Analysis of characteristics and trends of the In-Hospital Cardiac Arrest incidence in the Republic of Korea: clinical usefulness of national health insurance claim data

Backgrounds: In-Hospital Cardiac Arrest (IHCA) requires the preparation of considerable medical resources in hospitals. Furthermore, compared to Out-of-Hospital Cardiac Arrest, until recently, there have not been many studies on the incidence, characteristics, and prognosis of IHCA. This study is to examine IHCA event rates among hospitalized patients in the Republic of Korea from 2011 to 2015.

Methods: The incidence of IHCA in adults was extracted from claim data of the National Health Insurance Service from 2011 to 2015, and analyzed according to age, sex, the classification under the 7th revision of the Korean Standard Classification of Diseases (KCD-7), hospital types, and provinces.

Results: From 2011 to 2015, the overall incidence of IHCA in Korea was founded to be 3.00 per 1,000 hospitalizations. The overall 5-year IHCA incidence was higher in male at 3.92 cases per 1,000 hospitalizations and at female 2.19 cases per 1,000 hospitalizations. Incidence due to cardiovascular disease increased year by year, whereas incidences due to respiratory, neurological and infectious disease were decreasing, and in the case of oncologic disease, there was no change. In particular, patients with diseases of the circulatory system had at least a two times higher incidence compared to those with other diseases. The IHCA incidence in general hospitals and tertiary hospitals was at least two-fold higher than the national overall and showed an increasing trend. The provinces that showed a higher IHCA incidence than the five-year national overall were Jeju Special Self-Governing Province, Gangwon Province, and Seoul.

Conclusions: The results of this study can be used as important basic data to secure patient safety by reducing the occurrence of IHCA.

In-Hospital Cardiac Arrest; Incidence; Epidemiology; Big data; Claim data

[1] Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, et al. Heart disease and stroke statistics-2014 update: a report from the American Heart Association. Circulation. 2014; 129: e28-e292.

[2] Sandroni C, Nolan J, Cavallaro F, Antonelli M. In-hospital cardiac arrest: incidence, prognosis and possible measures to improve survival. Intensive Care Medicine. 2007; 33: 237-245.

[3] Idris AH, Bierens JJLM, Perkins GD, Wenzel V, Nadkarni V, Morley P, et al. 2015 revised Utstein-style recommended guidelines for uniform reporting of data from drowning-related resuscitation: an ILCOR advisory statement. Resuscitation. 2017; 118: 147-158.

[4] Krishna CK, Showkat HI, Taktani M, Khatri V. Out of hospital cardiac arrest resuscitation outcome in North India - CARO study. World Journal of Emergency Medicine. 2017; 8: 200-205.

[5] Monsieurs KG, Nolan JP, Bossaert LL, Greif R, Maconochie IK, Nikolaou NI, et al. European Resuscitation Council Guidelines for resuscitation 2015: section 1. Executive summary. Resuscitation. 2015; 95: 1-80.

[6] Neumar RW, Shuster M, Callaway CW, Gent LM, Atkins DL, Bhanji F, et al. Part 1: executive summary: 2015 American Heart Association Guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015; 132: S315-S367.

[7] Sinha SS, Sukul D, Lazarus JJ, Polavarapu V, Chan PS, Neumar RW, et al. Identifying important gaps in randomized controlled trials of adult cardiac arrest treatments: a systematic review of the published literature. Circulation: Cardiovascular Quality and Outcomes. 2016; 9: 749-756.

[8] Andersen LW, Holmberg MJ, Berg KM, Donnino MW, Granfeldt A. In-hospital cardiac arrest: a review. Journal of the American Medical Association. 2019; 321: 1200-1210.

[9] Andersen LW, Holmberg MJ, Løfgren B, Kirkegaard H, Granfeldt A. Adult in-hospital cardiac arrest in Denmark. Resuscitation. 2019; 140: 31- 36.

[10] Merchant RM, Yang L, Becker LB, Berg RA, Nadkarni V, Nichol G, et al. Incidence of treated cardiac arrest in hospitalized patients in the United States. Critical Care Medicine. 2011; 39: 2401-2406.

[11] Morrison LJ, Neumar RW, Zimmerman JL, Link MS, Newby LK, McMullan PW, et al. Strategies for improving survival after in-hospital cardiac arrest in the United States: 2013 consensus recommendations: a consensus statement from the American Heart Association. Circulation. 2013; 127: 1538-1563.

[12] Harrison DA, Patel K, Nixon E, Soar J, Smith GB, Gwinnutt C, et al. Development and validation of risk models to predict outcomes following in-hospital cardiac arrest attended by a hospital-based resuscitation team. Resuscitation. 2014; 85: 993-1000.

[13] Nam DJ, Kwon HW, Lee H, Ahn EK. National healthcare service and its big data analytics. Healthcare Informatics Research. 2018; 24: 247-249.

[14] Choi Y, Kwon IH, Jeong J, Chung J, Roh Y. Incidence of Adult in-hospital cardiac arrest using national representative patient sample in Korea. Healthcare Informatics Research. 2016; 22: 277-284.

[15] Kwon IH. In-hospital cardiac arrest incidence analysis using claim data in Korea. Kangwon, Republic of Korea: Graduate school, Kangwon National University. 2019.

[16] Nolan JP, Soar J, Smith GB, Gwinnutt C, Parrott F, Power S, et al. Incidence and outcome of in-hospital cardiac arrest in the United Kingdom National Cardiac Arrest Audit. Resuscitation. 2014; 85: 987-992.

[17] Thompson LE, Chan PS, Tang F, Nallamothu BK, Girotra S, Perman SM, et al. Long-term survival trends of medicare patients after in-hospital cardiac arrest: insights from get with the guidelines-resuscitation®. Resuscitation. 2018; 123: 58-64.

[18] Radeschi G, Mina A, Berta G, Fassiola A, Roasio A, Urso F, et al. Incidence and outcome of in-hospital cardiac arrest in Italy: a multicentre observational study in the Piedmont Region. Resuscitation. 2017; 119: 48- 55.

[19] Shao F, Li CS, Liang LR, Qin J, Ding N, Fu Y, et al. Incidence and outcome of adult in-hospital cardiac arrest in Beijing, China. Resuscitation. 2016; 102: 51-56.

[20] Aziz F, Paulo MS, Dababneh EH, Loney T. Epidemiology of in-hospital cardiac arrest in Abu Dhabi, United Arab Emirates, 2013-2015. Heart Asia. 2018; 10: e011029.

[21] Chan PS, Nallamothu BK, Krumholz HM, Spertus JA, Li Y, Hammill BG, et al. Long-term outcomes in elderly survivors of in-hospital cardiac arrest. New England Journal of Medicine. 2013; 368: 1019-1026.

[22] Perman SM, Stanton E, Soar J, Berg RA, Donnino MW, Mikkelsen ME, et al. Location of in-hospital cardiac arrest in the United States-variability in event rate and outcomes. Journal of the American Heart Association. 2016; 5: e003638.

[23] Tirkkonen J, Hellevuo H, Olkkola KT, Hoppu S. Aetiology of in-hospital cardiac arrest on general wards. Resuscitation. 2016; 107: 19-24.

[24] Wallmuller C, Meron G, Kurkciyan I, Schober A, Stratil P, Sterz F. Causes of in-hospital cardiac arrest and influence on outcome. Resuscitation. 2012; 83: 1206-1211.

[25] Merchant RM, Berg RA, Yang L, Becker LB, Groeneveld PW, Chan PS. Hospital variation in survival after in-hospital cardiac arrest. Journal of the American Heart Association. 2014; 3: e000400.

[26] Yun SB, Kim S, Ju S, Noh J, Kim C, Wong MS, et al. Analysis of accessibility to emergency rooms by dynamic population from mobile phone data: geography of social inequity in South Korea. PLoS ONE. 2020; 15: e0231079.

[27] Lyons PG, Edelson DP, Churpek MM. Rapid response systems. Resuscitation. 2018; 128: 191-197.

[28] Kwon J, Lee Y, Lee Y, Lee S, Park J. An algorithm based on deep learning for predicting In‐Hospital Cardiac Arrest. Journal of the American Heart Association. 2018; 7: e008678.