Sunday, July 05, 2009

Hospital Resuscitation Hasn't Improved Survival in Elderly

Fewer than one in five patients survive to hospital discharge; survival is even lower in certain groups

05 july 2009 -- Among elderly patients who undergo in-hospital cardiopulmonary resuscitation, overall survival rates have not improved since the early 1990s, and survival is especially low in men and minorities, according to a study published in the July 2 issue of the New England Journal of Medicine.

William J. Ehlenbach, M.D., of the University of Washington in Seattle, and colleagues analyzed 1992 to 2005 fee-for-service Medicare data and identified 433,985 patients who underwent in-hospital cardiopulmonary resuscitation, only 18.3 percent of whom survived to discharge.

Although the survival rate did not significantly change during the study period, the researchers observed an increase in the proportion of patients who underwent in-hospital cardiopulmonary resuscitation before death. They also found that older age, male sex, chronic disease burden, admission from a skilled nursing facility, and African-American or other non-Caucasian race were associated with poorer survival. Compared to similar Caucasian patients, African-Americans had 23.6 percent lower adjusted odds of survival, a finding partly explained by hospital effects.

"This study provides information useful to older patients and their clinicians in their decision about whether to choose to be resuscitated, since the proportion of elderly patients who choose resuscitation is directly related to the probability of survival that is presented to these patients," the authors conclude. "Our findings also provide a stimulus to understand the association between race and survival, with the goals of not only eliminating racial disparities in the quality of medical care but also understanding factors associated with the incidence of cardiopulmonary resuscitation."

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