Variation in outcomes among 24/7 percutaneous coronary intervention centres for patients resuscitated from out-of-hospital cardiac arrest

Bryn Mumma, Machelle D. Wilson, María F. García-Pintos, Pablo J. Erramouspe, Daniel J Tancredi

Research output: Contribution to journalArticle

Abstract

Background: Patients treated at 24/7 percutaneous coronary intervention (PCI) centres following out-of-hospital cardiac arrest (OHCA) have better outcomes than those treated at non-24/7 PCI centres. However, variation in outcomes between 24/7 PCI centres is not well studied. Objectives: To evaluate variation in outcomes among 24/7 PCI centres and to assess stability of 24/7 PCI centre performance. Methods: Adult patients in the California Office of Statewide Health Planning and Development Patient Discharge Database with a “present on admission” diagnosis of cardiac arrest admitted to a 24/7 PCI centre from 2011 to 2015 were included. Primary outcome was good neurologic recovery at hospital discharge. Secondary outcomes were survival to hospital discharge, cardiac catheterisation, and DNR orders within 24 h. Data were analysed using mixed effects logistic regression models. Hospitals were ranked each year and overall. Results: Of 27,122 patients admitted to 128 24/7 PCI centres, 41% (11,184) survived and 27% (7188) had good neurologic recovery. Adjusted rates of good neurologic recovery (18%–39%; p,0.001), survival (32%–51%; p < 0.0001), cardiac catheterisation (11%–49%; p < 0.0001) and DNR orders within 24 h (4.8%–49%; p < 0.0001) varied between 24/7 PCI centres. For the 26 hospitals with mean good neurologic rankings in the top or bottom tenth during 2011–2013, 14 (54%) remained in their respective tenth for 2014–2015. Conclusion: Significant variation exists between 24/7 PCI centres in good neurologic recovery following OHCA and persists over time. Future studies should evaluate hospital-level factors that contribute to these differences in outcomes between 24/7 PCI centres.

Original languageEnglish (US)
Pages (from-to)14-20
Number of pages7
JournalResuscitation
Volume135
DOIs
StatePublished - Feb 1 2019

Fingerprint

Out-of-Hospital Cardiac Arrest
Percutaneous Coronary Intervention
Nervous System
Cardiac Catheterization
Logistic Models
Health Planning
Survival
Patient Discharge
Heart Arrest
Databases

Keywords

  • 24/7 PCI centre
  • Cardiac arrest
  • Outcomes

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency
  • Cardiology and Cardiovascular Medicine

Cite this

Variation in outcomes among 24/7 percutaneous coronary intervention centres for patients resuscitated from out-of-hospital cardiac arrest. / Mumma, Bryn; Wilson, Machelle D.; García-Pintos, María F.; Erramouspe, Pablo J.; Tancredi, Daniel J.

In: Resuscitation, Vol. 135, 01.02.2019, p. 14-20.

Research output: Contribution to journalArticle

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abstract = "Background: Patients treated at 24/7 percutaneous coronary intervention (PCI) centres following out-of-hospital cardiac arrest (OHCA) have better outcomes than those treated at non-24/7 PCI centres. However, variation in outcomes between 24/7 PCI centres is not well studied. Objectives: To evaluate variation in outcomes among 24/7 PCI centres and to assess stability of 24/7 PCI centre performance. Methods: Adult patients in the California Office of Statewide Health Planning and Development Patient Discharge Database with a “present on admission” diagnosis of cardiac arrest admitted to a 24/7 PCI centre from 2011 to 2015 were included. Primary outcome was good neurologic recovery at hospital discharge. Secondary outcomes were survival to hospital discharge, cardiac catheterisation, and DNR orders within 24 h. Data were analysed using mixed effects logistic regression models. Hospitals were ranked each year and overall. Results: Of 27,122 patients admitted to 128 24/7 PCI centres, 41{\%} (11,184) survived and 27{\%} (7188) had good neurologic recovery. Adjusted rates of good neurologic recovery (18{\%}–39{\%}; p,0.001), survival (32{\%}–51{\%}; p < 0.0001), cardiac catheterisation (11{\%}–49{\%}; p < 0.0001) and DNR orders within 24 h (4.8{\%}–49{\%}; p < 0.0001) varied between 24/7 PCI centres. For the 26 hospitals with mean good neurologic rankings in the top or bottom tenth during 2011–2013, 14 (54{\%}) remained in their respective tenth for 2014–2015. Conclusion: Significant variation exists between 24/7 PCI centres in good neurologic recovery following OHCA and persists over time. Future studies should evaluate hospital-level factors that contribute to these differences in outcomes between 24/7 PCI centres.",
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T1 - Variation in outcomes among 24/7 percutaneous coronary intervention centres for patients resuscitated from out-of-hospital cardiac arrest

AU - Mumma, Bryn

AU - Wilson, Machelle D.

AU - García-Pintos, María F.

AU - Erramouspe, Pablo J.

AU - Tancredi, Daniel J

PY - 2019/2/1

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N2 - Background: Patients treated at 24/7 percutaneous coronary intervention (PCI) centres following out-of-hospital cardiac arrest (OHCA) have better outcomes than those treated at non-24/7 PCI centres. However, variation in outcomes between 24/7 PCI centres is not well studied. Objectives: To evaluate variation in outcomes among 24/7 PCI centres and to assess stability of 24/7 PCI centre performance. Methods: Adult patients in the California Office of Statewide Health Planning and Development Patient Discharge Database with a “present on admission” diagnosis of cardiac arrest admitted to a 24/7 PCI centre from 2011 to 2015 were included. Primary outcome was good neurologic recovery at hospital discharge. Secondary outcomes were survival to hospital discharge, cardiac catheterisation, and DNR orders within 24 h. Data were analysed using mixed effects logistic regression models. Hospitals were ranked each year and overall. Results: Of 27,122 patients admitted to 128 24/7 PCI centres, 41% (11,184) survived and 27% (7188) had good neurologic recovery. Adjusted rates of good neurologic recovery (18%–39%; p,0.001), survival (32%–51%; p < 0.0001), cardiac catheterisation (11%–49%; p < 0.0001) and DNR orders within 24 h (4.8%–49%; p < 0.0001) varied between 24/7 PCI centres. For the 26 hospitals with mean good neurologic rankings in the top or bottom tenth during 2011–2013, 14 (54%) remained in their respective tenth for 2014–2015. Conclusion: Significant variation exists between 24/7 PCI centres in good neurologic recovery following OHCA and persists over time. Future studies should evaluate hospital-level factors that contribute to these differences in outcomes between 24/7 PCI centres.

AB - Background: Patients treated at 24/7 percutaneous coronary intervention (PCI) centres following out-of-hospital cardiac arrest (OHCA) have better outcomes than those treated at non-24/7 PCI centres. However, variation in outcomes between 24/7 PCI centres is not well studied. Objectives: To evaluate variation in outcomes among 24/7 PCI centres and to assess stability of 24/7 PCI centre performance. Methods: Adult patients in the California Office of Statewide Health Planning and Development Patient Discharge Database with a “present on admission” diagnosis of cardiac arrest admitted to a 24/7 PCI centre from 2011 to 2015 were included. Primary outcome was good neurologic recovery at hospital discharge. Secondary outcomes were survival to hospital discharge, cardiac catheterisation, and DNR orders within 24 h. Data were analysed using mixed effects logistic regression models. Hospitals were ranked each year and overall. Results: Of 27,122 patients admitted to 128 24/7 PCI centres, 41% (11,184) survived and 27% (7188) had good neurologic recovery. Adjusted rates of good neurologic recovery (18%–39%; p,0.001), survival (32%–51%; p < 0.0001), cardiac catheterisation (11%–49%; p < 0.0001) and DNR orders within 24 h (4.8%–49%; p < 0.0001) varied between 24/7 PCI centres. For the 26 hospitals with mean good neurologic rankings in the top or bottom tenth during 2011–2013, 14 (54%) remained in their respective tenth for 2014–2015. Conclusion: Significant variation exists between 24/7 PCI centres in good neurologic recovery following OHCA and persists over time. Future studies should evaluate hospital-level factors that contribute to these differences in outcomes between 24/7 PCI centres.

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KW - Cardiac arrest

KW - Outcomes

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