SESSION TITLE: CAD/Coronary Syndromes Posters
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM
PURPOSE: Cardiac arrest is one of the major causes of mortality and morbidity. The survival rates after cardiac arrest are improving with advances in Cardio-pulmonary resuscitation (CPR). Post cardiac arrest hypothermia is shown to improve survival and neurological outcomes. Epidemiological factors, etiological factors and co-morbid conditions influencing the mortality are still debatable and require further exploration.
METHODS: We queried the Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample (NIS) between 2003 and 2011 and separated the hospitalizations with cardiac arrest (ICD-9 diagnostic code 427.5) who received therapeutic hypothermia (ICD-9 procedure code 99.81). We examined the factors associated with mortality using logistic regression model. Using SAS 9.2, Survey procedures were used to identify multivariate predictors of mortality, accommodating hierarchical two stage cluster design of NIS.
RESULTS: A total of 670 patients (Weighted N = 3283) who had cardiac arrest and received therapeutic hypothermia were available for analysis. After controlling for confounders, female sex (OR 0.58, 95% CI 0.39-0.86, p=0.007) and acute myocardial infarction were associated with decreased mortality (OR 0.59, 95% CI 0.4-0.87, p=0.009). Increasing age (OR 1.02, 95% CI 1.01-1.04, p=0.001) and African American race vs. Caucasian race (OR 1.77, 95% CI 1.02-3.07, p=0.04) were associated with increased mortality. Any respiratory illness (OR 0.53, 95% CI 0.23 -1.26), illnesses related to pulmonary circulation including Pulmonary Embolism (PE) (OR 0.78, 95% CI 0.44 -1.36), cerebrovascular diseases (OR 0.57 ,95% CI 0.29-1.11), Charlson Co-morbidity Index (OR 0.92, 95% CI 0.83-1.02), use of vasopressors (OR 1.36, 95%CI 0.82 -2.25), urban location of hospital (OR 0.64, 95% CI 0.26-1.53), teaching status of hospital (OR 0.96, 95% CI 0.61-1.51), and Hispanic race vs. Caucasian race (OR 1.07, 95% CI 0.61-1.85) were not associated with mortality after hypothermia in patients with cardiac arrest.
CONCLUSIONS: Increasing age and African American race are independent predictors of increased mortality whereas; female race and acute myocardial infarction are independent predictors of decreased mortality in patients receiving hypothermia after cardiac arrest.
CLINICAL IMPLICATIONS: Our study helps to understand the mortality risk and benefit in post cardiac arrest hypothermia patients and indicate that further investigation is warranted to refine the inclusion criteria for therapeutic hypothermia in patients with cardiac arrest.
DISCLOSURE: The following authors have nothing to disclose: Tapan Mehta, Ronak Soni, Khushboo Sheth, Kathan Mehta
No Product/Research Disclosure Information