br Resuscitation br Clinical paper br Contemporary impacts of a
Contemporary impacts of a cancer diagnosis on survival following in-hospital cardiac arrest
Avirup Guha a,b,1, Benjamin Buck a,1, Michael Biersmith a, Sameer Arora c,d, Vedat Yildiz e, Lai Wei e, Farrukh Awan f, Jennifer Woyach f, Juan Lopez-Mattei g,h, Juan Carlos Plana-Gomez i, Guilherme H. Oliveira b, Michael G. Fradley j, Daniel Addison a,*
a Division of Cardiology, Cardio-Oncology Program, The Ohio State University Medical Center, Columbus, OH, USA
b Harrington Heart and Vascular Institute at UH Cleveland Medical Center, Cleveland, OH, USA
c Division of Cardiology, University of North Carolina, Chapel Hill, NC, USA
d Division of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
e Division of Biostatistics, James Cancer Hospital and Solove Research Institute at The Ohio State University, Columbus, OH, USA
f Division of Hematology, James Cancer Hospital and Solove Research Institute at The Ohio State University, Columbus, OH, USA
g Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
h Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
i Division of Cardiology, Baylor College of Medicine, Houston, TX, USA
j Cardio-Oncology Program, Division of Cardiology, University of South Florida and Moffitt Cancer Center, Tampa, FL, USA
Aim: The objective of this 12-O-tetradecanoyl phorbol-13-acetate study was to determine whether survival and post-arrest procedural utilization following in-hospital cardiac arrest (IHCA) differ in patients with and without comorbid cancer.
Methods: We retrospectively reviewed all adult (age 18 years old) hospital admissions complicated by IHCA from 2003 to 2014 using the National Inpatient Sample (NIS) dataset. Utilizing propensity score matching using age, gender, race, insurance, all hospital level variables, HCUP mortality score, diabetes, hypertension and cardiopulmonary resuscitation use, rates of survival to hospital discharge and post-arrest procedural utilization were compared.
Conclusions: Patients with a history of cancer who sustain IHCA are less likely to receive post-arrest procedures and survive to hospital discharge. Given the expected rise in the rates of cancer survivorship, these findings highlight the need for broader application of potentially life-saving interventions to lower risk cancer patients who have sustained a cardiac arrest.
Keywords: Cancer, Cardiovascular disease, In-hospital cardiac arrest, Cardio-oncology
* Corresponding author at: Division of Cardiovascular Medicine, Davis Heart & Lung Research Institute, 473 West 12th Avenue, Suite 200, Columbus, OH, 43210, USA.
E-mail address: [email protected] (D. Addison).
1 These authors contributed equally.
Every year, approximately 200,000 patients suffer an in-hospital cardiac arrest (IHCA) in the U.S. From 2000 to 2014, rates of survival to discharge steadily increased from 14% to 25% coinciding with improvements in the delivery of advanced cardiac life support and the standardized of post-resuscitation care.1–4 This represents significant progress towards the stated goals of improved IHCA survival by 2020.5–7
Concurrently, long-term clinical outcomes among patients with cancer have dramatically improved, with several cancer populations experiencing a median survival well beyond 5 years.8 However, increasing data have shown that cancer survivors have increased rates of major cardiovascular events, including IHCA, with poorer outcomes.9 This holds true among this population despite reports of similar rates of CPR use in cancer patients compared to cancer-free subjects.10 Notably, many of these patients carry diagnoses of highly-treatable or non-advanced cancers (ex. breast or prostate cancers), suggesting that patients with cancer may be under-resuscitated. As such, there has been a focus amongst members of the medical community to address this disparity.