Nicholas A Morris1, Teresa L May2, Melissa Motta1, Sachin Agarwal3, Hooman Kamel4. 1. Department of Neurology, Program in Trauma, University of Maryland Medical Center, Baltimore, MD, United States. 2. Division of Pulmonary and Critical Care Medicine, Maine Medical Center, Portland, ME, United States. 3. Department of Neurology, Columbia University Medical Center, New York, NY, United States. 4. Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, United States; Department of Neurology, Weill Cornell Medicine, New York, NY, United States. Electronic address: hok9010@med.cornell.edu.
Abstract
INTRODUCTION: The long-term risk of seizures in cardiac arrest survivors is not established. We hypothesized that survivors of cardiac arrest face an increased long-term risk for seizures. METHODS: We performed a retrospective cohort study using 2008-2015 claims data from a nationally representative 5% sample of Medicare beneficiaries ≥66 years-old. Our exposure of interest was a hospital diagnosis code of cardiac arrest, defined by previously validated ICD-9-CM codes. Since we were interested in long-term risk, we excluded patients with a history of seizure, and those who were diagnosed with a seizure during hospitalization or died during the index hospitalization. Our outcome was a diagnosis of seizure. Survival statistics were used to calculate seizure incidence and Cox proportional hazards models were used to determine the association between cardiac arrest and long-term seizures after adjustment for demographics and Charlson comorbidities. RESULTS: Among 1,764,508 beneficiaries with a mean 4.5 years of follow-up, we identified 57,437 patients with cardiac arrest who survived to discharge without a seizure. The annual incidence of seizures was 1.26% (95% confidence interval [CI], 1.20-1.33%) compared to 0.61% (95% CI, 0.61-0.62%) in other Medicare patients. In unadjusted analysis, cardiac arrest was associated with an increased risk of post-discharge seizures (hazard ratio [HR], 1.8; 95% CI, 1.7-1.9), but the association was lost after adjustment for demographics and comorbidities (HR 0.9; 95% CI, 0.9-1.0; P = 0.12). CONCLUSION: The long-term risk of seizures was not elevated in patients with cardiac arrest who survived to hospital discharge without a seizure.
INTRODUCTION: The long-term risk of seizures in cardiac arrest survivors is not established. We hypothesized that survivors of cardiac arrest face an increased long-term risk for seizures. METHODS: We performed a retrospective cohort study using 2008-2015 claims data from a nationally representative 5% sample of Medicare beneficiaries ≥66 years-old. Our exposure of interest was a hospital diagnosis code of cardiac arrest, defined by previously validated ICD-9-CM codes. Since we were interested in long-term risk, we excluded patients with a history of seizure, and those who were diagnosed with a seizure during hospitalization or died during the index hospitalization. Our outcome was a diagnosis of seizure. Survival statistics were used to calculate seizure incidence and Cox proportional hazards models were used to determine the association between cardiac arrest and long-term seizures after adjustment for demographics and Charlson comorbidities. RESULTS: Among 1,764,508 beneficiaries with a mean 4.5 years of follow-up, we identified 57,437 patients with cardiac arrest who survived to discharge without a seizure. The annual incidence of seizures was 1.26% (95% confidence interval [CI], 1.20-1.33%) compared to 0.61% (95% CI, 0.61-0.62%) in other Medicare patients. In unadjusted analysis, cardiac arrest was associated with an increased risk of post-discharge seizures (hazard ratio [HR], 1.8; 95% CI, 1.7-1.9), but the association was lost after adjustment for demographics and comorbidities (HR 0.9; 95% CI, 0.9-1.0; P = 0.12). CONCLUSION: The long-term risk of seizures was not elevated in patients with cardiac arrest who survived to hospital discharge without a seizure.
Authors: Niels Secher; Kasper Adelborg; Péter Szentkúti; Christian Fynbo Christiansen; Asger Granfeldt; Victor W Henderson; Henrik Toft Sørensen Journal: JAMA Netw Open Date: 2022-05-02
Authors: Stacy C Brown; Zachary A King; Lindsey Kuohn; Hooman Kamel; Emily J Gilmore; Jennifer A Frontera; Santosh Murthy; Jennifer A Kim; Sacit Bulent Omay; Guido J Falcone; Kevin N Sheth Journal: Neurology Date: 2020-09-09 Impact factor: 11.800