The first documented cardiac arrest rhythm in hospitalized patients with heart failure

Patients with heart failure (HF) have abnormal cellular anatomy and myocardial mechanics that may impact the initial rhythm and subsequent outcomes in cardiac arrest (CA).

Patients with pre-existing HF are less likely to have ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT) as the first documented rhythm in CA and have poorer survival than patients without pre-existing HF.

Identify the first documented cardiac arrest rhythm (FDR) in hospitalized patients with and without a pre-existing history of HF.

We evaluated 60,389 consecutive, adult, index, pulseless CA events with documented initial rhythm in the National Registry of Cardiopulmonary Resuscitation. The primary endpoint was the FDR in patients with and without a history of pre-existing HF. Secondary endpoints were return of spontaneous circulation (ROSC), survival to discharge, and neurological outcome.

Thirty three percent of patients had a pre-existing diagnosis of HF. HF patients were more likely to have VF/pVT (25.9 vs. 23.2%) and less likely to have asystole (34.4 vs. 35.3%, p=<.0001) than non-HF. There was no difference in survival to discharge (18.3 vs. 18.2%, p=.66), or good neurological outcomes (82.2 vs. 83.2%, p=.23) between the groups. Women were less likely to have VF/pVT as the first documented rhythm in both HF and non-HF groups.

Hospitalized patients with HF are more likely than those without HF to have VF/pVT as the FDR in CA, however the clinical magnitude of this difference is small. Overall survival and neurological outcomes are no different than hospitalized arrest patients without HF.