This preprint is under consideration at Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
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Original research
Ester Elisabet Holmström
University of Helsinki Faculty of Medicine: Helsingin Yliopisto Laaketieteellinen tiedekunta
Corresponding Author
ORCiD: https://orcid.org/0000-0003-2073-6712
License:
This work is licensed under a CC BY 4.0 License. Read Full License
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 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.
Keywords
Elderly, Cardiac arrest, intensive care unit, critical care, cardiopulmonary resuscitation, OHCA, IHCA, ICUCA
Figure 1
Figure 2
This is a list of supplementary files associated with this preprint. Click to download.
- Additionalfile1.docx
Additional file 1. Table of TISS-point distribution for individual procedures
- Additionalfile2.docx
Additional file 2. Table of TISS-point distribution for individual procedures (OHCA-cases only)
- Additionalfile3.docx
Additional file 3. Table of TISS-point distribution for individual procedures (IHCA-cases only)
- Additionalfile4.docx
Additional file 4. Mean cost in euro based on initial rhythm a) shockable rhythms b) non-shockable rhythms
- Additionalfile5.docx
Additional file 5. KM-curves based on location of arrest a) all cases during the whole follow up-period, Log Rank p <0.001 b) OHCA, Log Rank p < 0.001 c) IHCA, Log Rank p = 0.003 d) ICUCA, Log Rank p = 0.079
- Additionalfile6.docx
Additional file 6. KM-curves based on initial rhythm a) Shockable rhythm (VF/VT), Log rank p < 0.001 b) Non-shockable rhythm, Log Rank p = 0.062
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This preprint is under consideration at Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Original research
Ester Elisabet Holmström
University of Helsinki Faculty of Medicine: Helsingin Yliopisto Laaketieteellinen tiedekunta
Corresponding Author
ORCiD: https://orcid.org/0000-0003-2073-6712
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 18 Mar, 2021
No community comments so far
Review #1 received
Received 10 Apr, 2021
Reviewers invited
Invitations sent on 30 Mar, 2021
Reviewer #1 agreed
On 30 Mar, 2021
First submitted
On 09 Mar, 2021
Editor assigned
On 09 Mar, 2021
Submission checks complete
On 09 Mar, 2021
Editor invited
On 09 Mar, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Critical Care & Emergency Medicine
License:
This work is licensed under a CC BY 4.0 License. Read Full License
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 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.
Figure 1
Figure 2
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