Background: Cancer is tied to a high risk of incident cardiovascular disease (CVD). In broad populations survival to hospital discharge following in-hospital cardiac arrest (IHCA) has improved over the last decade but whether this extends to cancer patients remains unknown.
Purpose: To determine the contemporary incidence, trends, peri-IHCA procedural utilization, and survival of IHCA events among cancer patients, and compare these rates to the general population without cancer.
Methods: From the U.S. National Inpatient Sample database, we queried all hospitalizations from 2003–14 for all patients ≥18 years old with an in-hospital (and not presentation) diagnosis of cardiac arrest. Procedures, including cardiopulmonary resuscitation (CPR) were identified by ICD-9 procedure codes; cancers and other comorbidities (including atrial fibrillation, congestive heart failure, prior coronary artery disease, and hypertension) were identified by ICD-9 diagnosis codes and Charlton comorbidity scores were computed. Rates of IHCA, CPR utilization, peri-IHCA procedural utilization, and in-hospital survival were compared between patients with and without cancer.
Results: Over the 12 years considered, we identified 87,287 IHCAs during hospitalizations of patients with cancer, out of a total of 1,144,755 IHCA events. The primary admission diagnosis was acute syndrome in 6.9%, heart failure and cardiogenic shock in 2.7%, sepsis and septic shock in 0.05%, PE in 2.5%, ischemic stroke in 1.0% and hemorrhagic stroke in 1.0%; IHCA cancer patients were older, more likely female, but had less CVD cormorbities (table). The incidence of IHCA increased in both groups over this period with a greater increase in the cancer patients (p=0.049; figure). In-hospital survival after CPR in the hospitalizations of cancer patients who sustained IHCA was 22.1% compared to 46.4% in the population at large (p<0.0001; figure) and the utilization of peri-IHCA procedures was lower among those with cancer.
Conclusions: Over the last decade the incidence of U.S. IHCAs has increased. However, the diagnosis of cancer is associated with more frequent IHCA events, lower peri-IHCA procedural utilization rates, and lower survival to discharge.