DALLAS, July 9, 2019 -- Significantly more patients suffer cardiac arrests in U.S. hospitals each year than previously estimated, according to new research in Circulation: Cardiovascular Quality and Outcomes, an American Heart Association journal.
Cardiac arrest, which occurs when the heart malfunctions and stops beating, is not the same as a heart attack, which occurs when blood flow to the heart is blocked.
Researchers developed a model for estimating cardiac arrest incidence using data on facilities from the American Hospital Association annual survey, which included hospitals linked to the American Heart Association's Get With The Guidelines®-Resuscitation (GWTG-R) registry. In 2011 when cardiac arrest data from the two registries was last analyzed, annual incidence was estimated to be 211,000 for adults and 6,000 in children.
The new study estimates that there are about 292,000 adult in-hospital cardiac arrests and 15,200 pediatric in-hospital events (of which 7,100 cases were pulseless cardiac arrests and 8,100 cases in which there was a pulse but still requiring CPR) in the United States each year. Compared to previous reports, the public health burden of adult and pediatric pulseless in-hospital cardiac arrest is approximately 38% and 18% greater than previously estimated.
"Our findings illustrate a concerning trend in U.S. hospitals, and show that cardiac arrest is a major public health problem," said Lars W. Andersen, M.D., M.P.H., Ph.D., D.M.Sc., study co-author and associate professor at Aarhus University in Denmark, who oversaw the study as a visiting researcher at Beth Israel Deaconess Medical Center's Department of Emergency Medicine in Boston. "Previous incidence estimates may no longer reflect the current public health burden of cardiac arrest in hospitalized patients across the U.S. Unfortunately, the data does not provide an explanation for the increase in adult in-hospital cardiac arrest, but it is likely due to many factors and may reflect an increase in actual events or in the reporting of cases over time."
Andersen said the findings may suggest that basic life support and advanced cardiac life support training programs - which traditionally have focused on out-of-hospital resuscitation - may need to be expanded to include potential in-hospital responders.
Researchers found no indication that the number of pediatric events has increased over time. Instead, the current estimates are based on a larger database and provide the most robust estimate of pediatric in-hospital cardiac arrest cases in the United States to date.
In 2015, prevention of in-hospital cardiac arrest was added to the Chain of Survival in the American Heart Association's Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Although preventing cardiac arrest is complex, possible steps to reduce in-hospital cases include educating more medical personnel, identifying deteriorating patients through early warning signs and early intervention by rapid response and emergency response teams.
"It is also important to note that end-of-life discussions and decisions are crucial in order to avoid attempts at resuscitation in patients where it is likely futile or against a patient's wishes," Andersen said.
He also noted that the findings should be interpreted with caution as data was limited to data from GWTG-R hospitals.
Co-authors are Mathias Johan Holmberg, M.D., M.P.H; Catherine Ross, M.D.; Garrett Fitzmaurice, Sc.D.; Paul Chan, M.D.; Jordan Duval-Arnould, Ph.D.; Anne Grossestreuer, Ph.D.; and Michael Donnino, M.D. Author disclosures are on the manuscript.
There was no specific funding for the study.
* Available multimedia is on right column of release link - https://newsroom.heart.org/news/cardiac-arrest-among-hospitalized-patients-may-be-underestimated?preview=325b581d2356be861a1450296b078226
Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association's policy or position. The association makes no representation or guarantee as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations and health insurance providers are available athttps://www.heart.org/en/about-us/aha-financial-information.
About the American Heart Association
The American Heart Association is a leading force for a world of longer, healthier lives. With nearly a century of lifesaving work, the Dallas-based association is dedicated to ensuring equitable health for all. We are a trustworthy source empowering people to improve their heart health, brain health and well-being. We collaborate with numerous organizations and millions of volunteers to fund innovative research, advocate for stronger public health policies, and share lifesaving resources and information. Connect with us on heart.org, Facebook, Twitter or by calling 1-800-AHA-USA1.