Long-Term Outcomes for Out-of-Hospital Cardiac Arrest in Elderly Patients: An Analysis of Cardiac Arrest Registry to Enhance Survival Data Linked to Medicare Files.
Long-Term Outcomes for Out-of-Hospital Cardiac Arrest in Elderly Patients: An Analysis of Cardiac Arrest Registry to Enhance Survival Data Linked to Medicare Files.
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DOI：
10.1161/circoutcomes.122.009042
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发表时间：
2022-10
影响因子：
6.9
通讯作者：
Merritt, Robert
中科院分区：
文献类型：
--
作者：
Chan, Paul S.;McNally, Bryan;Chang, Anping;Girotra, Saket;Al-Araji, Rabab;Mawani, Minaz;Ahn, Ki Ok;Merritt, Robert
大多数关于院外心脏骤停的研究主要集中在院内或短期生存。关于院外心脏骤停幸存者的长期结果和资源使用情况知之甚少。在这项观察研究中，我们描述了来自国家心脏骤停登记处以提高生存率 (CARES) 的患者的总体长期结果，这些患者与医疗保险文件相关联，以创建 CARES-MECCA（心脏骤停幸存者的死亡率、事件和费用）数据集。使用概率匹配算法将 2013 年至 2019 年 CARES 数据与 Medicare 数据关联起来。报告整个队列的总体长期死亡率、再入院率和指数住院费用。在 CARES 中幸存入院的 56,425 名 65 岁或以上患者中，26,875 名 (47.6%) 成功链接到医疗保险档案。指数住院费用的平均（±标准差）为$23,262 ± $24,199，中位费用为$14,636（四分位数范围：$9930-$30,033）。总体而言，8676 名患者 (32.3%) 幸存出院，其中 38.0% 出院回家，11.8% 接受临终关怀，其余 50.2% 接受其他住院、熟练护理或康复机构治疗。出院后死亡率最初很高（3个月时为27.0%），然后逐渐上升，1年和3年死亡率分别为37.1%和50.1%。在第一年，40.1% 的人至少重新入院一次，其中 19.7% 的人多次重新入院。 CARES-MECCA 登记册包含有关出院后结果和资源利用的丰富数据。使用该数据集将使未来能够调查老年患者院外心脏骤停的各种干预措施的长期有效性、成本和成本效益。
Most studies on out-of-hospital cardiac arrest have primarily focused on in-hospital or short-term survival. Little is known about long-term outcomes and resource use among survivors of out-of-hospital cardiac arrest. In this observationsl study, we describe overall long-term outcomes for patients from the national Cardiac Arrest Registry to Enhance Survival (CARES) linked to Medicare files to create the CARES-MECCA (Mortality, Events, and Costs for Cardiac Arrest survivors) dataset. CARES data between 2013–2019 were linked to Medicare data using probabilistic matching algorithms. Overall long-term mortality, readmissions, and index hospitalization costs are reported for the overall cohort. Among 56,425 patients who were 65 years of age or older in CARES who survived to hospital admission, 26,875 (47.6%) were successfully linked to Medicare files. Mean (± standard deviation) cost of the index hospitalization was $23,262 ± $24,199 and the median cost was $14,636 (interquartile range: $9930-$30,033). Overall, 8676 (32.3%) survived to hospital discharge with 38.0% discharged home, 11.8% to hospice care, and the remaining 50.2% to other inpatient, skilled nursing care, or rehabilitation facilities. Mortality after discharge was initially high (27.0% at 3 months) and then increased gradually, with 1- and 3-year mortality of 37.1% and 50.1%, respectively. During the first year, 40.1% were readmitted at least once, with 19.7% readmitted on more than one occasion. The CARES-MECCA registry includes rich data on post-discharge outcomes and resource utilization. Use of this dataset will enable future investigations on the long-term effectiveness, costs, and cost-effectiveness of various interventions for out-of-hospital cardiac arrest in elderly patients.