The results of a retrospective study published in Resuscitation suggest that post-resuscitation interventions are less aggressive following in-hospital cardiac arrest for patients with cancer compared with individuals without a history of cancer.
Although there is evidence that the clinical outcomes of patients experiencing in-hospital cardiac arrest, as well as of patients with cancer in general, have improved in recent years, findings from previously conducted studies suggest that a disparity exists between the clinical outcomes of patients with and without a history of cancer who experience a cardiac arrest while hospitalized.
Data from the National Inpatient Sample for the period between 2003 and 2014 were accessed in this case-control study in which hospitalized adult patients with a history of cancer were matched with hospitalized patients without a history of a cancer diagnosis using a risk-based propensity score.
Among the overall group of 1,893,768 patients who experienced a cardiac arrest while hospitalized, 112,926 patients had a previous diagnosis of cancer. The median patient age was 71 years and 68 years in those with and without a history of cancer, respectively. Rates of most pre-existing cardiovascular diseases were higher in the latter compared with the former patient group. For example, the percentages of patients admitted to the hospital with a diagnosis of acute coronary syndrome were 15.35% and 28.38% for those with a cancer diagnosis and those without a history of cancer, respectively (P <.0001). Similarly, the rates of pre-existing congestive heart failure were 25.73% in those with a history of cancer and 36.71% in the population of patients without a cancer diagnosis (P <.0001).
Patients with a cancer diagnosis were significantly less likely than those without a history of malignancy to undergo coronary angiography (6.4% vs. 21.7%; P <.0001) or percutaneous coronary intervention (2.3% vs. 12.3%; P <.0001) after experiencing cardiac arrest during hospitalization. This relative discrepancy regarding post-resuscitation procedures was also observed in a subgroup of patients with cancers associated with long-term survival.
Importantly, during the study time period, the percentage of patients with a history of cancer surviving to hospital discharge was lower compared with matched controls without a cancer diagnosis (22.6%-30.2% vs 40.2%–45.1%; P <.0001).
The study authors concluded that “additional research is needed to clarify the role of patient-physician perceptions of cancer prognosis and selective applications of post-resuscitation care.”
ReferenceGuha A, Buck B, Biersmith M, et al. Contemporary impacts of a cancer diagnosis on survival following in-hospital cardiac arrest. Resuscitation. 2019;142:30-37.