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In-Hospital Cardiac Arrest Takes Heavy Toll on Public Health

— Annual disability-adjusted life years analysis rarely applied to SCA, researcher says

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In-hospital cardiac arrest (IHCA) was a leading cause of annual disability-adjusted life years lost among U.S. adults in 2018, a researcher reported.

IHCA was responsible for 727 disability-adjusted life years (DALY) lost per 100,000 population, placing it 12th, in between road injuries and headache disorders, according to Ryan Coute, DO, of the Heersink School of Medicine at the University of Alabama at Birmingham.

Sudden cardiac arrest (SCA) in total, including IHCA and out-of-hospital cardiac arrest (OHCA), added up to 2,049 DALY per 100,000, putting it just one spot behind ischemic heart disease, according to findings presented at the American College of Emergency Physicians (ACEP) annual meeting.

Three-quarters of the study population died because of SCA, Coute noted.

The data demonstrate that cardiac arrest needs more attention publicly, Coute told 鶹ý. "These results should inform key policymakers, funding agencies, and the public of the significant burden of disease associated with cardiac arrest, and help allocate limited resources to maximally improve public health," Coute and colleagues stated in the presentation.

Metrics such as DALY have not traditionally been used to assess SCA, Coute pointed out.

He said this was the first national study on the impact of IHCA on DALY, following by his group, which found OHCA alone was the third leading cause of DALY in 2016. In 2018, OHCA was sixth on the list at 1,322 DALY lost per 100,000.

For the current retrospective analysis, the researchers examined data from 310 hospitals participating in the national database for 2018. Using the annual bed-days that year for all U.S. hospitals, results were extrapolated to a national level.

Database patients with missing information on age, gender, race, survival status, or neurologic outcome were excluded, according to the researchers.

They calculated DALY by adding years lived with a disability (YLD) to years of life lost (YLL). Patients who experienced more than one SCA of any variety were counted as having one SCA for the database.

YLD represented the prevalence of survivors multiplied by disability weight based on neurologic outcome ( score) at hospital discharge. YLL was calculated by multiplying IHCA deaths by the remaining life expectancy at the time of death. Life expectancy data came from the 2018 National Vital Statistics Report. "Disability weights were based on cardiac arrest data from Israel," Coute's group wrote.

They compared their data to the Global Burden of Disease (GBD) study's top 10 DALY causes in the U.S. They used the largest database available to them, Coute said, which represented about one-seventh of U.S. hospital beds.

One key limitation of the study was that IHCA overlaps with the DALY of other GBD diseases.

The researchers are now evaluating pediatric OHCA data from the same source, Coute reported, and he said he expects the overall SCA burden on DALY in that population to be more intense.

  • author['full_name']

    Ryan Basen reports for MedPage’s enterprise & investigative team. He often writes about issues concerning the practice and business of medicine, nurses, cannabis and psychedelic medicine, and sports medicine. Send story tips to r.basen@medpagetoday.com.

Disclosures

The study was supported by the NIH/National Heart, Lung, and Blood Institute and an Emergency Medicine Foundation resident research grant.

Primary Source

American College of Emergency Physicians

Coute R "Estimating the public health impact of sudden cardiac arrest in the United States" ACEP 2021.