Substantial hospital-to-hospital variation exists in postresuscitation survival, and greater hospital-based community social deprivation is associated with worse postresuscitation outcomes at the patient level.
Overall survival to discharge among patients with IHCA and sustained return of spontaneous circulation was 34.7%.
Postresuscitation risk-standardized survival rates varied substantially across hospitals, ranging from 25.0% to 44.8%.
Patients from hospitals in the least socially deprived communities had significantly higher postresuscitation risk-standardized survival than those in the most deprived communities.
Hospitals in higher Social Deprivation Index quartiles had higher proportions of early postresuscitation fever and death.
The postresuscitation phase of care is identified as a key driver of stagnant IHCA outcomes despite improvements in acute resuscitation survival.
This research examined what happens to patients after their heart restarts following a cardiac arrest while they are in the hospital. Using data from over 200,000 patients across 755 hospitals collected between 2001 and 2024, the study found that about 35% of patients whose hearts were successfully restarted ultimately survived to leave the hospital. Importantly, the chances of survival after the heart restart varied enormously depending on which hospital a patient was in — from as low as 25% at some hospitals to nearly 45% at others — suggesting that what happens in the hours and days after resuscitation matters greatly and differs significantly across institutions. The study also found that the social and economic conditions of the community surrounding a hospital were linked to patient outcomes. Patients treated at hospitals located in less economically disadvantaged areas had about 13% higher odds of surviving compared to those at hospitals in the most disadvantaged communities. Hospitals in more deprived communities also had higher rates of early fever after resuscitation, which is a known complication associated with worse outcomes. The relationship between deprivation and survival was not perfectly linear across all levels of deprivation, suggesting the dynamics are complex. This research suggests that the period of care after the heart is restarted — called post-resuscitation care — is an important and underappreciated opportunity to improve survival. While the science of restarting the heart has advanced considerably, the care delivered afterward has not improved at the same rate. The findings also highlight that social inequities may extend into the hospital setting, with patients in more economically disadvantaged communities receiving or experiencing lower quality post-resuscitation care. These results point to the need for targeted quality improvement efforts focused on post-resuscitation care, particularly in resource-limited or high-deprivation hospital settings.
Andrea L, Butler T, Moskowitz A. (2026). Survival After In-Hospital Cardiac Arrest and Return of Spontaneous Circulation: An Exploration of Outcome Variation and Relationship to Hospital Area Social Deprivation.. Journal of the American Heart Association. https://doi.org/10.1161/JAHA.126.049291