Intensive care–treated cardiac arrest : a retrospective study on the impact of extended age on mortality, neurological outcome, received treatments and healthcare-associated costs

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http://urn.fi/URN:NBN:fi:hulib-202105312351
Title: Intensive care–treated cardiac arrest : a retrospective study on the impact of extended age on mortality, neurological outcome, received treatments and healthcare-associated costs
Author: Holmström, Ester; Efendijev, Ilmar; Raj, Rahul; Pekkarinen, Pirkka; Litonius, Erik; Skrifvars, Markus
Contributor: University of Helsinki, Faculty of Medicine
Publisher: Helsingin yliopisto
Date: 2021
Language: eng
URI: http://urn.fi/URN:NBN:fi:hulib-202105312351
http://hdl.handle.net/10138/330412
Thesis level: master's thesis
Degree program: Lääketieteen koulutusohjelma
Degree Programme in Medicine
Utbildningsprogrammet i medicin
Specialisation: Ruotsinkielinen opintolinja
Study orientation in Swedish
Svenskspråkig studieinriktning
Abstract: Background: Cardiac arrest (CA) is a leading cause of death worldwide. As population ages, the need for research focusing on CA in elderly increases. This study investigated treatment intensity, 12-month neurological outcome, mortality and healthcare-associated costs for patients aged over 75 years treated for CA in an intensive care unit (ICU) of a tertiary hospital. Methods: This single-centre retrospective study included adult CA patients treated in a Finnish tertiary hospital’s ICU between 2005 and 2013. We stratified the study population into two age groups: <75 and ≥75 years. We compared interventions defined by the median daily therapeutic intervention scoring system (TISS-76) between the age groups to find differences in treatment intensity. We calculated cost-effectiveness by dividing the total one-year healthcare-associated costs of all patients by the number of survivors with a favourable neurological outcome. Favourable outcome was defined as a cerebral performance category (CPC) of 1–2 at 12 months after cardiac arrest. Logistic regression analysis was used to identify independent association between age group, mortality and neurological outcome. Results: This study included a total of 1,285 patients, of which 212 (16%) were ≥75 years of age. Treatment intensity was lower for the elderly compared to the younger group, with median TISS scores of 116 and 147, respectively (p < 0.001). The effective cost in euros for patients with a good one-year neurological outcome was €168,000 for the elderly and €120,000 for the younger group. At 12 months after CA 24% of the patients in the elderly group and 47% of the patients in the younger group had a CPC of 1-2 (p < 0.001). Age was an independent predictor of mortality (multivariate OR = 3.36, 95% CI:2.21-5.11, p < 0.001) and neurological outcome (multivariate OR = 3.27, 95% CI:2.12-5.03, p < 0.001). Conclusions: The elderly ICU-treated CA patients in this study had worse neurological outcomes, higher mortality and lower cost-effectiveness than younger patients. Further efforts are needed to recognize the tools for assessing which elderly patients benefit from a more aggressive treatment approach in order to improve the cost-effectiveness of post-CA management.
Subject: elderly
cardiac arrest
intensive care unit
critical care
cardiopulmonary resuscitation
out-of-hospital cardiac arrest
in-hospital cardiac arrest
in-intensive-care-unit cardiac arrest
elderly
cardiac arrest
intensive care unit
critical care
cardiopulmonary resuscitation
out-of-hospital cardiac arrest
in-hospital cardiac arrest
in-intensive-care-unit cardiac arrest


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