Prognostic Implications of Level-of-Care at Tertiary Heart Centers Compared With Other Hospitals After Resuscitation From Out-of-Hospital Cardiac Arrest

Helle Søholm; Jesper Kjaergaard; John Bro-Jeppesen; Jakob Hartvig-Thomsen; Freddy Lippert; Lars Køber; Niklas Nielsen; Magaly Engsig; Morten Steensen; Michael Wanscher; Finn Michael Karlsen; Christian Hassager

doi:10.1161/circoutcomes.115.001767

Prognostic Implications of Level-of-Care at Tertiary Heart Centers Compared With Other Hospitals After Resuscitation From Out-of-Hospital Cardiac Arrest

Helle Søholm, Jesper Kjaergaard, John Bro-Jeppesen, Jakob Hartvig-Thomsen, Freddy Lippert, Lars Køber, Niklas Nielsen, Magaly Engsig, Morten Steensen, Michael Wanscher, Finn Michael Karlsen, Christian Hassager

38 Citations (Scopus)

Abstract

Background - Studies have found higher survival rates after out-of-hospital cardiac arrest and admission to tertiary heart centers. The aim was to examine the level-of-care at tertiary centers compared with nontertiary hospitals and the association with outcome after out-of-hospital cardiac arrest. Methods and Results - Consecutive out-of-hospital cardiac arrest patients (n=1078) without ST-segment-elevation myocardial infarction admitted to tertiary centers (54%) and nontertiary hospitals (46%) were included (2002-2011). Patient charts were reviewed focusing on level-of-care and comorbidity. Survival to discharge differed significantly with 45% versus 24% of patients discharged alive (P<0.001), and after adjustment for prognostic factors admissions to tertiary centers were still associated with lower 30-day mortality (hazard ratio, 0.78 [0.64-0.96; P=0.02]), independent of comorbidity. The adjusted odds of predefined markers of level-of-care were higher in tertiary centers: admission to intensive care unit (odds ratio [OR], 1.8 [95% confidence interval, 1.2-2.5]), temporary pacemaker (OR, 6.4 [2.2-19]), vasoactive agents (OR, 1.5 [1.1-2.1]), acute (<24 hours) and late coronary angiography (OR, 10 [5.3-22] and 3.8 [2.5-5.7]), neurophysiological examination (OR, 1.8 [1.3-2.6]), and brain computed tomography (OR, 1.9 [1.4-2.6]), whereas no difference in therapeutic hypothermia was noted. Patients at tertiary centers were more often consulted by a cardiologist (OR, 8.6 [5.0-15]), had an echocardiography (OR, 2.8 [2.1-3.7]), and survivors more often had implantable cardioverter defibrillator's implanted (OR, 2.1 [1.2-3.6]). Conclusions - Admissions to tertiary centers were associated with significantly higher survival after out-of-hospital cardiac arrest in patients without ST-segment-elevation myocardial infarction in the Copenhagen area even after adjustment for prognostic factors including comorbidity. Level-of-care seems higher in tertiary centers both in the early phase, during the intensive care unit admission, and in the workup before discharge. The varying level-of-care may contribute to the survival difference; however, differences in comorbidity do not seem to matter significantly.

Original language	English
Journal	Circulation. Cardiovascular quality and outcomes
Volume	8
Issue number	3
Pages (from-to)	268-76
Number of pages	9
ISSN	1941-7713
DOIs	https://doi.org/10.1161/circoutcomes.115.001767
Publication status	Published - 26 May 2015

Keywords

Aged
Aged, 80 and over
Denmark
Female
Humans
Male
Middle Aged
Neurologic Examination
Out-of-Hospital Cardiac Arrest
Prognosis
Quality of Health Care
Resuscitation
Retrospective Studies
Tertiary Care Centers

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10.1161/circoutcomes.115.001767

CIRCOUTCOMES.115.001767Final published version, 453 KB

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Søholm, H., Kjaergaard, J., Bro-Jeppesen, J., Hartvig-Thomsen, J., Lippert, F., Køber, L., Nielsen, N., Engsig, M., Steensen, M., Wanscher, M., Karlsen, F. M., & Hassager, C. (2015). Prognostic Implications of Level-of-Care at Tertiary Heart Centers Compared With Other Hospitals After Resuscitation From Out-of-Hospital Cardiac Arrest. Circulation. Cardiovascular quality and outcomes, 8(3), 268-76. https://doi.org/10.1161/circoutcomes.115.001767

Prognostic Implications of Level-of-Care at Tertiary Heart Centers Compared With Other Hospitals After Resuscitation From Out-of-Hospital Cardiac Arrest. / Søholm, Helle; Kjaergaard, Jesper; Bro-Jeppesen, John et al.
In: Circulation. Cardiovascular quality and outcomes, Vol. 8, No. 3, 26.05.2015, p. 268-76.

Research output: Contribution to journal › Journal article › Research › peer-review

Søholm, H, Kjaergaard, J, Bro-Jeppesen, J, Hartvig-Thomsen, J, Lippert, F , Køber, L, Nielsen, N, Engsig, M, Steensen, M, Wanscher, M, Karlsen, FM & Hassager, C 2015, 'Prognostic Implications of Level-of-Care at Tertiary Heart Centers Compared With Other Hospitals After Resuscitation From Out-of-Hospital Cardiac Arrest', Circulation. Cardiovascular quality and outcomes, vol. 8, no. 3, pp. 268-76. https://doi.org/10.1161/circoutcomes.115.001767

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title = "Prognostic Implications of Level-of-Care at Tertiary Heart Centers Compared With Other Hospitals After Resuscitation From Out-of-Hospital Cardiac Arrest",

abstract = "Background - Studies have found higher survival rates after out-of-hospital cardiac arrest and admission to tertiary heart centers. The aim was to examine the level-of-care at tertiary centers compared with nontertiary hospitals and the association with outcome after out-of-hospital cardiac arrest. Methods and Results - Consecutive out-of-hospital cardiac arrest patients (n=1078) without ST-segment-elevation myocardial infarction admitted to tertiary centers (54%) and nontertiary hospitals (46%) were included (2002-2011). Patient charts were reviewed focusing on level-of-care and comorbidity. Survival to discharge differed significantly with 45% versus 24% of patients discharged alive (P<0.001), and after adjustment for prognostic factors admissions to tertiary centers were still associated with lower 30-day mortality (hazard ratio, 0.78 [0.64-0.96; P=0.02]), independent of comorbidity. The adjusted odds of predefined markers of level-of-care were higher in tertiary centers: admission to intensive care unit (odds ratio [OR], 1.8 [95% confidence interval, 1.2-2.5]), temporary pacemaker (OR, 6.4 [2.2-19]), vasoactive agents (OR, 1.5 [1.1-2.1]), acute (<24 hours) and late coronary angiography (OR, 10 [5.3-22] and 3.8 [2.5-5.7]), neurophysiological examination (OR, 1.8 [1.3-2.6]), and brain computed tomography (OR, 1.9 [1.4-2.6]), whereas no difference in therapeutic hypothermia was noted. Patients at tertiary centers were more often consulted by a cardiologist (OR, 8.6 [5.0-15]), had an echocardiography (OR, 2.8 [2.1-3.7]), and survivors more often had implantable cardioverter defibrillator's implanted (OR, 2.1 [1.2-3.6]). Conclusions - Admissions to tertiary centers were associated with significantly higher survival after out-of-hospital cardiac arrest in patients without ST-segment-elevation myocardial infarction in the Copenhagen area even after adjustment for prognostic factors including comorbidity. Level-of-care seems higher in tertiary centers both in the early phase, during the intensive care unit admission, and in the workup before discharge. The varying level-of-care may contribute to the survival difference; however, differences in comorbidity do not seem to matter significantly.",

keywords = "Aged, Aged, 80 and over, Denmark, Female, Humans, Male, Middle Aged, Neurologic Examination, Out-of-Hospital Cardiac Arrest, Prognosis, Quality of Health Care, Resuscitation, Retrospective Studies, Tertiary Care Centers",

author = "Helle S{\o}holm and Jesper Kjaergaard and John Bro-Jeppesen and Jakob Hartvig-Thomsen and Freddy Lippert and Lars K{\o}ber and Niklas Nielsen and Magaly Engsig and Morten Steensen and Michael Wanscher and Karlsen, {Finn Michael} and Christian Hassager",

note = "{\textcopyright} 2015 American Heart Association, Inc.",

year = "2015",

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doi = "10.1161/circoutcomes.115.001767",

language = "English",

volume = "8",

pages = "268--76",

journal = "Circulation. Cardiovascular quality and outcomes",

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T1 - Prognostic Implications of Level-of-Care at Tertiary Heart Centers Compared With Other Hospitals After Resuscitation From Out-of-Hospital Cardiac Arrest

AU - Søholm, Helle

AU - Kjaergaard, Jesper

AU - Bro-Jeppesen, John

AU - Hartvig-Thomsen, Jakob

AU - Lippert, Freddy

AU - Køber, Lars

AU - Nielsen, Niklas

AU - Engsig, Magaly

AU - Steensen, Morten

AU - Wanscher, Michael

AU - Karlsen, Finn Michael

AU - Hassager, Christian

PY - 2015/5/26

Y1 - 2015/5/26

N2 - Background - Studies have found higher survival rates after out-of-hospital cardiac arrest and admission to tertiary heart centers. The aim was to examine the level-of-care at tertiary centers compared with nontertiary hospitals and the association with outcome after out-of-hospital cardiac arrest. Methods and Results - Consecutive out-of-hospital cardiac arrest patients (n=1078) without ST-segment-elevation myocardial infarction admitted to tertiary centers (54%) and nontertiary hospitals (46%) were included (2002-2011). Patient charts were reviewed focusing on level-of-care and comorbidity. Survival to discharge differed significantly with 45% versus 24% of patients discharged alive (P<0.001), and after adjustment for prognostic factors admissions to tertiary centers were still associated with lower 30-day mortality (hazard ratio, 0.78 [0.64-0.96; P=0.02]), independent of comorbidity. The adjusted odds of predefined markers of level-of-care were higher in tertiary centers: admission to intensive care unit (odds ratio [OR], 1.8 [95% confidence interval, 1.2-2.5]), temporary pacemaker (OR, 6.4 [2.2-19]), vasoactive agents (OR, 1.5 [1.1-2.1]), acute (<24 hours) and late coronary angiography (OR, 10 [5.3-22] and 3.8 [2.5-5.7]), neurophysiological examination (OR, 1.8 [1.3-2.6]), and brain computed tomography (OR, 1.9 [1.4-2.6]), whereas no difference in therapeutic hypothermia was noted. Patients at tertiary centers were more often consulted by a cardiologist (OR, 8.6 [5.0-15]), had an echocardiography (OR, 2.8 [2.1-3.7]), and survivors more often had implantable cardioverter defibrillator's implanted (OR, 2.1 [1.2-3.6]). Conclusions - Admissions to tertiary centers were associated with significantly higher survival after out-of-hospital cardiac arrest in patients without ST-segment-elevation myocardial infarction in the Copenhagen area even after adjustment for prognostic factors including comorbidity. Level-of-care seems higher in tertiary centers both in the early phase, during the intensive care unit admission, and in the workup before discharge. The varying level-of-care may contribute to the survival difference; however, differences in comorbidity do not seem to matter significantly.

AB - Background - Studies have found higher survival rates after out-of-hospital cardiac arrest and admission to tertiary heart centers. The aim was to examine the level-of-care at tertiary centers compared with nontertiary hospitals and the association with outcome after out-of-hospital cardiac arrest. Methods and Results - Consecutive out-of-hospital cardiac arrest patients (n=1078) without ST-segment-elevation myocardial infarction admitted to tertiary centers (54%) and nontertiary hospitals (46%) were included (2002-2011). Patient charts were reviewed focusing on level-of-care and comorbidity. Survival to discharge differed significantly with 45% versus 24% of patients discharged alive (P<0.001), and after adjustment for prognostic factors admissions to tertiary centers were still associated with lower 30-day mortality (hazard ratio, 0.78 [0.64-0.96; P=0.02]), independent of comorbidity. The adjusted odds of predefined markers of level-of-care were higher in tertiary centers: admission to intensive care unit (odds ratio [OR], 1.8 [95% confidence interval, 1.2-2.5]), temporary pacemaker (OR, 6.4 [2.2-19]), vasoactive agents (OR, 1.5 [1.1-2.1]), acute (<24 hours) and late coronary angiography (OR, 10 [5.3-22] and 3.8 [2.5-5.7]), neurophysiological examination (OR, 1.8 [1.3-2.6]), and brain computed tomography (OR, 1.9 [1.4-2.6]), whereas no difference in therapeutic hypothermia was noted. Patients at tertiary centers were more often consulted by a cardiologist (OR, 8.6 [5.0-15]), had an echocardiography (OR, 2.8 [2.1-3.7]), and survivors more often had implantable cardioverter defibrillator's implanted (OR, 2.1 [1.2-3.6]). Conclusions - Admissions to tertiary centers were associated with significantly higher survival after out-of-hospital cardiac arrest in patients without ST-segment-elevation myocardial infarction in the Copenhagen area even after adjustment for prognostic factors including comorbidity. Level-of-care seems higher in tertiary centers both in the early phase, during the intensive care unit admission, and in the workup before discharge. The varying level-of-care may contribute to the survival difference; however, differences in comorbidity do not seem to matter significantly.

KW - Aged

KW - Aged, 80 and over

KW - Denmark

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Neurologic Examination

KW - Out-of-Hospital Cardiac Arrest

KW - Prognosis

KW - Quality of Health Care

KW - Resuscitation

KW - Retrospective Studies

KW - Tertiary Care Centers

U2 - 10.1161/circoutcomes.115.001767

DO - 10.1161/circoutcomes.115.001767

M3 - Journal article

C2 - 25944632

SN - 1941-7713

VL - 8

SP - 268

EP - 276

JO - Circulation. Cardiovascular quality and outcomes

JF - Circulation. Cardiovascular quality and outcomes

IS - 3

ER -

Prognostic Implications of Level-of-Care at Tertiary Heart Centers Compared With Other Hospitals After Resuscitation From Out-of-Hospital Cardiac Arrest

Abstract

Keywords

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