title: The first documented cardiac arrest rhythm in hospitalized patients with heart failure.
abstract: BACKGROUND
  Patients with heart failure (HF) have abnormal cellular anatomy and myocardial mechanics that may impact the initial rhythm and subsequent outcomes in cardiac arrest (CA).
  
  
  OBJECTIVE
  Patients with pre-existing HF are less likely to have ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT) as the first documented rhythm in CA and have poorer survival than patients without pre-existing HF.
  
  
  OBJECTIVE
  Identify the first documented cardiac arrest rhythm (FDR) in hospitalized patients with and without a pre-existing history of HF.
  
  
  METHODS
  We evaluated 60,389 consecutive, adult, index, pulseless CA events with documented initial rhythm in the National Registry of Cardiopulmonary Resuscitation. The primary endpoint was the FDR in patients with and without a history of pre-existing HF. Secondary endpoints were return of spontaneous circulation (ROSC), survival to discharge, and neurological outcome.
  
  
  RESULTS
  Thirty three percent of patients had a pre-existing diagnosis of HF. HF patients were more likely to have VF/pVT (25.9 vs. 23.2%) and less likely to have asystole (34.4 vs. 35.3%, p=<.0001) than non-HF. There was no difference in survival to discharge (18.3 vs. 18.2%, p=.66), or good neurological outcomes (82.2 vs. 83.2%, p=.23) between the groups. Women were less likely to have VF/pVT as the first documented rhythm in both HF and non-HF groups.
  
  
  CONCLUSIONS
  Hospitalized patients with HF are more likely than those without HF to have VF/pVT as the FDR in CA, however the clinical magnitude of this difference is small. Overall survival and neurological outcomes are no different than hospitalized arrest patients without HF.
authors.affiliation: Internal Medicine and Emergency Medicine, Virginia Commonwealth University, 1200 East Marshall Street - West Hospital, 5th Floor, Richmond, VA 23298, United States. mpeberdy@aol.com
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Peberdy
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Ornato
authors.forename: Penny
authors.initials: P
authors.lastname: Reynolds
authors.forename: Leroy R
authors.initials: LR
authors.lastname: Thacker
authors.forename: Max Harry
authors.initials: MH
authors.lastname: Weil
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation; D015897:Comorbidity; D005260:Female; D006323:Heart Arrest / Q000503:physiopathology / Q000628:therapy; D006333:Heart Failure / Q000150:complications / Q000503:physiopathology* / Q000628:therapy; D006801:Humans; D007297:Inpatients; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012042:Registries; D012307:Risk Factors; D015996:Survival Rate; D017180:Tachycardia, Ventricular / Q000150:complications / Q000503:physiopathology* / Q000628:therapy; D014693:Ventricular Fibrillation / Q000150:complications / Q000503:physiopathology* / Q000628:therapy