Long-Term Outcomes Among Elderly Survivors of Out-of-Hospital Cardiac Arrest
Long-Term Outcomes Among Elderly Survivors of Out-of-Hospital Cardiac Arrest
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DOI：
10.1161/jaha.115.002924
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发表时间：
2016-03-01
影响因子：
5.4
通讯作者：
Curtis, Lesley H.
中科院分区：
文献类型：
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作者：
Chan, Paul S.;McNally, Bryan;Curtis, Lesley H.
背景-大多数关于院外心脏骤停的研究都集中在即刻存活率上。然而，鲜为人知的是长期的结果和资源使用之间survivor.Methods和结果，在国家CARES注册，我们确定了16 206名65岁或以上的成年人与院外心脏骤停2005年至2010年。在1127例存活出院的患者中，我们评估了1年死亡率、累积再入院率和随访住院费用是否因患者的种族、性别、初始心脏骤停节律、旁观者实施心肺复苏、出院神经系统状态和功能状态（出院处置）而不同。出院后1年总死亡率为31.8%。在存活者中，性别、种族或初始心脏骤停节律的长期死亡率无差异，但出院时功能状态较差和严重神经功能障碍与死亡率较高相关。此外，与第一反应者相比，由旁观者实施心肺复苏的死亡率降低了23%（风险比0.77 [置信区间0.58-1.02]）。除死亡率外，638例（56.6%）患者在第一年内再次入院，累积再次入院发生率为197/100患者年。平均1年住院费用为23 765 +/- 41 002美元。年龄较小、黑人、出院时严重神经功能障碍以及医院倾向于专业护理或康复机构均与较高的1年住院费用相关（P均<0.05）。
Background-Most studies on out-of-hospital cardiac arrest have focused on immediate survival. However, little is known about long-term outcomes and resource use among survivors.Methods and Results-Within the national CARES registry, we identified 16 206 adults 65 years or older with an out-of-hospital cardiac arrest between 2005 and 2010. Among 1127 patients who were discharged alive, we evaluated whether 1-year mortality, cumulative readmission incidence, and follow-up inpatient costs differed according to patients' race, sex, initial cardiac arrest rhythm, bystander delivery of cardiopulmonary resuscitation, discharge neurological status, and functional status (hospital discharge disposition). Overall 1-year mortality after hospital discharge was 31.8%. Among survivors, there were no long-term mortality differences by sex, race, or initial cardiac arrest rhythm, but worse functional status and severe neurological disability at discharge were associated with higher mortality. Moreover, compared with first responders, cardiopulmonary resuscitation delivered by bystanders was associated with 23% lower mortality (hazard ratio 0.77 [confidence interval 0.58-1.02]). Besides mortality, 638 (56.6%) patients were readmitted within the first year, and the cumulative readmission incidence was 197 per 100 patient-years. Mean 1-year inpatient costs were $23 765 +/- 41 002. Younger age, black race, severe neurological disability at discharge, and hospital disposition to a skilled nursing or rehabilitation facility were each associated with higher 1-year inpatient costs (P for all