title: Regional variation in the incidence and outcomes of in-hospital cardiac arrest in the United States.
abstract: BACKGROUND
  Regional variation in the incidence and outcomes of in-hospital cardiac arrest (IHCA) is not well studied and may have important health and policy implications.
  
  
  RESULTS
  We used the 2003 to 2011 Nationwide Inpatient Sample databases to identify patients≥18 years of age who underwent cardiopulmonary resuscitation (International Classification of Diseases, Ninth Edition, Clinical Modification procedure codes 99.60 and 99.63) for IHCA. Regional differences in IHCA incidence, survival to hospital discharge, and resource use (total hospital cost and discharge disposition among survivors) were analyzed. Of 838,465 patients with IHCA, 162,270 (19.4%) were in the Northeast, 159,581 (19.0%) were in the Midwest, 316,201 (37.7%) were in the South, and 200,413 (23.9%) were in the West. Overall IHCA incidence in the United States was 2.85 per 1000 hospital admissions. IHCA incidence was lowest in the Midwest and highest in the West (2.33 and 3.73 per 1000 hospital admissions, respectively). Compared with the Northeast, risk-adjusted survival to discharge was significantly higher in the Midwest (odds ratio, 1.33; 95% confidence interval, 1.31-1.36), South (odds ratio, 1.21; 95% confidence interval, 1.19-1.23), and West (odds ratio, 1.25; 95% confidence interval, 1.23-1.27). IHCA survival increased significantly from 2003 to 2011 in the United States and in all regions (all Ptrend<0.001). Total hospital cost was highest in the West, whereas discharge to skilled nursing facility and use of home health care among survivors was highest in the Northeast.
  
  
  CONCLUSIONS
  We observed significant regional variation in IHCA incidence, survival, and resource use in the United States. This variation was explained only partially by differences in patient and hospital characteristics. Further studies are needed to identify other potential factors responsible for these regional differences to improve outcomes after IHCA.
authors: From New York Medical College, Valhalla, NY (D.K., S.K., W.S.A., M.M., S.I., D.J., S.S., H.A.C., W.H.F., J.A.P.); Icahn School of Medicine at Mount Sinai Hospital, New York, NY (C.P.); University of Texas Southwestern Medical Center, Dallas (C.A.); VA Medical Center, Washington, DC (A.A.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); and David-Geffen School of Medicine, University of California at Los Angeles (UCLA), Los Angeles (G.C.F.).
authors: Dhaval
authors: D
authors: Kolte
authors: From New York Medical College, Valhalla, NY (D.K., S.K., W.S.A., M.M., S.I., D.J., S.S., H.A.C., W.H.F., J.A.P.); Icahn School of Medicine at Mount Sinai Hospital, New York, NY (C.P.); University of Texas Southwestern Medical Center, Dallas (C.A.); VA Medical Center, Washington, DC (A.A.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); and David-Geffen School of Medicine, University of California at Los Angeles (UCLA), Los Angeles (G.C.F.).
authors: Sahil
authors: S
authors: Khera
authors: From New York Medical College, Valhalla, NY (D.K., S.K., W.S.A., M.M., S.I., D.J., S.S., H.A.C., W.H.F., J.A.P.); Icahn School of Medicine at Mount Sinai Hospital, New York, NY (C.P.); University of Texas Southwestern Medical Center, Dallas (C.A.); VA Medical Center, Washington, DC (A.A.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); and David-Geffen School of Medicine, University of California at Los Angeles (UCLA), Los Angeles (G.C.F.).
authors: Wilbert S
authors: WS
authors: Aronow
authors: From New York Medical College, Valhalla, NY (D.K., S.K., W.S.A., M.M., S.I., D.J., S.S., H.A.C., W.H.F., J.A.P.); Icahn School of Medicine at Mount Sinai Hospital, New York, NY (C.P.); University of Texas Southwestern Medical Center, Dallas (C.A.); VA Medical Center, Washington, DC (A.A.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); and David-Geffen School of Medicine, University of California at Los Angeles (UCLA), Los Angeles (G.C.F.).
authors: Chandrasekar
authors: C
authors: Palaniswamy
authors: From New York Medical College, Valhalla, NY (D.K., S.K., W.S.A., M.M., S.I., D.J., S.S., H.A.C., W.H.F., J.A.P.); Icahn School of Medicine at Mount Sinai Hospital, New York, NY (C.P.); University of Texas Southwestern Medical Center, Dallas (C.A.); VA Medical Center, Washington, DC (A.A.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); and David-Geffen School of Medicine, University of California at Los Angeles (UCLA), Los Angeles (G.C.F.).
authors: Marjan
authors: M
authors: Mujib
authors: From New York Medical College, Valhalla, NY (D.K., S.K., W.S.A., M.M., S.I., D.J., S.S., H.A.C., W.H.F., J.A.P.); Icahn School of Medicine at Mount Sinai Hospital, New York, NY (C.P.); University of Texas Southwestern Medical Center, Dallas (C.A.); VA Medical Center, Washington, DC (A.A.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); and David-Geffen School of Medicine, University of California at Los Angeles (UCLA), Los Angeles (G.C.F.).
authors: Chul
authors: C
authors: Ahn
authors: From New York Medical College, Valhalla, NY (D.K., S.K., W.S.A., M.M., S.I., D.J., S.S., H.A.C., W.H.F., J.A.P.); Icahn School of Medicine at Mount Sinai Hospital, New York, NY (C.P.); University of Texas Southwestern Medical Center, Dallas (C.A.); VA Medical Center, Washington, DC (A.A.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); and David-Geffen School of Medicine, University of California at Los Angeles (UCLA), Los Angeles (G.C.F.).
authors: Sei
authors: S
authors: Iwai
authors: From New York Medical College, Valhalla, NY (D.K., S.K., W.S.A., M.M., S.I., D.J., S.S., H.A.C., W.H.F., J.A.P.); Icahn School of Medicine at Mount Sinai Hospital, New York, NY (C.P.); University of Texas Southwestern Medical Center, Dallas (C.A.); VA Medical Center, Washington, DC (A.A.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); and David-Geffen School of Medicine, University of California at Los Angeles (UCLA), Los Angeles (G.C.F.).
authors: Diwakar
authors: D
authors: Jain
authors: From New York Medical College, Valhalla, NY (D.K., S.K., W.S.A., M.M., S.I., D.J., S.S., H.A.C., W.H.F., J.A.P.); Icahn School of Medicine at Mount Sinai Hospital, New York, NY (C.P.); University of Texas Southwestern Medical Center, Dallas (C.A.); VA Medical Center, Washington, DC (A.A.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); and David-Geffen School of Medicine, University of California at Los Angeles (UCLA), Los Angeles (G.C.F.).
authors: Sachin
authors: S
authors: Sule
authors: From New York Medical College, Valhalla, NY (D.K., S.K., W.S.A., M.M., S.I., D.J., S.S., H.A.C., W.H.F., J.A.P.); Icahn School of Medicine at Mount Sinai Hospital, New York, NY (C.P.); University of Texas Southwestern Medical Center, Dallas (C.A.); VA Medical Center, Washington, DC (A.A.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); and David-Geffen School of Medicine, University of California at Los Angeles (UCLA), Los Angeles (G.C.F.).
authors: Ali
authors: A
authors: Ahmed
authors: From New York Medical College, Valhalla, NY (D.K., S.K., W.S.A., M.M., S.I., D.J., S.S., H.A.C., W.H.F., J.A.P.); Icahn School of Medicine at Mount Sinai Hospital, New York, NY (C.P.); University of Texas Southwestern Medical Center, Dallas (C.A.); VA Medical Center, Washington, DC (A.A.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); and David-Geffen School of Medicine, University of California at Los Angeles (UCLA), Los Angeles (G.C.F.).
authors: Howard A
authors: HA
authors: Cooper
authors: From New York Medical College, Valhalla, NY (D.K., S.K., W.S.A., M.M., S.I., D.J., S.S., H.A.C., W.H.F., J.A.P.); Icahn School of Medicine at Mount Sinai Hospital, New York, NY (C.P.); University of Texas Southwestern Medical Center, Dallas (C.A.); VA Medical Center, Washington, DC (A.A.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); and David-Geffen School of Medicine, University of California at Los Angeles (UCLA), Los Angeles (G.C.F.).
authors: William H
authors: WH
authors: Frishman
authors: From New York Medical College, Valhalla, NY (D.K., S.K., W.S.A., M.M., S.I., D.J., S.S., H.A.C., W.H.F., J.A.P.); Icahn School of Medicine at Mount Sinai Hospital, New York, NY (C.P.); University of Texas Southwestern Medical Center, Dallas (C.A.); VA Medical Center, Washington, DC (A.A.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); and David-Geffen School of Medicine, University of California at Los Angeles (UCLA), Los Angeles (G.C.F.).
authors: Deepak L
authors: DL
authors: Bhatt
authors: From New York Medical College, Valhalla, NY (D.K., S.K., W.S.A., M.M., S.I., D.J., S.S., H.A.C., W.H.F., J.A.P.); Icahn School of Medicine at Mount Sinai Hospital, New York, NY (C.P.); University of Texas Southwestern Medical Center, Dallas (C.A.); VA Medical Center, Washington, DC (A.A.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); and David-Geffen School of Medicine, University of California at Los Angeles (UCLA), Los Angeles (G.C.F.).
authors: Julio A
authors: JA
authors: Panza
authors: From New York Medical College, Valhalla, NY (D.K., S.K., W.S.A., M.M., S.I., D.J., S.S., H.A.C., W.H.F., J.A.P.); Icahn School of Medicine at Mount Sinai Hospital, New York, NY (C.P.); University of Texas Southwestern Medical Center, Dallas (C.A.); VA Medical Center, Washington, DC (A.A.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); and David-Geffen School of Medicine, University of California at Los Angeles (UCLA), Los Angeles (G.C.F.). gfonarow@mednet.ucla.edu.
authors: Gregg C
authors: GC
authors: Fonarow
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006323:Heart Arrest / Q000191:economics / Q000453:epidemiology* / Q000628:therapy; D006699:Home Care Services / Q000706:statistics & numerical data; D017721:Hospital Costs; D017052:Hospital Mortality; D006761:Hospitals / Q000145:classification / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D038801:International Classification of Diseases; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: cardiopulmonary resuscitation; costs and cost analysis; heart arrest; survival