Health Policy and Health Services Research
Background: In-hospital cardiac arrest (IHCA) contributes to increased morbidity and mortality. However, not many epidemiological data were readily available. The study aimed to reveal the incidence and outcomes of patients with in-hospital cardiac arrest in Taiwan between 2006 and 2013.
Methods: This is a retrospective cohort study using the Taiwan National Health Insurance Research Database. We identified eligible adults who developed episodes of IHCA in the ED or during hospitalization between 2006 and 2013. We calculated the standardized incidence rate of IHCA, and documented outcomes including survival to hospital discharge and survival at 6-month post-discharge. Temporal trends were analyzed using Joinpoint models. We also compared the differences in the incidence and outcomes between hospitals of different levels (i.e., medical centers, regional hospitals, and local hospitals and others). Logistic regression with an interaction term between index year and the level of hospitals were applied.
Results: Among the 1,218,426 eligible ED and hospital admissions, 3,344 patients developed IHCA. The average incidence rate of IHCA events was 2.8 per 1000 hospital visits. The incidence has gradually decreased from 6.2 per 1000 hospital visits in 2006 (95% confidence interval [CI], 5.6 – 6.9) to 1.8 per 1000 hospital visits in 2013 (95% CI, 1.4 – 2.3). The incidence of IHCA was significantly different between hospitals at different levels (medical center, 2.1 per 1000 hospital visits; regional hospital, 2.6 per 1000 hospital visits; local and other hospitals, 4.5 per 1000 hospital visits). It was also significantly decreased over time (p<.001). To the contrary, both the rate of survival to hospital discharge (22.3%) and survival at 6-month post-discharge (13.8%) were not significantly changed over time. The rates of survival to hospital discharge were different between hospitals of different levels (medical centers, 28.4%; regional hospitals, 21.3%; local and other hospitals, 15.9%, p<.001). However, it was not significantly changed over time (p=.48).
The incidence of IHCA in Taiwan has decreased over the study period between 2006 and 2013, but the survivals from IHCA remained unchanged. Medical centers had a lower incidence rate and a higher survival rate of IHCA.