Abstract
Background
In-hospital cardiac arrest (IHCA) is common and associated with high mortality. Frailty
is increasingly recognized as a predictor of worse prognosis among critically ill
patients, but its association with outcomes and resource utilization following IHCA
is unknown.
Methods
We performed a retrospective analysis (2013–2016) of a prospectively collected registry
from two hospitals of consecutive hospitalized adult patients with IHCA occurring
on the hospital wards. We defined frailty using the Clinical Frailty Scale (CFS) score
≥5. CFS scores were based on validated medical review criteria. The primary outcome
is hospital mortality. Secondary outcomes include return of spontaneous circulation
(ROSC), discharge to long-term care, and hospital costs. We used multivariable logistic
regression to adjust for known confounders.
Results
We included 477 patients, and 124 (26.0%) had frailty. Frailty was associated with
increased odds of hospital death (adjusted odds ratio [aOR]: 2.91 [95% confidence
interval [CI]: 2.37–3.48) and discharge to long-term care (aOR 1.94 [95% CI: 1.57–2.32]).
Compared with patients without frailty, patients with frailty had decreased odds of
ROSC following IHCA (aOR 0.63 [95% CI: 0.41–0.93]). No difference in mean total costs
was demonstrated between patients with and without frailty ($50,799 vs. $45,849).
Frail patients did have higher cost-per-survivor ($947,546 vs. $161,550).
Conclusions
Frail individuals who experience an IHCA are more likely to die in hospital or be
discharged to long-term care, and less likely to achieve ROSC in comparison with individuals
who are not frail. The hospital costs per-survivor of IHCA are increased when frailty
is present.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ResuscitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- In-hospital cardiac arrest: a review.JAMA. 2019; 321: 1200-1210
- Strategies for improving survival after in-hospital cardiac arrest in the United States: 2013 consensus recommendations: a consensus statement from the American Heart Association.Circulation. 2013; 127: 1538-1563
- Incidence, location and reasons for avoidable in-hospital cardiac arrest in a district general hospital.Resuscitation. 2002; 54: 115-123
- Increasing survival after admission to UK critical care units following cardiopulmonary resuscitation.Crit Care. 2016; 20: 219
- Meta-analysis of outcomes of the 2005 and 2010 cardiopulmonary resuscitation guidelines for adults with in-hospital cardiac arrest.Am J Emerg Med. 2016; 34: 1133-1139
- One-year survival after in-hospital cardiac arrest: a systematic review and meta-analysis.Resuscitation. 2018; 132: 90-100
- Pre- and intra-arrest prognostic factors associated with survival following in-hospital cardiac arrest: systematic review and meta-analysis.BMJ. 2019;
- In-hospital cardiac arrest: are we overlooking a key distinction?.Curr Opin Crit Care. 2018; 24: 151-157
- Frailty in elderly people.Lancet. 2013; 381: 752-762
- Frailty in older adults: evidence for a phenotype.J Gerontol A Biol Sci Med Sci. 2001; 56: M146-56
- Prevalence of frailty in Canadians 18-79 years old in the Canadian Health Measures Survey.BMC Geriatr. 2017; 17: 28
- A prospective multicenter cohort study of frailty in younger critically ill patients.Crit Care. 2016; 20: 175
- A global clinical measure of fitness and frailty in elderly people.CMAJ. 2005; 173: 489-495
- Association between frailty and short- and long-term outcomes among critically ill patients: a multicentre prospective cohort study.CMAJ. 2014; 186: E95-102
- Prevalence and impact of frailty on mortality in elderly ICU patients: a prospective, multicenter, observational study.Intensive Care Med. 2014; 40: 674-682
- Frailty and subsequent disability and mortality among patients with critical illness.Am J Respir Crit Care Med. 2017; 196: 64-72
- Association of frailty with short-term outcomes, organ support and resource use in critically ill patients.Intensive Care Med. 2018; 44: 1512-1520
- Frailty and associated outcomes and resource utilization among older ICU patients with suspected infection.Crit Care Med. 2019; 47: e669-e676
- Frailty and invasive mechanical ventilation: association with outcomes, extubation failure, and tracheostomy.Intensive Care Med. 2019;
- The impact of frailty on intensive care unit outcomes: a systematic review and meta-analysis.Intensive Care Med. 2017; 43: 1105-1122
- Long-term outcomes in elderly survivors of in-hospital cardiac arrest.N Engl J Med. 2013; 368: 1019-1026
- Levers for addressing medical underuse and overuse: achieving high-value health care.Lancet. 2017; 390: 191-202
- De-implementing low value care in critically ill patients: a call for action-less is more.Intensive Care Med. 2019;
- Sepsis-3 septic shock criteria and associated mortality among infected hospitalized patients assessed by a rapid response team.Chest. 2018; 154: 309-316
- Outcomes and costs of patients admitted to the ICU due to spontaneous intracranial hemorrhage.Crit Care Med. 2018; 46: e395-e403
- Outcomes of older hospitalized patients requiring rapid response team activation for acute deterioration.Crit Care Med. 2018; 46: 1953-1960
- Incidence and outcome of in-hospital cardiac arrest in the United Kingdom National Cardiac Arrest Audit.Resuscitation. 2014; 85: 987-992
- Comorbidity measures for use with administrative data.Med Care. 1998; 36: 8-27
- Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome.Crit Care Med. 1995; 23: 1638-1652
- Emergency department disposition decisions and associated mortality and costs in ICU patients with suspected infection.Crit Care. 2018; 22: 172
- Patterns of health care use in a high-cost inpatient population in Ottawa, Ontario: a retrospective observational study.CMAJ Open. 2015; 3: E111-8
- Nine equivalents of nursing manpower use score (NEMS).Intensive Care Med. 1997; 23: 760-765
- Assessing frailty in the intensive care unit: a reliability and validity study.J Crit Care. 2018; 45: 197-203
- Advanced statistics: understanding medical record review (MRR) studies.Acad Emerg Med. 2004; 11: 187-192
- Control of confounding and reporting of results in causal inference studies. Guidance for Authors from Editors of Respiratory, Sleep, and Critical Care Journals.Ann Am Thorac Soc. 2019; 16: 22-28
- Survival and neurological outcome in the elderly after in-hospital cardiac arrest.Resuscitation. 2017; 118: 101-106
- The chance of survival and the functional outcome after in-hospital cardiopulmonary resuscitation in older people: a systematic review.Age Ageing. 2014; 43: 456-463
- Patterns of resuscitation care and survival after in-hospital cardiac arrest in patients with advanced cancer.J Oncol Pract. 2017; 13: e821-e830
- Frailty is associated with reduced prospect of discharge home after in-hospital cardiac arrest.Intern Med J. 2018;
- Frailty is associated with adverse outcome from in-hospital cardiopulmonary resuscitation.Resuscitation. 2019;
- The influence of the probability of survival on patients’ preferences regarding cardiopulmonary resuscitation.N Engl J Med. 1994; 330: 545-549
- Cardiopulmonary resuscitation on television. Miracles and misinformation.N Engl J Med. 1996; 334: 1578-1582
- Frailty as a predictor of death or new disability after surgery: a prospective cohort study.Ann Surg. 2018;
- Why is it so hard to stop doing things that are unwanted, non-beneficial, or unsustainable?.Lancet Respir Med. 2019; 7: 558-560
- Mortality and costs following extracorporeal membrane oxygenation in critically ill adults: a population-based cohort study.Intensive Care Med. 2019; 45: 1580-1589
- COSCA (Core Outcome Set for Cardiac Arrest) in adults: an advisory statement from the International Liaison Committee on Resuscitation.Resuscitation. 2018; 127: 147-163
Article info
Publication history
Published online: November 27, 2019
Accepted:
November 16,
2019
Received in revised form:
November 2,
2019
Received:
September 23,
2019
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2019 Elsevier B.V. All rights reserved.
