Survival After In‐Hospital Cardiac Arrest and Return of Spontaneous Circulation: An Exploration of Outcome Variation and Relationship to Hospital Area Social Deprivation
- 1Bronx Center for Critical Care Outcomes and Resuscitation Research Montefiore Medical Center Bronx NY USA
- 2Division of Critical Care Medicine Montefiore Medical Center Bronx NY USA
Abstract
Background: In‐hospital cardiac arrest (IHCA) survival has improved over the past 2 decades due to better acute resuscitation survival, but postresuscitation survival, a key to the IHCA chain of survival, has remained stagnant over time.
Methods: We performed a cohort study linking the American Heart Association GWTG‐R (Get With The Guidelines–Resuscitation) registry to the American Hospital Association survey, including adult patients with IHCA with sustained return of spontaneous circulation from 2001 to 2024. Postresuscitation risk‐standardized survival rates were calculated using predicted (hospital‐specific) to expected (population‐averaged) survival, reflecting whether post–return of spontaneous circulation survival at a given hospital was better or worse than expected for an average hospital. Social Deprivation Index was assigned via ZIP‐to‐ZIP Code Tabulation Area linkage and analyzed by quartile.
Results: Of 686 273 IHCAs, 206467 from 755 hospitals were included. Overall, 71 691 (34.7%) survived to discharge. The median risk‐standardized survival rate was 33.9% (interquartile range, 32.6%–35.1%). The risk‐standardized survival rate varied substantially across hospitals (25.0% to 44.8%). Five hundred ninety‐five (78.8%) hospitals were linked to the Social Deprivation Index by ZIP code. Patients from hospitals in the lowest Social Deprivation Index quartile (least deprivation) had a higher postresuscitation risk‐standardized survival rate than those in the highest quartile (adjusted odds ratio, 1.13 [95% CI, 1.03–1.23]; P<0.01); the relationship across quartiles was not monotonic. Hospitals in higher Social Deprivation Index quartiles (more deprivation) had higher proportions of early postresuscitation fever and death.
Conclusions: Substantial hospital‐to‐hospital variation exists in postresuscitation survival, and greater hospital‐based community social deprivation is associated with worse postresuscitation outcomes at the patient level. These results identify the postresuscitation phase of care as a promising area for future quality improvement and research efforts to improve outcomes after IHCA.
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BibTeX
@article{andrea2026survival,
title = {{Survival After In‐Hospital Cardiac Arrest and Return of Spontaneous Circulation: An Exploration of Outcome Variation and Relationship to Hospital Area Social Deprivation}},
author = {Luke Andrea and Thomas Butler and Ari Moskowitz and American Heart Association's Get With The Guidelines–Resuscitation Investigators},
journal = {Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease},
year = {2026},
month = sep,
doi = {10.1161/jaha.126.049291},
url = {https://doi.org/10.1161/jaha.126.049291},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Survival After In‐Hospital Cardiac Arrest and Return of Spontaneous Circulation: An Exploration of Outcome Variation and Relationship to Hospital Area Social Deprivation
AU - Luke Andrea
AU - Thomas Butler
AU - Ari Moskowitz
AU - American Heart Association's Get With The Guidelines–Resuscitation Investigators
PY - 2026
DA - 2026/09/09
JO - Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
DO - 10.1161/jaha.126.049291
UR - https://doi.org/10.1161/jaha.126.049291
AB - Background: In‐hospital cardiac arrest (IHCA) survival has improved over the past 2 decades due to better acute resuscitation survival, but postresuscitation survival, a key to the IHCA chain of survival, has remained stagnant over time. Methods: We performed a cohort study linking the American Heart Association GWTG‐R (Get With The Guidelines–Resuscitation) registry to the American Hospital Association survey, including adult patients with IHCA with sustained return of spontaneous circulation from 2001 to 2024. Postresuscitation risk‐standardized survival rates were calculated using predicted (hospital‐specific) to expected (population‐averaged) survival, reflecting whether post–return of spontaneous circulation survival at a given hospital was better or worse than expected for an average hospital. Social Deprivation Index was assigned via ZIP‐to‐ZIP Code Tabulation Area linkage and analyzed by quartile. Results: Of 686 273 IHCAs, 206467 from 755 hospitals were included. Overall, 71 691 (34.7%) survived to discharge. The median risk‐standardized survival rate was 33.9% (interquartile range, 32.6%–35.1%). The risk‐standardized survival rate varied substantially across hospitals (25.0% to 44.8%). Five hundred ninety‐five (78.8%) hospitals were linked to the Social Deprivation Index by ZIP code. Patients from hospitals in the lowest Social Deprivation Index quartile (least deprivation) had a higher postresuscitation risk‐standardized survival rate than those in the highest quartile (adjusted odds ratio, 1.13 [95% CI, 1.03–1.23]; P<0.01); the relationship across quartiles was not monotonic. Hospitals in higher Social Deprivation Index quartiles (more deprivation) had higher proportions of early postresuscitation fever and death. Conclusions: Substantial hospital‐to‐hospital variation exists in postresuscitation survival, and greater hospital‐based community social deprivation is associated with worse postresuscitation outcomes at the patient level. These results identify the postresuscitation phase of care as a promising area for future quality improvement and research efforts to improve outcomes after IHCA.
SN - 2047-9980
ER -