Author + information
- Received August 17, 2017
- Revision received November 9, 2017
- Accepted November 15, 2017
- Published online January 22, 2018.
- Uchenna R. Ofoma, MD, MSa,∗ (, )
- Suresh Basnet, MDb,
- Andrea Berger, MASc,
- H. Lester Kirchner, PhDc,
- Saket Girotra, MD, SMd,
- for the American Heart Association Get With the Guidelines – Resuscitation Investigators
- aDepartment of Critical Care Medicine, Geisinger Health System, Danville, Pennsylvania
- bDepartment of Critical Care Medicine, Winchester Medical Center, Winchester, Virginia
- cBiomedical & Translational Informatics, Geisinger Health System, Danville, Pennsylvania
- dDivision of Cardiovascular Diseases, Department of Medicine, University of Iowa Hospitals and Clinics and the Iowa City Veterans Affairs Medical Center, Iowa City, Iowa
- ↵∗Address for correspondence:
Dr. Uchenna R. Ofoma, Department of Critical Care Medicine, Geisinger Health System, 100 North Academy Avenue, Danville, Pennsylvania 17822.
Background Survival after in-hospital cardiac arrest (IHCA) is lower during nights and weekends (off-hours) compared with daytime during weekdays (on-hours). As overall IHCA survival has improved over time, it remains unknown whether survival differences between on-hours and off-hours have changed.
Objectives This study sought to examine temporal trends in survival differences between on-hours and off-hours IHCA.
Methods We identified 151,071 adults at 470 U.S. hospitals in the Get with the Guidelines–Resuscitation registry during 2000 to 2014. Using multivariable logistic regression with generalized estimating equations, we examined whether survival trends in IHCA differed during on-hours (Monday to Friday 7:00 am to 10:59 pm) versus off-hours (Monday to Friday 11:00 pm to 6:59 am, and Saturday to Sunday, all day).
Results Among 151,071 participants, 79,091 (52.4%) had an IHCA during off-hours. Risk-adjusted survival improved over time in both groups (on-hours: 16.0% in 2000, 25.2% in 2014; off-hours: 11.9% in 2000, 21.9% in 2014; p for trend <0.001 for both). However, there was no significant change in the survival difference over time between on-hours and off-hours, either on an absolute (p = 0.75) or a relative scale (p = 0.059). Acute resuscitation survival improved significantly in both groups (on-hours: 56.1% in 2000, 71% in 2014; off-hours: 46.9% in 2000, 68.2% in 2014; p for trend <0.001 for both) and the difference between on-hours and off-hours narrowed over time (p = 0.02 absolute scale, p < 0.001 relative scale). In contrast, although post-resuscitation survival also improved over time in both groups (p for trend < 0.001 for both), the absolute and relative difference persisted.
Conclusions Despite an overall improvement in survival, lower survival in IHCA during off-hours compared with on-hours persists.
Dr. Ofoma has received support from the Geisinger Health System Foundation (SRC-S-43). Dr. Girotra is supported by a career development award (K08HL122527) from the National Heart, Lung, and Blood Institute. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 17, 2017.
- Revision received November 9, 2017.
- Accepted November 15, 2017.
- 2018 American College of Cardiology Foundation
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