Prognosis of cardiac arrest in home care clients and nursing home residents: a population-level retrospective cohort study

Aim — To evaluate the prognosis of 30-day survival post-cardiac arrest among patients receiving home care and nursing home residents.

Methods — We conducted a population-level retrospective cohort study of community-dwelling adults (≥18 years) who received cardiac arrest care at a hospital in Ontario, Canada, between 2006 to 2018. We linked population-based health datasets using the Home Care Dataset to identify patients receiving home care and the Continuing Care Reporting System to identify nursing home residents. We included both out-of-hospital and in-hospital cardiac arrests. We determined unadjusted and adjusted associations using logistic regression after adjusting for age and sex. We converted relative measures to absolute risks.

Results — Our cohort contained 86,836 individuals. Most arrests (55.5 %) occurred out-of-hospital, with 9,316 patients enrolled in home care and 2,394 residing in a nursing home. When compared to those receiving no support services, the likelihood of survival to 30-days was lower for those receiving home care (RD = −6.5; 95 %CI = −7.5 – −5.0), with similar results found within sub-groups of out-of-hospital (RD = −6.7; 95 %CI = −7.6 – −5.7) and in-hospital arrests (RD = −8.7; 95 %CI = −10.6 – −7.3). The likelihood of 30-day survival was lower for nursing home residents (RD = −7.2; 95 %CI = −9.3 – −5.3) with similar results found within sub-groups of out-of-hospital (RD = −8.6; 95 %CI = −10.6 – −5.7) and in-hospital arrests (RD = −5.0; 95 %CI = −7.8 – −2.1).

Conclusion — Patients receiving home care and nursing home residents had worse overall prognoses of survival post-cardiac arrest compared to those receiving no pre-arrest support, highlighting two medically-complex groups likely to benefit from advance care planning.