full cohort, of whom 206,467 drawn from 755 hospitals were included in the primary analysis. Overall, 71,691 (34.7%) patients who achieved ROSC survived to hospital discharge. Median hospital-level risk-standardized post-ROSC survival was 34.3% (IQR 29.6-39.3%). Variation in post-ROSC risk-standardized survival across hospitals and changes over time can be found in Figures 1 & 2. A total of 595 (78.8%) hospitals could be linked by zip-code to SDI. Hospitals in the highest quartile of SDI (i.e. most deprivation) had lower risk-standardized post-ROSC survival as compared to hospitals in the lowest quartile (p=0.026, Figure 3). At the patient level, those patients in the highest quartile of SDI had a lower odds of post-ROSC survival as compared to the lowest quartile (aOR 0.86, 95%CI 0.79-0.94, p<0.01).
Conclusions
Substantial hospital-to-hospital variation exists in post-ROSC survival, and greater area social deprivation predicts worse post-ROSC outcomes. Standardizing post-resuscitation care processes, especially in high SDI settings, may improve overall IHCA outcomes.