Association Between a Hospital’s Rate of Cardiac Arrest Incidence and Cardiac Arrest Survival | Cardiology | JAMA Internal Medicine | JAMA Network
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Original Investigation
July 8, 2013

Association Between a Hospital’s Rate of Cardiac Arrest Incidence and Cardiac Arrest Survival

Author Affiliations
  • 1Division of General Medicine, University of Michigan, Ann Arbor
  • 2Divison of Cardiovascular Medicine, University of Michigan, Ann Arbor
  • 3Department of Internal Medicine, University of Michigan, and Veterans Affairs Health Services Research and Development Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor
  • 4St Luke’s Mid-America Heart and Vascular Institute, Kansas City, Missouri
  • 5University of Missouri, Kansas City
  • 6currently with the Division of General Medicine, Department of Internal Medicine, University of Michigan, and Veterans Affairs Ann Arbor Healthcare System
JAMA Intern Med. 2013;173(13):1186-1195. doi:10.1001/jamainternmed.2013.1026

Importance  National efforts to measure hospital performance in treating cardiac arrest have focused on case survival, with the hope of improving survival after cardiac arrest. However, it is plausible that hospitals with high case-survival rates do a poor job of preventing cardiac arrests in the first place.

Objective  To describe the association between inpatient cardiac arrest incidence and survival rates.

Design  Within a large, national registry, we identified hospitals with at least 50 adult in-hospital cardiac arrest cases between January 1, 2000, and November 30, 2009. We used multivariable hierarchical regression to evaluate the correlation between a hospital’s cardiac arrest incidence rate and its case-survival rate after adjusting for patient and hospital characteristics.

Main Outcomes and Measures  The correlation between a hospital’s incidence rate and case-survival rate for cardiac arrest.

Results  Of 102 153 cases at 358 hospitals, the median hospital cardiac arrest incidence rate was 4.02 per 1000 admissions (interquartile range, 2.95-5.65 per 1000 admissions), and the median hospital case-survival rate was 18.8% (interquartile range, 14.5%-22.6%). In crude analyses, hospitals with higher case-survival rates also had lower cardiac arrest incidence (r, −0.16; P = .003). This relationship persisted after adjusting for patient characteristics (r, −0.15; P = .004). After adjusting for potential mediators of this relationship (ie, hospital characteristics), the relationship between incidence and case survival was attenuated (r, −0.07; P = .18). The one modifiable hospital factor that most attenuated this relationship was a hospital’s nurse-to-bed ratio (r, −0.12; P = .03).

Conclusions and Relevance  Hospitals with exceptional rates of survival for in-hospital cardiac arrest are also better at preventing cardiac arrests, even after adjusting for patient case mix. This relationship is partially mediated by measured hospital attributes. Performance measures focused on case-survival rates seem an appropriate first step in quality measurement for in-hospital cardiac arrest.