title: Long-Term Outcomes Among Elderly Survivors of Out-of-Hospital Cardiac Arrest.
abstract: BACKGROUND
  Most studies on out-of-hospital cardiac arrest have focused on immediate survival. However, little is known about long-term outcomes and resource use among survivors.
  
  
  RESULTS
  Within the national CARES registry, we identified 16 206 adults 65 years or older with an out-of-hospital cardiac arrest between 2005 and 2010. Among 1127 patients who were discharged alive, we evaluated whether 1-year mortality, cumulative readmission incidence, and follow-up inpatient costs differed according to patients' race, sex, initial cardiac arrest rhythm, bystander delivery of cardiopulmonary resuscitation, discharge neurological status, and functional status (hospital discharge disposition). Overall 1-year mortality after hospital discharge was 31.8%. Among survivors, there were no long-term mortality differences by sex, race, or initial cardiac arrest rhythm, but worse functional status and severe neurological disability at discharge were associated with higher mortality. Moreover, compared with first responders, cardiopulmonary resuscitation delivered by bystanders was associated with 23% lower mortality (hazard ratio 0.77 [confidence interval 0.58-1.02]). Besides mortality, 638 (56.6%) patients were readmitted within the first year, and the cumulative readmission incidence was 197 per 100 patient-years. Mean 1-year inpatient costs were $23 765±41 002. Younger age, black race, severe neurological disability at discharge, and hospital disposition to a skilled nursing or rehabilitation facility were each associated with higher 1-year inpatient costs (P for all <0.05).
  
  
  CONCLUSIONS
  Among elderly survivors of out-of-hospital cardiac arrest, nearly 1 in 3 patients die within the first year. Long-term mortality and inpatient costs differed substantially by certain demographic factors, whether cardiopulmonary resuscitation was initiated by a bystander, discharge neurological status, and hospital disposition.
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City, MO University of Missouri-Kansas City, Kansas City, MO pchan@saint-lukes.org.
authors.forename: Paul S
authors.initials: PS
authors.lastname: Chan
authors.affiliation: Department of Emergency Medicine, Emory University, Atlanta, GA Rollins School of Public Health, Atlanta, GA.
authors.forename: Bryan
authors.initials: B
authors.lastname: McNally
authors.affiliation: VA Health Services Research and Development Center of Excellence, VA Ann Arbor Healthcare System, Department of Internal Medicine and Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI.
authors.forename: Brahmajee K
authors.initials: BK
authors.lastname: Nallamothu
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City, MO.
authors.forename: Fengming
authors.initials: F
authors.lastname: Tang
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC.
authors.forename: Bradley G
authors.initials: BG
authors.lastname: Hammill
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City, MO University of Missouri-Kansas City, Kansas City, MO.
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC Department of Medicine, Duke University School of Medicine, Durham, NC.
authors.forename: Lesley H
authors.initials: LH
authors.lastname: Curtis
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects / Q000191:economics / Q000401:mortality; D004185:Disability Evaluation; D005260:Female; D015577:Geriatric Assessment; D017721:Hospital Costs; D006801:Humans; D008297:Male; D006278:Medicare; D009460:Neurologic Examination; D058687:Out-of-Hospital Cardiac Arrest / Q000175:diagnosis / Q000191:economics / Q000401:mortality / Q000628:therapy*; D010351:Patient Discharge; D010359:Patient Readmission / Q000191:economics; D012042:Registries; D012047:Rehabilitation Centers; D012307:Risk Factors; D012866:Skilled Nursing Facilities; D017741:Survivors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
keywords: cardiac arrest; cost; outcomes research; survival