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      Outcome and Cost-Effectiveness of Cardiopulmonary Resuscitation after In-Hospital Cardiac Arrest in Octogenarians

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          Context: Octogenarians are the fastest growing segment of the population and little is known about the results of cardiopulmonary resuscitation (CPR) after in-hospital cardiac arrest in this population. Objective: We sought to investigate the clinical benefit and cost-effectiveness of CPR after in-hospital cardiac arrest in octogenarians. Main Outcome Measure: Years of life saved. Design: Effectiveness data were obtained from a review of 91,372 hospital discharges from January 1st, 1993 until June 30th, 1996. Cardiac arrest was reported in 956 patients. The study group consisted of 474 patients ≧80 years old. CPR costs included equipment and training, physician and nursing time and medications. Post-CPR expenses included in-hospital true cost, repeat hospitalizations, physician office visits, nursing home, rehabilitation, and chronic care hospital costs. Life expectancy of the patients who were still alive at the end of the study was estimated from census data. A utility of 0.8 was used to calculate quality-adjusted-life years saved (QALYS). We used a societal perspective for analysis. Results: The study population was 86 ± 4.8 years old (range 80–103), and 42% were male. Fifty-four patients (11%) were discharged alive, 35 to a chronic care facility and 19 to their home. Assuming that a cardiac arrest without CPR has 100% mortality, 12 octogenarians required treatment with CPR in order to save one life to hospital discharge. Similarly, 29 octogenarian patients with cardiac arrest have to be treated with CPR to net one long-term survivor (mean survival 21 months, with a range from 9 to 48 months). The cost-effectiveness ratio, after estimating the life expectancy of octogenarian survivors, was USD 50,412 per year of life saved, and USD 63,015 per QALYS. However, a utility of 0.5 yielded a cost of USD 100,825 per QALYS. Conclusion: In comparison with other life-saving strategies, CPR in octogenarians is effective. The favorable cost-effectiveness ratio is highly dependent on the patients’ preference for quality rather than quantity of life, as expressed by the utility assumptions.

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          Most cited references 5

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          Survival after the age of 80 in the United States, Sweden, France, England, and Japan.

           K Manton,  J Vaupel (1995)
          In many developed countries, life expectancy at birth is higher than in the United States. Newly available data permit, for the first time, reliable cross-national comparisons of mortality among persons 80 years of age or older. Such comparisons are important, because in many developed countries more than half of women and a third of men now die after the age of 80. We used extinct-cohort methods to assess mortality in Japan, Sweden, France, and England (including Wales) and among U.S. whites for cohorts born from 1880 to 1894, and used cross-sectional data for the year 1987. Extinct-cohort methods rely on continuously collected data from death certificates and do not use the less reliable data from censuses. In the United States, life expectancy at the age of 80 and survival from the ages of 80 to 100 significantly exceeded life expectancy in Sweden, France, England, and Japan (P < 0.01). This finding was confirmed with accurate cross-sectional data for 1987. The average life expectancy in the United States is 9.1 years for 80-year-old white women and 7.0 years for 80-year-old white men. For people 80 years old or older, life expectancy is greater in the United States than it is in Sweden, France, England, and Japan. This finding suggests that elderly Americans are receiving better health care than the elderly citizens of other developed countries.
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            Health Values of Hospitalized Patients 80 Years or Older

             Joel Tsevat (1998)
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              In-hospital cardiopulmonary resuscitation.

              A retrospective review of 399 cardiopulmonary resuscitation (CPR) efforts in 329 veterans was performed to evaluate the observation that few geriatric patients were discharged alive after they underwent CPR. Cardiopulmonary resuscitation efforts with witnessed arrests were more frequently successful than efforts with unwitnessed arrests (47.7% vs 29.9%) and resulted in live discharge more often than efforts with unwitnessed arrests. Cardiopulmonary resuscitation efforts that resulted in a live discharge were more brief and involved a lower mean number of medication doses. Of the 77 CPR efforts in patients 70 years of age or older who had arrests, 24 (31%) were successful, and in 22 (92%), patients were alive after 24 hours. None lived to discharge. There were 322 CPR efforts in the younger cohort; 137 (43%) were successful, in 124 (91%) of these 137 efforts, patients were alive after 24 hours, and in 22 (16%), patients were discharged alive. Older patients were significantly less likely to live to discharge both at the time of arrest and 24 hours after successful resuscitation. When a multivariate analysis was used, the presence of sepsis, cancer, increased age, increased number of medication doses administered, and absence of witness were all "predictive" of poor outcome. Cardiopulmonary resuscitation should be administered only to those who have the greatest potential benefit from this emotionally and physically traumatic procedure.

                Author and article information

                S. Karger AG
                March 2002
                07 March 2002
                : 97
                : 1
                : 6-11
                aDivision of Cardiology, Mount Sinai Medical Center and the University of Miami School of Medicine, Miami Beach, Fla., bDivision of General Internal Medicine and Health Services Research, University of California, Los Angeles, Calif., and cDivision of Cardiology, University of California, San Francisco, Calif., USA
                47412 Cardiology 2002;97:6–11
                © 2002 S. Karger AG, Basel

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                Page count
                Figures: 1, Tables: 1, References: 19, Pages: 6
                General Cardiology


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