Heart Attacks Are Not a Death Sentence

A new study has found that survivors of cardiac arrest who received intensive care can expect long-term quality of life, and that the allocation of resources to their treatment is equally as justified as the treatment of other intensive care patient groups.

Researchers at Philipps University (Marburg, Germany) assessed the health status of patients five years after their discharge from the intensive care unit (ICU) of University Hospital Aachen (Germany), and combined it with a full economic evaluation. The study followed 354 patients admitted to the ICU with cardiac arrest. Of these, 204 died prior to discharge from the hospital, and of the 150 remaining patients, 40 died before year five, leaving 110 patients (31%) who were eligible for the survey. The total costs for the ICU treatment of all 354 patients amounted to more than EUR 6.3 million.

The researcher found that the per capita expenditure was approximately double the cost of an average ICU patient, but compared favorably to a variety of other routine interventions such as mechanical ventilation or kidney dialysis. Furthermore, patients who survived cardiac arrest did not necessarily have as bleak a prognosis as is often anticipated; the researchers found that health-related quality of life five years after discharge was only slightly lower than healthy controls of the same age and gender of the patients. The study was published on July 18, 2008, in Critical Care, a BioMed Central open access journal.

"Economic constraints create pressure to ration ICU care. Restricting the demand for futile medical services by limiting access to the ICU, at least for those patients likely to die anyway, has been proposed as a way of lowering expenditures,” said lead author of Juergen Graf, M.D., of the departments of anesthesia, and intensive care medicine and cardiovascular surgery. "Our study is the first to demonstrate that patients who survive cardiac arrest without severe neurological disabilities may expect fair long-term survival and a good quality of life for reasonable expenses to the health care system.”

The annual incidence of sudden cardiac arrest in central Europe is approximately 9 per 10,000 inhabitants. Thus, more than 600,000 people may be affected each year. Since the 1960s, immediate CPR has been considered life saving for sudden cardiac arrests; following successful CPR, patients are routinely admitted to ICUs to manage both the causes and acute sequelae. Since ICUs consume a large proportion of hospital budgets, yet care for a minority of patients, determining whether ICU admission of this population constitutes a reasonable use of resources, has become an ethical issue.


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Philipps University
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