Prognosis of cardiac arrest in home care clients and nursing home residents: A population-level retrospective cohort study

Fabrice I Mowbray; Aaron Jones; Ryan P Strum; Luke Turcotte; Farid Foroutan; Kerstin de Wit; Andrew Worster; Lauren E Griffith; Paul Hebert; George Heckman; Dennis T Ko; Connie Schumacher; Anastasia Gayowsky; Andrew P Costa

doi:10.1016/j.resplu.2022.100328

Prognosis of cardiac arrest in home care clients and nursing home residents: A population-level retrospective cohort study

Resusc Plus. 2022 Nov 17:12:100328. doi: 10.1016/j.resplu.2022.100328. eCollection 2022 Dec.

Authors

Fabrice I Mowbray¹, Aaron Jones¹, Ryan P Strum¹, Luke Turcotte^{2

3}, Farid Foroutan⁴, Kerstin de Wit⁵, Andrew Worster⁵, Lauren E Griffith^{1

6}, Paul Hebert^{2

7}, George Heckman^{3

8}, Dennis T Ko^{9

10}, Connie Schumacher¹¹, Anastasia Gayowsky⁹, Andrew P Costa^{1

12}

Affiliations

¹ Department of Health Research Methods, Evidence and Impact, McMaster University, 175 Longwood Rd. S, Hamilton, ON L8P 0A1, Canada.
² Bruyere Research Institute, 85 Primrose Ave., Ottawa, ON 85K1R 6M1, Canada.
³ School of Public Health Science, Faculty of Applied Science, University of Waterloo, 200 University Ave W., Waterloo, ON N2L 3G1, Canada.
⁴ Ted Rogers Centre for Heart Research, University Health Network. 661 University Ave, Toronto, ON, Canada.
⁵ Division of Emergency Medicine, Department of Medicine, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada.
⁶ McMaster Institute for Research on Aging, McMaster University. 1280 Main St W, Hamilton, ON L8S 4L8, Canada.
⁷ Department of Medicine, Division of Palliative Care, University of Ottawa, Canada.
⁸ Schlegel Research Institute for Aging, Waterloo, ON, Canada.
⁹ Institute for Clinical and Evaluative Sciences, G1-06 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada.
¹⁰ Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto, G106, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada.
¹¹ School of Nursing, Faculty of Applied Health Sciences, Brock University, 1812 Sir Isaac Brock Way, St. Catherine's, ON LS2 3A1, Canada.
¹² St. Joseph's Health System, 50 Charlton Ave E, Hamilton, ON, Canada.

Abstract

Aim: To evaluate the prognosis of 30-day survival post-cardiac arrest among patients receiving home care and nursing home residents.

Methods: We conducted a population-level retrospective cohort study of community-dwelling adults (≥18 years) who received cardiac arrest care at a hospital in Ontario, Canada, between 2006 to 2018. We linked population-based health datasets using the Home Care Dataset to identify patients receiving home care and the Continuing Care Reporting System to identify nursing home residents. We included both out-of-hospital and in-hospital cardiac arrests. We determined unadjusted and adjusted associations using logistic regression after adjusting for age and sex. We converted relative measures to absolute risks.

Results: Our cohort contained 86,836 individuals. Most arrests (55.5 %) occurred out-of-hospital, with 9,316 patients enrolled in home care and 2,394 residing in a nursing home. When compared to those receiving no support services, the likelihood of survival to 30-days was lower for those receiving home care (RD = -6.5; 95 %CI = -7.5 - -5.0), with similar results found within sub-groups of out-of-hospital (RD = -6.7; 95 %CI = -7.6 - -5.7) and in-hospital arrests (RD = -8.7; 95 %CI = -10.6 - -7.3). The likelihood of 30-day survival was lower for nursing home residents (RD = -7.2; 95 %CI = -9.3 - -5.3) with similar results found within sub-groups of out-of-hospital (RD = -8.6; 95 %CI = -10.6 - -5.7) and in-hospital arrests (RD = -5.0; 95 %CI = -7.8 - -2.1).

Conclusion: Patients receiving home care and nursing home residents had worse overall prognoses of survival post-cardiac arrest compared to those receiving no pre-arrest support, highlighting two medically-complex groups likely to benefit from advance care planning.

Keywords: Cardiac arrest; Home care; Nursing home; Prognosis; Survival.