title: Readmission rates and long-term hospital costs among survivors of an in-hospital cardiac arrest.
abstract: BACKGROUND
  Although an in-hospital cardiac arrest is common, little is known about readmission patterns and an inpatient resource use among survivors of an in-hospital cardiac arrest.
  
  
  RESULTS
  Within a large national registry, we examined long-term inpatient use among 6972 adults aged ≥65 years who survived an in-hospital cardiac arrest. We examined 30-day and 1-year readmission rates and inpatient costs, overall and by patient demographics, hospital disposition (discharge destination), and neurological status at discharge. The mean age was 75.8±7.0 years, 56% were men, and 12% were black. There were a total of 2005 readmissions during the first 30 days (cumulative incidence rate, 35 readmissions/100 patients; 95% confidence interval, 33-37) and 8751 readmissions at 1 year (cumulative incidence rate, 185 readmissions/100 patients; 95% confidence interval, 177-190). Overall, mean inpatient costs were $7741±$2323 at 30 days and $18 629±$9411 at 1 year. Thirty-day inpatient costs were higher in patients of younger age (≥85 years, $6052 [reference]; 75-84 years, $7444 [adjusted cost ratio, 1.23; 1.06-1.42; 65-74 years, $8291 [adjusted cost ratio, 1.37; 1.19-1.59; both P<0.001) and black race (whites, $7413; blacks, $9044; adjusted cost ratio, 1.22; 1.05-1.42; P<0.001), as well as those discharged with severe neurological disability or to skilled nursing or rehabilitation facilities. These differences in resource use persisted at 1 year and were largely because of higher readmission rates.
  
  
  CONCLUSIONS
  Survivors of an in-hospital cardiac arrest have frequent readmissions and high follow-up inpatient costs. Readmissions and inpatient costs were higher in certain subgroups, including patients of younger age and black race.
authors.affiliation: From the Saint Luke's Mid America Heart Institute, Kansas City, MO (P.S.C., Y.L., J.A.S.); Department of Internal Medicine, University of Missouri-Kansas City (P.S.C., J.A.S.); Department of Internal Medicine, The VA Health Services Research and Development Center of Excellence, VA Ann Arbor Healthcare System, and Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor (B.K.N.); Yale University School of Medicine and the Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT (H.M.K.); Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (L.H.C., B.G.H.). pchan@saint-lukes.org.
authors.forename: Paul S
authors.initials: PS
authors.lastname: Chan
authors.affiliation: From the Saint Luke's Mid America Heart Institute, Kansas City, MO (P.S.C., Y.L., J.A.S.); Department of Internal Medicine, University of Missouri-Kansas City (P.S.C., J.A.S.); Department of Internal Medicine, The VA Health Services Research and Development Center of Excellence, VA Ann Arbor Healthcare System, and Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor (B.K.N.); Yale University School of Medicine and the Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT (H.M.K.); Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (L.H.C., B.G.H.).
authors.forename: Brahmajee K
authors.initials: BK
authors.lastname: Nallamothu
authors.affiliation: From the Saint Luke's Mid America Heart Institute, Kansas City, MO (P.S.C., Y.L., J.A.S.); Department of Internal Medicine, University of Missouri-Kansas City (P.S.C., J.A.S.); Department of Internal Medicine, The VA Health Services Research and Development Center of Excellence, VA Ann Arbor Healthcare System, and Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor (B.K.N.); Yale University School of Medicine and the Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT (H.M.K.); Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (L.H.C., B.G.H.).
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
authors.affiliation: From the Saint Luke's Mid America Heart Institute, Kansas City, MO (P.S.C., Y.L., J.A.S.); Department of Internal Medicine, University of Missouri-Kansas City (P.S.C., J.A.S.); Department of Internal Medicine, The VA Health Services Research and Development Center of Excellence, VA Ann Arbor Healthcare System, and Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor (B.K.N.); Yale University School of Medicine and the Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT (H.M.K.); Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (L.H.C., B.G.H.).
authors.forename: Lesley H
authors.initials: LH
authors.lastname: Curtis
authors.affiliation: From the Saint Luke's Mid America Heart Institute, Kansas City, MO (P.S.C., Y.L., J.A.S.); Department of Internal Medicine, University of Missouri-Kansas City (P.S.C., J.A.S.); Department of Internal Medicine, The VA Health Services Research and Development Center of Excellence, VA Ann Arbor Healthcare System, and Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor (B.K.N.); Yale University School of Medicine and the Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT (H.M.K.); Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (L.H.C., B.G.H.).
authors.forename: Yan
authors.initials: Y
authors.lastname: Li
authors.affiliation: From the Saint Luke's Mid America Heart Institute, Kansas City, MO (P.S.C., Y.L., J.A.S.); Department of Internal Medicine, University of Missouri-Kansas City (P.S.C., J.A.S.); Department of Internal Medicine, The VA Health Services Research and Development Center of Excellence, VA Ann Arbor Healthcare System, and Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor (B.K.N.); Yale University School of Medicine and the Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT (H.M.K.); Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (L.H.C., B.G.H.).
authors.forename: Bradley G
authors.initials: BG
authors.lastname: Hammill
authors.affiliation: From the Saint Luke's Mid America Heart Institute, Kansas City, MO (P.S.C., Y.L., J.A.S.); Department of Internal Medicine, University of Missouri-Kansas City (P.S.C., J.A.S.); Department of Internal Medicine, The VA Health Services Research and Development Center of Excellence, VA Ann Arbor Healthcare System, and Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor (B.K.N.); Yale University School of Medicine and the Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT (H.M.K.); Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (L.H.C., B.G.H.).
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006323:Heart Arrest / Q000191:economics*; D017721:Hospital Costs / Q000706:statistics & numerical data*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data*; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D017741:Survivors; D014481:United States / Q000453:epidemiology
keywords: costs and cost analysis; heart arrest; outcome assessment (health care); patient readmission