Shannon M Fernando1, Daniel I McIsaac2, Bram Rochwerg3, Deborah J Cook3, Sean M Bagshaw4, John Muscedere5, Laveena Munshi6, Jerry P Nolan7, Jeffrey J Perry8, James Downar9, Chintan Dave10, Peter M Reardon11, Peter Tanuseputro12, Kwadwo Kyeremanteng13. 1. Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada; Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada. Electronic address: sfernando@qmed.ca. 2. Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada. 3. Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada. 4. Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada. 5. Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada. 6. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Department of Medicine, Sinai Health System, Toronto, ON, Canada. 7. Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK; Warwick Clinical Trials Unit, University of Warwick, Coventry, UK. 8. Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada. 9. Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Bruyere Research Institute, Ottawa, ON, Canada; Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada. 10. Department of Medicine, University of Ottawa, Ottawa, ON, Canada. 11. Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada; Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada. 12. School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Bruyere Research Institute, Ottawa, ON, Canada; Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada. 13. Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Medicine, University of Ottawa, Ottawa, ON, Canada; Institut du Savoir Montfort, Ottawa, ON, Canada.
Abstract
BACKGROUND: In-hospital cardiac arrest (IHCA) is common and associated with high mortality. Frailty is increasingly recognized as a predictor of worse prognosis among critically ill patients, but its association with outcomes and resource utilization following IHCA is unknown. METHODS: We performed a retrospective analysis (2013-2016) of a prospectively collected registry from two hospitals of consecutive hospitalized adult patients with IHCA occurring on the hospital wards. We defined frailty using the Clinical Frailty Scale (CFS) score ≥5. CFS scores were based on validated medical review criteria. The primary outcome is hospital mortality. Secondary outcomes include return of spontaneous circulation (ROSC), discharge to long-term care, and hospital costs. We used multivariable logistic regression to adjust for known confounders. RESULTS: We included 477 patients, and 124 (26.0%) had frailty. Frailty was associated with increased odds of hospital death (adjusted odds ratio [aOR]: 2.91 [95% confidence interval [CI]: 2.37-3.48) and discharge to long-term care (aOR 1.94 [95% CI: 1.57-2.32]). Compared with patients without frailty, patients with frailty had decreased odds of ROSC following IHCA (aOR 0.63 [95% CI: 0.41-0.93]). No difference in mean total costs was demonstrated between patients with and without frailty ($50,799 vs. $45,849). Frail patients did have higher cost-per-survivor ($947,546 vs. $161,550). CONCLUSIONS: Frail individuals who experience an IHCA are more likely to die in hospital or be discharged to long-term care, and less likely to achieve ROSC in comparison with individuals who are not frail. The hospital costs per-survivor of IHCA are increased when frailty is present.
BACKGROUND: In-hospital cardiac arrest (IHCA) is common and associated with high mortality. Frailty is increasingly recognized as a predictor of worse prognosis among critically ill patients, but its association with outcomes and resource utilization following IHCA is unknown. METHODS: We performed a retrospective analysis (2013-2016) of a prospectively collected registry from two hospitals of consecutive hospitalized adult patients with IHCA occurring on the hospital wards. We defined frailty using the Clinical Frailty Scale (CFS) score ≥5. CFS scores were based on validated medical review criteria. The primary outcome is hospital mortality. Secondary outcomes include return of spontaneous circulation (ROSC), discharge to long-term care, and hospital costs. We used multivariable logistic regression to adjust for known confounders. RESULTS: We included 477 patients, and 124 (26.0%) had frailty. Frailty was associated with increased odds of hospital death (adjusted odds ratio [aOR]: 2.91 [95% confidence interval [CI]: 2.37-3.48) and discharge to long-term care (aOR 1.94 [95% CI: 1.57-2.32]). Compared with patients without frailty, patients with frailty had decreased odds of ROSC following IHCA (aOR 0.63 [95% CI: 0.41-0.93]). No difference in mean total costs was demonstrated between patients with and without frailty ($50,799 vs. $45,849). Frail patients did have higher cost-per-survivor ($947,546 vs. $161,550). CONCLUSIONS: Frail individuals who experience an IHCA are more likely to die in hospital or be discharged to long-term care, and less likely to achieve ROSC in comparison with individuals who are not frail. The hospital costs per-survivor of IHCA are increased when frailty is present.
Authors: Ester Holmström; Ilmar Efendijev; Rahul Raj; Pirkka T Pekkarinen; Erik Litonius; Markus B Skrifvars Journal: Scand J Trauma Resusc Emerg Med Date: 2021-07-28 Impact factor: 2.953
Authors: Michelle Samuel; Jean-Claude Tardif; Paul Khairy; François Roubille; David D Waters; Jean C Grégoire; Fausto J Pinto; Aldo P Maggioni; Rafael Diaz; Colin Berry; Wolfgang Koenig; Petr Ostadal; Jose Lopez-Sendon; Habib Gamra; Ghassan S Kiwan; Marie-Pierre Dubé; Mylène Provencher; Andreas Orfanos; Lucie Blondeau; Simon Kouz; Philippe L L'Allier; Reda Ibrahim; Nadia Bouabdallaoui; Dominic Mitchell; Marie-Claude Guertin; Jacques Lelorier Journal: Eur Heart J Qual Care Clin Outcomes Date: 2021-09-16
Authors: Eva Piscator; Therese Djärv; Katarina Rakovic; Emil Boström; Sune Forsberg; Martin J Holzmann; Johan Herlitz; Katarina Göransson Journal: Resusc Plus Date: 2021-04-29