In-Hospital Cardiac Arrest More Common Than Previously Thought

New research is suggesting significantly more patients suffer from cardiac arrests in US hospitals than previously estimated.





Using data from the American Heart Association (AHA) annual survey, investigators estimated that a total of 292,000 adult and 15,200 pediatric cases of cardiac arrest occur in hospitals across the US annually. 



“Our findings illustrate a concerning trend in U.S. hospitals, and show that cardiac arrest is a major public health problem,” said study co-author Lars Andersen, MD, MPH, PhD, DMSc, associate professor at Aarhus University in Denmark, who oversaw the study as a visiting researcher at Beth Israel Deaconess Medical Center’s Department of Emergency Medicine in Boston. “Previous incidence estimates may no longer reflect the current public health burden of cardiac arrest in hospitalized patients across the U.S.”

Investigators developed a negative binomial regression model using the Get With The Guidelines-Resuscitation (GWTG-R) registry to estimate the incidence of index pulseless in-hospital cardiac arrest based on hospital-level characteristics. Investigators then applied the model to predict in-hospital cardiac arrests using data from the AHA annual survey. 



Investigators performed separate analyses for groups of adult and pediatric patients(less than 18 years old) for cardiac arrest. Investigators also performed additional analyses to evaluate rates of recurrent cardiac arrests and pediatric patients requiring cardiopulmonary resuscitation for poor perfusion.

From the 398 GWTG-R hospitals identified, investigators estimated the average incidence across all hospitals in the US between 2008 and 2017 was 292,000 cases per year. Investigators noted that these results were similar when adding the number of admissions to the model in the post hoc analysis. When including both index and recurrent events, investigators estimated that the average annual incidence between 2008 and 2017 was 357,900. 



A total of 212 pediatric hospitals with pulseless cardiac arrests and 158 with nonpulseless events were linked to the GWTG-R registry. Investigators noted 6004 pulseless cardiac arrests and 5022 nonpulseless events were registered in the GWTG-R registry between 2008 and 2017. 



After analyses, investigators estimated that the average national nonpulseless event incidence was estimated at 8100 cases per year. When including both index and recurrent nonpulseless events, the average annual incidence was estimated at 11,600 cases. The overall national pediatric in-hospital event incidence was calculated at 15,200 cases per year. 



Investigators noted that the study’s findings should be interpreted with caution due to the fact that data was limited to that obtained from GWTG-R hospitals. 



“Unfortunately, the data does not provide an explanation for the increase in adult in-hospital cardiac arrest, but it is likely due to many factors and may reflect an increase in actual events or in the reporting of cases over time,” Andersen said. 



This study, titled “Annual Incidence of Adult and Pediatric In-Hospital Cardiac Arrest in the United States,” is published in Circulation: Cardiovascular Quality and Outcomes, an AHA journal.