Harvard Heart Letter

Overall health may determine survival after cardiac arrest

Survival rates for people brought to the emergency department following an out-of-hospital cardiac arrest vary widely among hospitals, so quality of care was long assumed to be the determining factor. But research conducted by physicians at Harvard-affiliated Beth Israel Deaconess Medical Center (BIDMC) and two other medical centers suggests that health also plays a key role. The researchers examined 208 adults who survived a cardiac arrest and were admitted to two sophisticated urban teaching hospitals: BIDMC in Boston and Henry Ford Hospital in Detroit. All patients received state-of-the art care, yet those in Boston fared much better than those in Detroit.

Upon close examination, the Detroit patients were found to be much sicker than those in Boston, with significantly higher rates of end-stage kidney disease, hypertension, diabetes, heart failure, and lung disease. In addition, more patients in the Detroit group had an arrhythmia strongly associated with poor outcome. Additionally, after they started hospital treatment, the Detroit patients were significantly more likely to be critically ill.

Despite the differences in patients that influenced outcomes, the researchers emphasized that quality of hospital care remains important.

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