Guideline-Based Care Changes In-House Cardiac Arrest Survival

HealthDay News – Implementation of quality-of-care performance measures in hospitals resulted in higher survival rates after in-house cardiac arrest (IHCA), according to a study published in JAMA Cardiology.

Monique L. Anderson, MD, from the Duke University Medical Center in Durham, N.C., and colleagues examined hospital-level variation to determine whether hospital process composite performance measures of IHCA care quality correlate with patient outcomes. Data from the Get With the Guidelines-Resuscitation program were analyzed for 35,283 patients with IHCA from 261 U.S. Hospitals. The hospital process composite performance score for IHCA was calculated using five guideline-recommended process measures.

The researchers found that the median IHCA hospital process composite performance was 89.7%, with variation from 82.6 to 94.8% among hospital quartiles. There was a linear correlation for IHCA hospital process composite performance with risk-standardized hospital survival to discharge rates: 21.1, 21.4, 22.8, and 23.4%,  respectively, from the lowest to highest performance quartiles (P < 0.001). 

Each 10% increase in a hospital’s process composite performance correlated with increased odds of survival after adjustment (adjusted odds ratio, 1.22; P = 0.01). There was also a correlation seen for hospital process composite quality performance with favorable neurologic status at discharge (P = 0.004).

“The quality of guideline-based care for IHCA varies significantly among U.S. hospitals and is associated with patient survival and neurologic outcomes,” the authors write.

One author disclosed financial ties to the pharmaceutical industry.

Summary and Clinical Applicability

The cross-sectional analysis performed in this study showed that hospital implementation and adherence to quality-of-care performance measures resulted in higher survival rates after in-house cardiac arrest (IHCA).

The authors expressed this significance of this finding when stating “on the basis of an estimated 190,000 to 200,000 IHCAs per year in the United States, we estimate an additional 22,990 to 24,200 lives would be saved per year if all hospitals operated at the level of the highest-performing hospital”.

Furthermore, “significant opportunities remain for improving adherence to guideline-recommended care overall and with individual process-of-care measures”, the authors write.

Reference

Anderson ML, Nichol G, Dai D, et al. Association Between Hospital Process Composite Performance and Patient Outcomes After In-Hospital Cardiac Arrest Care. JAMA Cardiol. Published online February 24, 2016.