title: Long-term outcomes after in-hospital CPR in older adults with chronic illness.
abstract: 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.
authors.affiliation: From the Division of Pulmonary and Critical Care, University of Vermont, Burlington, VT. Electronic address: renee.stapleton@uvm.edu.
authors.forename: Renee D
authors.initials: RD
authors.lastname: Stapleton
authors.affiliation: Division of Pulmonary and Critical Care, University of Wisconsin, Madison, WI.
authors.forename: William J
authors.initials: WJ
authors.lastname: Ehlenbach
authors.affiliation: Departments of Family Medicine, Medicine, Public Health, and Preventative Medicine and Center for Research in Occupational and Environmental Toxicology, Oregon Health and Science University, Portland, OR.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Deyo
authors.affiliation: Division of Pulmonary and Critical Care, Harborview Medical Center, University of Washington, Seattle, WA.
authors.forename: J Randall
authors.initials: JR
authors.lastname: Curtis
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation; D002908:Chronic Disease / Q000401:mortality / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000401:mortality* / Q000628:therapy; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007297:Inpatients; D008297:Male; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology
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