Tertiary heart centers associated with longer survival after cardiac arrest

After patients experienced an out-of-hospital cardiac arrest, they had significantly higher survival rates if they were admitted to tertiary heart centers compared with nontertiary hospitals, according to a Danish study.

The level of care in tertiary heart centers was also higher following the cardiac arrest, during admission to an intensive care unit (ICU) and before patients were discharged from the hospital.

Lead researcher Helle Søholm, MD, of Copenhagen University Hospital in Denmark, and colleagues published their findings online in Circulation: Cardiovascular Quality and Outcomes on May 5.

They examined 1,078 patients with an out-of-hospital cardiac arrest without STEMI from June 2002 through 2011. Of the patients, 54 percent were admitted to tertiary heart centers and 46 percent were admitted to a nontertiary hospital.

They found that patients admitted to the tertiary centers were younger and were more likely to be male and have their cardiac arrest in public. They also were more likely to have a CT of the brain, coronary angiography and neurophysiological examination when admitted to the ICU.

The researchers wrote that 45 percent of patients admitted to tertiary heart centers survived until hospital discharge compared with 24 percent of patients admitted to nontertiary hospitals. After adjusting for age, sex and comorbidities, they found that survival was significantly higher among the patients in tertiary heart centers.

In addition, of the patients treated with therapeutic hypothermia and admitted to the ICU, 16 percent of patients at tertiary centers and 46 percent of patients at nontertiary hospitals died within 96 hours.

The study’s nonrandomized, retrospective design was a potential limitation, according to the researchers. They also said they did not have data on patients’ socioeconomic status before an out-of-hospital cardiac arrest, which may have contributed to where patients were admitted. However, they noted that admission to a tertiary center or nontertiary hospital in Denmark is only determined by distance and not health insurance coverage or socioeconomic status.