Published Online
on September 28, 2009

A more recent version of this article appeared on November 1, 2009

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Original Article

Factors Associated With Neurologically-Intact Survival for Patients With Acute Heart Failure and In-Hospital Cardiac Arrest

Phillip D. Levy^1,6; Hong Ye²; Scott Compton³; Paul S. Chan⁴; Gregory Luke Larkin⁵ and Robert Welch¹

¹ Wayne State University School of Medicine, Detroit, MI;
² William Beaumont Hospital, Royal Oak, MI;
³ University of Medicine and Dentistry, Newark, NJ;
⁴ Mid-America Heart Institute, Kansas City, MO;
⁵ Yale School of Medicine, New Haven, CT

^* Corresponding author; email: phillevy_2000{at}yahoo.com

Background—Hospitalized heart failure (HF) patients are at risk for cardiac arrest. The ability to predict who may survive such an event with or without neurologic deficit would enhance the information upon which patients and providers establish resuscitative preferences.

Methods and Results—We identified 13,063 adult patients with acute HF who had cardiac arrest at 457 hospitals participating in the National Registry of Cardiopulmonary Resuscitation, between January 1, 2000 and December 31, 2007. Neurological status was determined on admission and discharge by cerebral performance category (CPC) with neurologically-intact survival (NIS) = CPC 1 or 2 (no or moderate dysfunction) and non-NIS = CPC 3 (severe dysfunction), 4 (coma) or 5 (brain death). Factors available pre-arrest (demographics, pre-existing conditions and interventions in-place) were assessed for association with NIS using multivariable logistic regression, initially without then with adjustment for arrest-related variables and hospital characteristics. NIS occurred in 2,307 (17.7%) patients and was associated by adjusted odds ratio (OR) with 18 pre-arrest factors; 4 positively and 14 negatively. Association (OR; 95% confidence interval) was strongest for 4 specific variables: acute stroke (0.38; 0.25, 0.58), prior history of malignancy (0.49; 0.39, 0.63), vasopressor use (0.50; 0.43, 0.59), and assisted or mechanical ventilation (0.53; 0.45, 0.61).

Conclusions—A number of pre-arrest factors appear to be associated with NIS, the majority inversely. Consideration of these prior to cardiac arrest could enhance the resuscitative decision-making process for patients with acute HF.

Key Words: acute heart failure • cardiac arrest • cerebral performance category • neurologically intact survival