Key result
PEA or asystole arrest linked to ~11% higher 30-day readmission versus VT/VF.
Why the study?
Does pulseless electrical activity or asystole compared to ventricular tachycardia or fibrillation increase 30-day all-cause readmission in cardiac arrest survivors?
Cohort (n=251,346)
Yes
Does pulseless electrical activity or asystole compared to ventricular tachycardia or fibrillation increase 30-day all-cause readmission in cardiac arrest survivors?
Effect estimate: difference 2.0% (95% CI 1.7-2.4)
Absolute Event Rate: 20.3% vs 18.3%
p-value: p=<.001
Nearly one in five cardiac arrest survivors are readmitted within 30 days, with slightly higher readmission rates observed in those with pulseless electrical activity or asystole compared to ventricular arrhythmias.
May inform targeted transitional care after nonshockable arrest; leaves open causal pathways and preventive strategies.
MethodsThis cohort study used data from the Nationwide Readmissions Database (NRD) from 2010 to 2014.Data analysis was performed from January 1, 2010, to November 30, 2014.The NRD collects annual discharge data and enables nationally representative readmission analyses.5 All hospitalizations associated with either out-of-hospital CA or in-hospital CA were selected based on the International Classification of Diseases, Ninth Revision, Clinical Modification code 427.5.Among those with CA, ventricular tachycardia and ventricular fibrillation were identified by codes 427.1 and 427.4,respectively.Pulseless electrical activity or asystole arrests were defined as CA without concomitant ventricular arrhythmia.The primary outcome of interest was 30-day all-cause readmission.To identify independent risk factors associated with 30-day readmission following discharge after CA, we created a multivariable Cox proportional hazards regression model.The Weill Cornell Medicine institutional review board deemed this study exempt because the NRD is a publicly available database containing deidentified patient information.All analyses were performed using SAS statistical software version 9.4 (SAS Institute).All tests were 2-sided, with P < .05indicating statistical significance.This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline. ResultsThere were 251 346 patients who survived the CA-related index hospitalization.Median (interquartile range) age was 64.8 (53.7-75.8)years, and 106 831 participants (42.5%) were women (Table 1).Among CA survivors, 49 305 (19.6%) were readmitted within 30 days after discharge.While 30-day readmission rate was higher in the cohort with pulseless electrical activity or asystole than in the cohort with ventricular tachycardia or ventricular fibrillation (20.3% vs 18.3%; difference, 2.0%; 95% CI, 1.7%-2.4%;P < .001), the median (interquartile range) time to readmission was 9 (4-18) days for both cohorts.
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Yeo et al. (2019) conducted a cohort in Cardiac Arrest (n=251,346). Pulseless electrical activity or asystole vs. Ventricular tachycardia or ventricular fibrillation was evaluated on 30-day all-cause readmission (difference 2.0%, 95% CI 1.7-2.4, p=<.001). Pulseless electrical activity or asystole was associated with a higher 30-day all-cause readmission rate compared to ventricular tachycardia or fibrillation (20.3% vs 18.3%; P<.001).
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