Bradley Steven M, Kaboli Peter, Kamphuis Lee A, Chan Paul S, Iwashyna Theodore J, Nallamothu Brahmajee K
VA Eastern Colorado Health Care System, Denver, CO; Minneapolis Heart Institute, Minneapolis, MN.
Iowa City Veterans Affairs Medical Center and the University of Iowa Carver College of Medicine, Iowa City, IA.
Am Heart J. 2017 Nov;193:117-123. doi: 10.1016/j.ahj.2017.05.018. Epub 2017 Aug 7.
Despite significant attention to resuscitation care by hospitals, national data on trends in the incidence and survival of patients with inhospital cardiac arrest (IHCA) are limited.
To determine trends and hospital-level variation in the incidence and outcomes associated with IHCA. In exploratory analyses, we evaluated the relationship between hospital-level IHCA incidence and outcomes with general hospital-wide quality improvement activities.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of 2,205,123 hospitalizations at 101 Veterans Health Administration (VHA) hospitals between 2008 and 2012.
Risk- and reliability-adjusted hospital-level IHCA incidence and survival to hospital discharge.
A total of 8821 (0.40%) IHCA occurred between 2008 and 2012, with no significant change in risk-adjusted incidence over this time (P = .77). Hospital-level IHCA incidence varied substantially across facilities, with a median hospital incidence of 4.0 per 1000 hospitalizations and a range from 1.4 to 11.8 per 1000 hospitalizations. Overall, survival to discharge after IHCA was 31.2%. Risk-adjusted odds of survival increased over the study period (2012 vs 2008, OR: 1.49, 95% CI: 1.27, 1.75) but survival varied substantially across facilities from 20.3% to 45.4%. General hospital quality improvement activities were inconsistently associated with IHCA incidence and survival.
Within the VHA, the incidence and outcomes of IHCA showed important trends over time but varied substantially across hospitals with no consistent link to general hospital quality improvement activities. Identification of specific resuscitation practices at hospitals with low incidence and high survival of IHCA may guide further improvements for inhospital resuscitation.
尽管医院对复苏护理给予了高度关注，但关于住院心脏骤停（IHCA）患者发病率和生存率趋势的全国性数据有限。
确定与IHCA相关的发病率和结局的趋势及医院层面的差异。在探索性分析中，我们评估了医院层面的IHCA发病率和结局与一般医院范围质量改进活动之间的关系。
设计、设置和参与者：对2008年至2012年间101家退伍军人健康管理局（VHA）医院的2205123例住院病例进行回顾性队列研究。
风险和可靠性调整后的医院层面IHCA发病率及出院生存率。
2008年至2012年间共发生8821例（0.40%）IHCA，在此期间风险调整后的发病率无显著变化（P = 0.77）。各医院的医院层面IHCA发病率差异很大，医院发病率中位数为每1000例住院病例4.0例，范围为每1000例住院病例1.4至11.8例。总体而言，IHCA后出院生存率为31.2%。在研究期间，风险调整后的生存几率有所增加（2012年与2008年相比，OR：1.49，95%CI：1.27，1.75），但各医院生存率差异很大，从20.3%至45.4%不等。一般医院质量改进活动与IHCA发病率和生存率的关联并不一致。
在VHA内部，IHCA的发病率和结局随时间呈现重要趋势，但各医院差异很大，且与一般医院质量改进活动无一致关联。识别IHCA发病率低且生存率高的医院的特定复苏实践可能会指导住院复苏的进一步改进。
