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Original Research: Critical Care |

Long-term Outcomes After In-Hospital CPR in Older Adults With Chronic IllnessCPR Outcomes in Patients With Chronic Disease

Renee D. Stapleton, MD, PhD, FCCP; William J. Ehlenbach, MD; Richard A. Deyo, MD, MPH; J. Randall Curtis, MD, MPH
Author and Funding Information

From the Division of Pulmonary and Critical Care (Dr Stapleton), University of Vermont, Burlington, VT; Division of Pulmonary and Critical Care (Dr Ehlenbach), University of Wisconsin, Madison, WI; Departments of Family Medicine, Medicine, Public Health, and Preventative Medicine and Center for Research in Occupational and Environmental Toxicology (Dr Deyo), Oregon Health and Science University, Portland, OR; and Division of Pulmonary and Critical Care (Dr Curtis), Harborview Medical Center, University of Washington, Seattle, WA.

CORRESPONDENCE TO: Renee D. Stapleton, MD, PhD, FCCP, Division of Pulmonary and Critical Care Medicine, University of Vermont College of Medicine, 149 Beaumont Ave, HSRF 222, Burlington, VT 05405; e-mail: renee.stapleton@uvm.edu


FUNDING/SUPPORT: This research was supported by an ASP-CHEST Foundation of the American College of Chest Physicians-Geriatric Development Research Award funded by The Atlantic Philanthropies, CHEST Foundation, The John A. Hartford Foundation, and the Association of Specialty Professors (to Dr Stapleton). It was also supported by a National Institutes of Health/National Center for Research Resources (NCRR) Roadmap K12 Award [8K12RR023265 to Dr Stapleton] and an NCRR Center of Biomedical Research Excellence (COBRE) Award [5P20RR015557 to Dr Stapleton]. Additional funding included a Paul Beeson Career Development Award in Aging Research [5K23AG038352] funded by the National Institute on Aging, The Atlantic Philanthropies, The John A. Hartford Foundation, the Starr Foundation, and an anonymous donor (to Dr Ehlenbach) and a Midcareer Investigator Award in Patient-Oriented Research [K24 HL68593 to Dr Curtis].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(5):1214-1225. doi:10.1378/chest.13-2110
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BACKGROUND:  Outcomes after in-hospital CPR in older adults with chronic illness are unclear.

METHODS:  We examined inpatient Medicare data from 1994 through 2005 to identify CPR recipients. We grouped beneficiaries aged ≥ 67 years by severity of six chronic diseases—COPD, congestive heart failure (CHF), chronic kidney disease (CKD), malignancy, diabetes, and cirrhosis—and investigated survival to discharge, discharge destination, rehospitalizations, and long-term survival.

RESULTS:  We identified 358,682 CPR recipients. Most patients with chronic disease were less likely to survive to discharge (eg, 14.8% in the advanced COPD group [P < .001] and 11.3% in the advanced malignancy group [P < .001]) than patients without chronic illness (17.3%). Among discharge survivors, the median long-term survival was shorter in patients with chronic illness (eg, 5.0, 3.5, and 2.8 months in the advanced COPD, malignancy, and cirrhosis groups, respectively; P < .001 for all) than without (26.7 months). Although 7.2% of CPR recipients without chronic disease were discharged home and survived at least 6 months without readmission, ≤ 2.0% of recipients with advanced COPD, CHF, malignancy, and cirrhosis (P < .001 for all) met these criteria. Adjusted analyses confirmed that most subgroups with chronic illness had lower hospital discharge survival, and among discharge survivors, most were discharged home less often, experienced more hospital readmissions, and had worse long-term survival.

CONCLUSIONS:  Older CPR recipients with any of the six underlying chronic diseases investigated generally have much worse outcomes than CPR recipients without chronic disease. These findings may substantially affect decisions about CPR in patients with chronic illness.

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