Long-term outcomes in elderly survivors of in-hospital cardiac arrest.
Long-term outcomes in elderly survivors of in-hospital cardiac arrest.
复制标题
DOI：
10.1056/nejmoa1200657
复制
发表时间：
2013-03-14
期刊：
影响因子：
--
通讯作者：
American Heart Association Get with the Guidelines–Resuscitation Investigators
中科院分区：
文献类型：
--
作者：
Chan PS;Nallamothu BK;Krumholz HM;Spertus JA;Li Y;Hammill BG;Curtis LH;American Heart Association Get with the Guidelines–Resuscitation Investigators
对于住院心脏骤停的老年幸存者的长期结果知之甚少。我们测定了住院心脏骤停幸存者的长期存活率和再住院率，并检查了这些结果是否根据人口统计特征和出院时的神经状况而不同。我们将国家住院心脏骤停登记的数据与联邦医疗保险的文件联系起来，确定了6972名65岁或65岁以上的成年人，他们在2000至2008年间的一次住院心脏骤停后出院。对1年存活期和再入院的预测因素进行了检验。出院一年后，58.5%的患者还活着，34.4%的患者没有再次入院。老年患者的1年生存率低于年轻患者(65-74岁、75-84岁和≥85岁患者分别为63.7%、58.6%和49.7%；P<；0.001)，男性患者低于女性患者(58.6%比60.9%，P=0.03)，黑人患者比白人患者低(52.5%比60.4%，P=0.001)。在出院时轻度或无神经功能障碍的患者中，风险调整后的1年存活率为72.8%，而在中度神经功能障碍患者中为61.1%，在重度神经功能障碍患者中为42.2%，在昏迷或植物状态患者中为10.2%(所有比较P<；0.001)。此外，黑人患者、女性患者和有严重神经功能障碍的患者的1年再住院率更高(P<；所有比较均为0.05)。存活率和再住院率的差异在两年内持续存在。3年后，住院心脏骤停患者的存活率与因心力衰竭住院并活着出院的患者相似(分别为43.5%和44.9%；风险比为0.98；95%可信区间为0.95~1.02；P=0.35)。在住院心脏骤停的老年幸存者中，近60%的人在1年内存活，3年存活率与心力衰竭患者相似。存活率和再住院率根据患者的人口学特征和出院时的神经状况而有所不同。(由美国心脏协会和国家心脏、肺和血液研究所资助。)
Little is known about the long-term outcomes in elderly survivors of in-hospital cardiac arrest. We determined rates of long-term survival and readmission among survivors of in-hospital cardiac arrest and examined whether these outcomes differed according to demographic characteristics and neurologic status at discharge. We linked data from a national registry of inpatient cardiac arrests with Medicare files and identified 6972 adults, 65 years of age or older, who were discharged from the hospital after surviving an in-hospital cardiac arrest between 2000 and 2008. Predictors of 1-year survival and of readmission to the hospital were examined. One year after hospital discharge, 58.5% of the patients were alive, and 34.4% had not been readmitted to the hospital. The risk-adjusted rate of 1-year survival was lower among older patients than among younger patients (63.7%, 58.6%, and 49.7% among patients 65 to 74, 75 to 84, and ≥85 years of age, respectively; P<0.001), among men than among women (58.6% vs. 60.9%, P = 0.03), and among black patients than among white patients (52.5% vs. 60.4%, P = 0.001). The risk-adjusted rate of 1-year survival was 72.8% among patients with mild or no neurologic disability at discharge, as compared with 61.1% among patients with moderate neurologic disability, 42.2% among those with severe neurologic disability, and 10.2% among those in a coma or vegetative state (P<0.001 for all comparisons). Moreover, 1-year readmission rates were higher among patients who were black, those who were women, and those who had substantial neurologic disability (P<0.05 for all comparisons). These differences in survival and readmission rates persisted at 2 years. At 3 years, the rate of survival among survivors of in-hospital cardiac arrest was similar to that of patients who had been hospitalized with heart failure and were discharged alive (43.5% and 44.9%, respectively; risk ratio, 0.98; 95% confidence interval, 0.95 to 1.02; P = 0.35). Among elderly survivors of in-hospital cardiac arrest, nearly 60% were alive at 1 year, and the rate of 3-year survival was similar to that among patients with heart failure. Survival and readmission rates differed according to the demographic characteristics of the patients and neurologic status at discharge. (Funded by the American Heart Association and the National Heart, Lung, and Blood Institute.)