July 17, 2008–MARBURG, Germany-- Resuscitated cardiac arrest patients treated in an ICU who leave the hospital without severe neurological disabilities may expect a reasonable quality of life over the next five years, a German study found.
"We believe our study is the first to demonstrate that patients who leave the hospital following cardiac arrest without severe neurological disabilities may expect fair long-term survival and quality of life for reasonable expenses to the healthcare system," Dr. Graf's team concluded.
ICUs care for only a minority of patients, but they consume a large proportion of the hospital budget. Thus, Dr. Graf said, "restricting the demands for futile medical services by limiting access to the ICU, at least for patients likely to die anyway, has been proposed as a theoretical model to lower expenditures."
To investigate the costs and long-term health status after CPR for out-of-hospital or in-hospital cardiac arrest, the researchers investigated patients' health status five years after discharge from the University Hospital of Aachen in Germany and combined these outcomes with a full economic evaluation.
Of 354 patients admitted to the ICU from January 1999 through December 2001, 150 (42%) were discharged and 110 (31%) were alive in 2004, five years after hospital discharge. Eventually 81 five-year survivors answered the survey.
The researchers found the health-related quality of life at five years after hospital discharge was only slightly lower than age- and gender-matched apparently healthy German controls.
In addition, both the reported survival in the ICU and the hospital and health-related quality of life did not differ when compared with publications that were based on similar cardiac-arrest patients, other medical ICU patients, or ICU patients with sepsis.
After hospital discharge, only three patients (4%) relied on daily custodial care while six lived in nursing homes (5%).
Five years after hospital discharge, 13 (16%) were employed, 13 (16%) were early retired, and 48 (59%) were regularly retired because of age.
In 2004, the total ICU costs for all 354 patients amounted to 6,312,700 € (about $8.1 million U.S.). In February 2004 the exchange rate was $1.285 so each Euro was worth $1.285 U.S.
This was approximately double the cost for an average ICU patient, but it compared favorably with other routine interventions, such as drug-eluting stents, mechanical intervention, and dialysis, in a variety of critically ill and non-ICU patients, the researchers said.
These outcomes compared favorably with general cardiovascular and pulmonary ICU patients from the same ICU, they said.
The results also compared favorably with other cost profiles for a variety of other interventions routinely done for the critically ill as well as non-ICU patients, they said.
Although these patients may incur considerable costs and resource consumption, the trade-off between costs and outcome justifies such resource allocation, at least in comparison with other ICU patient groups.
Reference: Graf J, et al "Healthcare costs, long-term survival and quality of life following ICU admission after cardiac arrest"Critical Care 2008.
-Judith Groch, MedPage Today