External validation and insights about the calibration of the return of spontaneous circulation after cardiac arrest (RACA) score

Antidepressant use, but not polypharmacy, is associated with worse outcomes after in-hospital cardiac arrest in older people

BACKGROUND

It is already known that age and some chronic diseases are associated with worse outcomes after in-hospital cardiac arrest (IHCA). Usually, patients with two or more chronic diseases are treated with multiple medicines, which is commonly referred as polypharmacy (five or more medications). The objective of this study was to evaluate the association between polypharmacy and antidepressant use before hospital admission with return of spontaneous circulation (ROSC) and in-hospital mortality in IHCA.

METHODS

This retrospective study included patients over 18 years of age with IHCA, attended by the rapid response team in hospital wards, from March 2018 to September 2023. The exclusion criteria were the absence of information regarding polypharmacy, pregnancy, and the presence of an express "do-not-resuscitate order". Data were collected from the electronic medical records.

RESULTS

A total of 578 patients with IHCA were evaluated; 42 patients were excluded due to the absence of information regarding polypharmacy and 24 due to "natural death permission". Thus, we included 512 patients in the analysis. The mean age was 64.4 ± 14.9 years; 52.3% were male, and 54.5% were older people. Polypharmacy was prescribed for 50.8% of patients, 48.4% had ROSC, and in-hospital mortality was 92.0%. In logistic regression models, the polypharmacy regimen use in the older population was not associated with ROSC (odds ratio [OR]: 1.122; 95% confidence interval [CI]: 0.660-1.906; p: 0.672) or mortality (OR: 1.185; 95% CI: 0.170-8.260; p: 0.864). Regarding antidepressant use, it was associated with lower rates of ROSC (OR: 0.412; 95% CI: 0.183-0.925; p: 0.032) but was not associated with mortality in older people (OR: 1.682; 95% CI: 0.129-21.996; p: 0.692).

CONCLUSIONS

In conclusion, polypharmacy regimen was not associated with ROSC and in-hospital mortality; however, antidepressant use was associated with lower rates of ROSC only in older patients.