Trends in Survival After In-Hospital Cardiac Arrest During Nights and Weekends

American Heart Association Get With the Guidelines – Resuscitation Investigators

Research output: Contribution to journalArticle

Abstract

Background: Survival after in-hospital cardiac arrest (IHCA) is lower during nights and weekends (off-hours) compared with daytime during weekdays (on-hours). As overall IHCA survival has improved over time, it remains unknown whether survival differences between on-hours and off-hours have changed. Objectives: This study sought to examine temporal trends in survival differences between on-hours and off-hours IHCA. Methods: We identified 151,071 adults at 470 U.S. hospitals in the Get with the Guidelines–Resuscitation registry during 2000 to 2014. Using multivariable logistic regression with generalized estimating equations, we examined whether survival trends in IHCA differed during on-hours (Monday to Friday 7:00 AM to 10:59 PM) versus off-hours (Monday to Friday 11:00 PM to 6:59 AM, and Saturday to Sunday, all day). Results: Among 151,071 participants, 79,091 (52.4%) had an IHCA during off-hours. Risk-adjusted survival improved over time in both groups (on-hours: 16.0% in 2000, 25.2% in 2014; off-hours: 11.9% in 2000, 21.9% in 2014; p for trend <0.001 for both). However, there was no significant change in the survival difference over time between on-hours and off-hours, either on an absolute (p = 0.75) or a relative scale (p = 0.059). Acute resuscitation survival improved significantly in both groups (on-hours: 56.1% in 2000, 71% in 2014; off-hours: 46.9% in 2000, 68.2% in 2014; p for trend <0.001 for both) and the difference between on-hours and off-hours narrowed over time (p = 0.02 absolute scale, p < 0.001 relative scale). In contrast, although post-resuscitation survival also improved over time in both groups (p for trend < 0.001 for both), the absolute and relative difference persisted. Conclusions: Despite an overall improvement in survival, lower survival in IHCA during off-hours compared with on-hours persists.

Original languageEnglish (US)
Pages (from-to)402-411
Number of pages10
JournalJournal of the American College of Cardiology
Volume71
Issue number4
DOIs
StatePublished - Jan 30 2018

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Heart Arrest
Resuscitation
Registries
Logistic Models

Keywords

  • cardiac arrest
  • cardiopulmonary resuscitation
  • outcome
  • patient safety
  • return of spontaneous circulation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

American Heart Association Get With the Guidelines – Resuscitation Investigators (2018). Trends in Survival After In-Hospital Cardiac Arrest During Nights and Weekends. Journal of the American College of Cardiology, 71(4), 402-411. https://doi.org/10.1016/j.jacc.2017.11.043

Trends in Survival After In-Hospital Cardiac Arrest During Nights and Weekends. / American Heart Association Get With the Guidelines – Resuscitation Investigators.

In: Journal of the American College of Cardiology, Vol. 71, No. 4, 30.01.2018, p. 402-411.

Research output: Contribution to journalArticle

American Heart Association Get With the Guidelines – Resuscitation Investigators 2018, 'Trends in Survival After In-Hospital Cardiac Arrest During Nights and Weekends', Journal of the American College of Cardiology, vol. 71, no. 4, pp. 402-411. https://doi.org/10.1016/j.jacc.2017.11.043
American Heart Association Get With the Guidelines – Resuscitation Investigators. Trends in Survival After In-Hospital Cardiac Arrest During Nights and Weekends. Journal of the American College of Cardiology. 2018 Jan 30;71(4):402-411. https://doi.org/10.1016/j.jacc.2017.11.043
American Heart Association Get With the Guidelines – Resuscitation Investigators. / Trends in Survival After In-Hospital Cardiac Arrest During Nights and Weekends. In: Journal of the American College of Cardiology. 2018 ; Vol. 71, No. 4. pp. 402-411.
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abstract = "Background: Survival after in-hospital cardiac arrest (IHCA) is lower during nights and weekends (off-hours) compared with daytime during weekdays (on-hours). As overall IHCA survival has improved over time, it remains unknown whether survival differences between on-hours and off-hours have changed. Objectives: This study sought to examine temporal trends in survival differences between on-hours and off-hours IHCA. Methods: We identified 151,071 adults at 470 U.S. hospitals in the Get with the Guidelines–Resuscitation registry during 2000 to 2014. Using multivariable logistic regression with generalized estimating equations, we examined whether survival trends in IHCA differed during on-hours (Monday to Friday 7:00 AM to 10:59 PM) versus off-hours (Monday to Friday 11:00 PM to 6:59 AM, and Saturday to Sunday, all day). Results: Among 151,071 participants, 79,091 (52.4{\%}) had an IHCA during off-hours. Risk-adjusted survival improved over time in both groups (on-hours: 16.0{\%} in 2000, 25.2{\%} in 2014; off-hours: 11.9{\%} in 2000, 21.9{\%} in 2014; p for trend <0.001 for both). However, there was no significant change in the survival difference over time between on-hours and off-hours, either on an absolute (p = 0.75) or a relative scale (p = 0.059). Acute resuscitation survival improved significantly in both groups (on-hours: 56.1{\%} in 2000, 71{\%} in 2014; off-hours: 46.9{\%} in 2000, 68.2{\%} in 2014; p for trend <0.001 for both) and the difference between on-hours and off-hours narrowed over time (p = 0.02 absolute scale, p < 0.001 relative scale). In contrast, although post-resuscitation survival also improved over time in both groups (p for trend < 0.001 for both), the absolute and relative difference persisted. Conclusions: Despite an overall improvement in survival, lower survival in IHCA during off-hours compared with on-hours persists.",
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author = "{American Heart Association Get With the Guidelines – Resuscitation Investigators} and Ofoma, {Uchenna R.} and Suresh Basnet and Andrea Berger and Kirchner, {H. Lester} and Saket Girotra and Benjamin Abella and Anderson, {Monique L.} and Bradley, {Steven M.} and Chan, {Paul S.} and Edelson, {Dana P.} and Churpek, {Matthew M.} and Romergryko Geocadin and Goldberger, {Zachary D.} and Howard, {Patricia K.} and Kurz, {Michael C.} and Mosesso, {Vincent N.} and Boulos Nassar and Ornato, {Joseph P.} and Peberdy, {Mary Ann} and Perman, {Sarah M.}",
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T1 - Trends in Survival After In-Hospital Cardiac Arrest During Nights and Weekends

AU - American Heart Association Get With the Guidelines – Resuscitation Investigators

AU - Ofoma, Uchenna R.

AU - Basnet, Suresh

AU - Berger, Andrea

AU - Kirchner, H. Lester

AU - Girotra, Saket

AU - Abella, Benjamin

AU - Anderson, Monique L.

AU - Bradley, Steven M.

AU - Chan, Paul S.

AU - Edelson, Dana P.

AU - Churpek, Matthew M.

AU - Geocadin, Romergryko

AU - Goldberger, Zachary D.

AU - Howard, Patricia K.

AU - Kurz, Michael C.

AU - Mosesso, Vincent N.

AU - Nassar, Boulos

AU - Ornato, Joseph P.

AU - Peberdy, Mary Ann

AU - Perman, Sarah M.

PY - 2018/1/30

Y1 - 2018/1/30

N2 - Background: Survival after in-hospital cardiac arrest (IHCA) is lower during nights and weekends (off-hours) compared with daytime during weekdays (on-hours). As overall IHCA survival has improved over time, it remains unknown whether survival differences between on-hours and off-hours have changed. Objectives: This study sought to examine temporal trends in survival differences between on-hours and off-hours IHCA. Methods: We identified 151,071 adults at 470 U.S. hospitals in the Get with the Guidelines–Resuscitation registry during 2000 to 2014. Using multivariable logistic regression with generalized estimating equations, we examined whether survival trends in IHCA differed during on-hours (Monday to Friday 7:00 AM to 10:59 PM) versus off-hours (Monday to Friday 11:00 PM to 6:59 AM, and Saturday to Sunday, all day). Results: Among 151,071 participants, 79,091 (52.4%) had an IHCA during off-hours. Risk-adjusted survival improved over time in both groups (on-hours: 16.0% in 2000, 25.2% in 2014; off-hours: 11.9% in 2000, 21.9% in 2014; p for trend <0.001 for both). However, there was no significant change in the survival difference over time between on-hours and off-hours, either on an absolute (p = 0.75) or a relative scale (p = 0.059). Acute resuscitation survival improved significantly in both groups (on-hours: 56.1% in 2000, 71% in 2014; off-hours: 46.9% in 2000, 68.2% in 2014; p for trend <0.001 for both) and the difference between on-hours and off-hours narrowed over time (p = 0.02 absolute scale, p < 0.001 relative scale). In contrast, although post-resuscitation survival also improved over time in both groups (p for trend < 0.001 for both), the absolute and relative difference persisted. Conclusions: Despite an overall improvement in survival, lower survival in IHCA during off-hours compared with on-hours persists.

AB - Background: Survival after in-hospital cardiac arrest (IHCA) is lower during nights and weekends (off-hours) compared with daytime during weekdays (on-hours). As overall IHCA survival has improved over time, it remains unknown whether survival differences between on-hours and off-hours have changed. Objectives: This study sought to examine temporal trends in survival differences between on-hours and off-hours IHCA. Methods: We identified 151,071 adults at 470 U.S. hospitals in the Get with the Guidelines–Resuscitation registry during 2000 to 2014. Using multivariable logistic regression with generalized estimating equations, we examined whether survival trends in IHCA differed during on-hours (Monday to Friday 7:00 AM to 10:59 PM) versus off-hours (Monday to Friday 11:00 PM to 6:59 AM, and Saturday to Sunday, all day). Results: Among 151,071 participants, 79,091 (52.4%) had an IHCA during off-hours. Risk-adjusted survival improved over time in both groups (on-hours: 16.0% in 2000, 25.2% in 2014; off-hours: 11.9% in 2000, 21.9% in 2014; p for trend <0.001 for both). However, there was no significant change in the survival difference over time between on-hours and off-hours, either on an absolute (p = 0.75) or a relative scale (p = 0.059). Acute resuscitation survival improved significantly in both groups (on-hours: 56.1% in 2000, 71% in 2014; off-hours: 46.9% in 2000, 68.2% in 2014; p for trend <0.001 for both) and the difference between on-hours and off-hours narrowed over time (p = 0.02 absolute scale, p < 0.001 relative scale). In contrast, although post-resuscitation survival also improved over time in both groups (p for trend < 0.001 for both), the absolute and relative difference persisted. Conclusions: Despite an overall improvement in survival, lower survival in IHCA during off-hours compared with on-hours persists.

KW - cardiac arrest

KW - cardiopulmonary resuscitation

KW - outcome

KW - patient safety

KW - return of spontaneous circulation

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