Factors Associated with Survival with Preserved Neurologic Function for Patients with Congestive Heart Failure and In-hospital Cardiac Arrest

Abstract Background Survival after out-of-hospital cardiac arrest (OHCA) has increased in recent years but is still only 10%. Little is known about the association between post-resuscitation comorbidity and heart failure after discharge from the initial OHCA-admission. Purpose In OHCA-survivors we aimed to describe predictors of left ventricular (LV) dysfunction, defined as LV ejection fraction (LVEF) <40%, at follow-up. Methods A consecutive cohort of OHCA-patients with cardiac cause from 2007 to 2011 without a pre-OHCA congestive heart failure diagnosis (according to the Danish National Patient Registry, which holds data on all Danish citizens) were retrospectively examined. Logistic regression analyses were used to assess factors associated with LV dysfunction (LVEF <40%) at follow-up after a median of 6 months. Follow-up was not performed systematically in the OHCA-survivors and data from follow-up was assessed by reading of patient charts. Results A total of 365 OHCA-survivors with a mean age of 61 years were discharged alive from hospital. LVEF <40% at hospital discharge was seen in 54% (n=184, 7% missing), and at follow-up after a median of 6 months 19% (n=69) of the total OHCA-cohort of survivors still had LV dysfunction. Factors associated with LV dysfunction at follow-up were chronic ischemic heart disease (IHD) prior to OHCA (odds ratio (OR) = 2.9 (95% CI: 1.2 – 7.1)) and ST-elevation myocardial infarction (STEMI) as cause of OHCA (OR = 2.9 (1.4–6.0)), whereas age, gender, high comorbidity burden prior to OHCA or pre-hospital circumstances (including shockable cardiac arrest rhythm) were not. Conclusion More than half of OHCA-survivors with LVEF <40% at hospital discharge improved LV function and LV dysfunction at follow-up after a median of 6 months after discharge was present in 1 in 5 (19%) of the cohort. Chronic IHD and STEMI were the only factors significantly associated with LV dysfunction at follow-up. A systematic follow-up including echocardiography in the outpatient clinic for OHCA-survivors is recommended especially in patients with reduced LV function at discharge and in STEMI-patients in order to assess the appropriateness of heart failure medication and an implantable cardiac defibrillator. Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Danish Foundation Trygfonden

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Abstract 113: Readmission Rates and Causes for In-Hospital Cardiac Arrest Survivors at 30 and 180 Days: Insights from Nationwide Readmission Database

Circulation ◽

10.1161/circ.140.suppl_2.113 ◽

2019 ◽

Vol 140 (Suppl_2) ◽

Author(s):

Ahmed Elkaryoni ◽

Paul Chan

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Cardiac Arrest ◽

Hospital Discharge ◽

Readmission Rates ◽

Common Cause ◽

Icd 10 ◽

Nationwide Readmission Database ◽

Hospital Cardiac Arrest ◽

Over Time

Introduction: Rates of survival to discharge for patients with in-hospital cardiac arrest (IHCA) have improved over the past 2 decades from 13% in 2000 to 25% in 2016. Yet, little is known about rates and causes of readmissions among those survivors. We sought to investigate early and late rates and causes of readmission for IHCA survivors at 30 and 180 days after discharge. Methods: Within the Nationwide Readmission Database (NRD), we identified patients 18 years of age or older who survived to hospital discharge after an IHCA between 2010 and 2016. IHCA was defined by an ICD-9 or ICD-10 diagnosis code (cardiac arrest, ventricular fibrillation or flutter) combined with a procedure code (defibrillation or external chest compression). We evaluated rates and causes of 30 and 180 days readmission and examined whether these have changed over time. Results: A total of 86,140 patients had an IHCA and survived to hospital discharge. Overall, mean age was 64.3 ± 14.9, women were 40.1%, and the mean length of stay was 15.1 ±17.9 days. All-cause readmission rates at 30 and 180 days were 22.7% and 69.9%, respectively. Readmission rates decreased over time. Thirty-day readmission rates decreased from 23.8% in 2010 to 21.1% in 2016, and 180-day readmission rates decreased from 76.1% to 63.6%. (Figure) Among readmitted patients, 13.5% were readmitted more than once at 30 days and 44.9% were readmitted more than once at 180 days. The most common cause of 30-day readmissions were congestive heart failure (11.7%), infection/septicemia (11.4%), and cardiac dysrhythmias (5.3%),whereas the top causes of 180-day readmissions were congestive heart failure (11.9%), infection/septicemia (11.3%), and respiratory insufficiency, or device complications (4.6%). Conclusion: All-cause readmission rates for IHCA survivors at 30 and 180 days have decreased over time, Congestive heart failure is the most common cause of readmissions but accounts for only 11.7% and 11.9% of readmissions at 30 and 180 days.

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Mechanical circulatory support for refractory out-of-hospital cardiac arrest: a Danish nationwide multicenter study

Critical Care ◽

10.1186/s13054-021-03606-5 ◽

2021 ◽

Vol 25 (1) ◽

Author(s):

Sivagowry Rasalingam Mørk ◽

Carsten Stengaard ◽

Louise Linde ◽

Jacob Eifer Møller ◽

Lisette Okkels Jensen ◽

...

Keyword(s):

Logistic Regression ◽

Cardiac Arrest ◽

Survival Rate ◽

Neurological Outcome ◽

Mechanical Circulatory Support ◽

Circulatory Support ◽

Good Neurological Outcome ◽

Factors Associated ◽

National Consensus ◽

Hospital Cardiac Arrest

Abstract Background Mechanical circulatory support (MCS) with either extracorporeal membrane oxygenation or Impella has shown potential as a salvage therapy for patients with refractory out-of-hospital cardiac arrest (OHCA). The objective of this study was to describe the gradual implementation, survival and adherence to the national consensus with respect to use of MCS for OHCA in Denmark, and to identify factors associated with outcome. Methods This retrospective, observational cohort study included patients receiving MCS for OHCA at all tertiary cardiac arrest centers (n = 4) in Denmark between July 2011 and December 2020. Logistic regression and Kaplan–Meier survival analysis were used to determine association with outcome. Outcome was presented as survival to hospital discharge with good neurological outcome, 30-day survival and predictors of 30-day mortality. Results A total of 259 patients were included in the study. Thirty-day survival was 26%. Sixty-five (25%) survived to hospital discharge and a good neurological outcome (Glasgow–Pittsburgh Cerebral Performance Categories 1–2) was observed in 94% of these patients. Strict adherence to the national consensus showed a 30-day survival rate of 30% compared with 22% in patients violating one or more criteria. Adding criteria to the national consensus such as signs of life during cardiopulmonary resuscitation (CPR), pre-hospital low-flow < 100 min, pH > 6.8 and lactate < 15 mmol/L increased the survival rate to 48%, but would exclude 58% of the survivors from the current cohort. Logistic regression identified asystole (RR 1.36, 95% CI 1.18–1.57), pulseless electrical activity (RR 1.20, 95% CI 1.03–1.41), initial pH < 6.8 (RR 1.28, 95% CI 1.12–1.46) and lactate levels > 15 mmol/L (RR 1.16, 95% CI 1.16–1.53) as factors associated with increased risk of 30-day mortality. Patients presenting signs of life during CPR had reduced risk of 30-day mortality (RR 0.63, 95% CI 0.52–0.76). Conclusions A high survival rate with a good neurological outcome was observed in this Danish population of patients treated with MCS for OHCA. Stringent patient selection for MCS may produce higher survival rates but potentially withholds life-saving treatment in a significant proportion of survivors.

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Factors associated with shockable versus non-shockable rhythms in patients with in-hospital cardiac arrest

Resuscitation ◽

10.1016/j.resuscitation.2020.11.022 ◽

2021 ◽

Vol 158 ◽

pp. 166-174

Author(s):

Nikola Stankovic ◽

Maria Høybye ◽

Mathias J. Holmberg ◽

Kasper G. Lauridsen ◽

Lars W. Andersen ◽

...

Keyword(s):

Cardiac Arrest ◽

Factors Associated ◽

Hospital Cardiac Arrest

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Factors Associated with Successful Resuscitation after In-Hospital Cardiac Arrest: an prospective observational study performed in a tertiary hospital in south west of China

Resuscitation ◽

10.1016/j.resuscitation.2019.06.059 ◽

2019 ◽

Vol 142 ◽

pp. e22

Author(s):

Yarong He ◽

Peng Yao ◽

Tianyong Han ◽

Qin Li ◽

Yu Cao

Keyword(s):

Cardiac Arrest ◽

Observational Study ◽

Prospective Observational Study ◽

Tertiary Hospital ◽

Successful Resuscitation ◽

Factors Associated ◽

South West ◽

Hospital Cardiac Arrest

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Improving Survival and Neurologic Function for Younger Age Groups After Out-of-Hospital Cardiac Arrest in Sweden

Pediatric Critical Care Medicine ◽

10.1097/pcc.0000000000000503 ◽

2015 ◽

Vol 16 (8) ◽

pp. 750-757 ◽

Cited By ~ 23

Author(s):

Jan Gelberg ◽

Anneli Strömsöe ◽

Jacob Hollenberg ◽

Peter Radell ◽

Andreas Claesson ◽

...

Keyword(s):

Cardiac Arrest ◽

Age Groups ◽

Younger Age ◽

Neurologic Function ◽

Hospital Cardiac Arrest

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Work factors associated with return to work in out-of-hospital cardiac arrest survivors

Resuscitation ◽

10.1016/j.resuscitation.2018.05.021 ◽

2018 ◽

Vol 128 ◽

pp. 170-174 ◽

Cited By ~ 7

Author(s):

Alexis Descatha ◽

Florence Dumas ◽

Wulfran Bougouin ◽

Alain Cariou ◽

Guillaume Geri

Keyword(s):

Cardiac Arrest ◽

Return To Work ◽

Factors Associated ◽

Work Factors ◽

Hospital Cardiac Arrest

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Increased 5-year risk of stroke, atrial fibrillation, acute coronary syndrome and heart failure in out-of-hospital cardiac arrest survivors relative to population controls: a nationwide register-based

European Heart Journal ◽

10.1093/ehjci/ehaa946.0753 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

K Kragholm ◽

K Bundgaard ◽

M Wissenberg ◽

F Folke ◽

F Lippert ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Acute Coronary Syndrome ◽

Cardiac Arrest ◽

Lipid Lowering ◽

Registration System ◽

Coronary Syndrome ◽

Hospital Cardiac Arrest ◽

Population Controls ◽

Age And Sex

Abstract Background Out-of-hospital cardiac arrest (OHCA) survivors are a selected group of patients with younger age and less comorbid conditions relative to non-survivors. Long-term risk of stroke, atrial fibrillation or flutter (AF), acute coronary syndrome (ACS) and heart failure (HF) in OHCA survivors not diagnosed with any of these conditions as part of the cardiac arrest is unknown. Purpose To examine 5-year risk of stroke, AF, ACS and HF in 30-day OHCA survivors relative to age- and sex-matched population controls. Methods OHCA 30-day survivors and age- and sex-matched population controls not previously diagnosed with stroke, AF, ACS or HF or during the first 30 days after cardiac arrest were included using Danish Cardiac Arrest Registry data from 2001–2015 as well as the Danish Civil Registration System. Characteristics are compared using totals and percentages for categorical data and median and 25–75% percentiles for continuous data. Five-year outcomes are compared using cumulative incidence plots as well as Shared Frailty Cox regression modeling, unadjusted and adjusted for potential confounders including age, sex, hypertension, diabetes, chronic obstructive pulmonary disease (COPD), peripheral arterial disease (PAD), chronic ischemic heart disease (IHD), transient ischemic attack (TIA), thyroid disease, cholesterol-lowering, antiplatelet and anticoagulant agents. Results Of 4362 30-day survivors, 1063 were stroke-, AF-, ACS- and HF-naïve and 1051 were matched to population controls using age, sex and time of OHCA event as matching variables. The figure depicts the risk of stroke beyond day 30 to 5 years of follow-up was 4.7% versus 1.7% for OHCA survivors vs. controls. Risks of AF, ACS and HF were 7.0% vs. 2.1%, 4.7% versus 1.2% and 12.2% vs. 1.0%, respectively. OHCA 30-day survivors were significantly more likely to have PAD relative to controls, 4.9% vs. 1.1%. Differences in IHD (22.0% vs. 1.7%), hypertension (28.1% vs. 14.6%), diabetes (9.5% vs. 4.1%), lipid-lowering agents (27.6% vs. 9.5%), COPD (11.3% vs. 2.2%) were also significant. When adjusting for these comorbidities as well as for thyroid diseases, chronic kidney disease, cancer, antiplatelet and anticoagulant therapy, differences remained highly significant: HR stroke 3.33 [95% CI 2.21–5.02], HR AF 3.26 [2.28–4.66], HR ACS 3.36 [2.14–5.27] and HR HF 11.50 [8.02–16.48]. Conclusion We demonstrate an increased five-year risk of stroke, atrial fibrillation or flutter, acute coronary syndrome and heart failure in out-of-hospital cardiac arrest survivors without prior existence of any of these conditions. These results indicate that OHCA survivors continue to remain high-risk patients for cardiovascular events and prevention intervention is warranted. Funding Acknowledgement Type of funding source: None

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Low PCSK-9 levels Are Associated with Favorable Neurologic Function after Resuscitation from out of Hospital Cardiac Arrest

Journal of Clinical Medicine ◽

10.3390/jcm9082606 ◽

2020 ◽

Vol 9 (8) ◽

pp. 2606

Author(s):

Anne Merrelaar ◽

Nina Buchtele ◽

Christoph Schriefl ◽

Christian Clodi ◽

Michael Poppe ◽

...

Keyword(s):

Cardiac Arrest ◽

Neurological Outcome ◽

Primary Outcome ◽

Characteristic Curve ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Hepatic Uptake ◽

Logistic Regression Models ◽

Neurologic Function ◽

Hospital Cardiac Arrest

Endotoxemia after cardiopulmonary resuscitation (CPR) is associated with unfavorable outcome. Proprotein convertase subtilisin/kexin type-9 (PCSK–9) regulates low-density lipoprotein receptors, which mediate the hepatic uptake of endotoxins. We hypothesized that PCSK–9 concentrations are associated with neurological outcome in patients after CPR. Successfully resuscitated out-of-hospital cardiac arrest patients were included prospectively (n = 79). PCSK–9 levels were measured on admission, 12 h and 24 h thereafter, and after rewarming. The primary outcome was favorable neurologic function at day 30, defined by cerebral performance categories (CPC 1–2 = favorable vs. CPC 3–5 = unfavorable). Receiver operating characteristic curve analysis was used to identify the PCSK–9 level cut-off for optimal discrimination between favorable and unfavorable 30-day neurologic function. Logistic regression models were calculated to estimate the effect of PCSK–9 levels on the primary outcome, given as odds ratio (OR) and 95% confidence interval (95%CI). PCSK–9 levels on admission were significantly lower in patients with favorable 30-day neurologic function (median 158 ng/mL, (quartiles: 124–225) vs. 207 ng/mL (174–259); p = 0.019). The optimally discriminating PCSK–9 level cut-off was 165 ng/mL. In patients with PCSK–9 levels ≥ 165 ng/mL, the odds of unfavorable neurological outcome were 4.7-fold higher compared to those with PCSK–9 levels < 165 ng/mL. In conclusion, low PCSK–9 levels were associated with favorable neurologic function.

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