Cost Study Raises Questions on Revival of the Seriously Ill

For the first time, doctors have put a price tag on the extraordinary measures used to resuscitate seriously ill patients who suffer cardiac arrest in a hospital, raising ethical questions about whether the efforts are worth the cost.

An average of $161,000 is spent to care for each patient whose heart stops beating while hospitalized and survives to be discharged, according to results released Tuesday by researchers at the Duke University Medical Center in North Carolina.

The high costs prompted the researchers to call for better pre-hospital counseling of patients and for further study to better determine which patients are likely to benefit from heart resuscitation.

“All we suggest is that in the counseling of patients, keep in mind that it’s a costly procedure,” said Dr. Christopher M. O’Connor, a cardiologist at the center.

At the American College of Cardiology’s scientific sessions at the Anaheim Convention Center, O’Connor said that once the resuscitation procedure is begun in the hospital, it triggers a medical avalanche of costly care.

“It’s like a house of cards, and it collapses,” he said.

The high cost of the care, which doesn’t include doctor’s fees, means that whenever possible doctors should discuss hospital care with their patients while their patients are well enough to make an informed decision about it, he said.

“I think the best time to do the counseling is when the patient is healthy, in the office,” O’Connor said. “Some patients are very comfortable talking about this . . . some say that if something happened, let nature take its course.”

During cardiac arrest, the heart stops beating and the person stops breathing. If not revived immediately with cardiopulmonary resuscitation, the patient dies.

Dr. Mark Thel, a cardiology researcher at the Duke University center and one of the study’s authors, said that 60% of the 146 patients they studied had been successfully revived, but only seven left the hospital alive. He said five of the seven were still alive and doing well three years later.

Underlying problems such as cancer, infection, or kidney or immune system failure were the main reasons for death, he said. Because resuscitating patients costs so much, and most of the patients who survive the procedure live only briefly and usually on life support, Thel said further research should identify those patients for whom the procedure is worthwhile.

Dr. Leslie Blackhall, a professor of medicine at the USC Medical School and a researcher in medical ethics at the Pacific Center for Health Policy and Research, said that patients who suffer cardiac arrest in hospitals are usually unconscious after resuscitation and function only with the help of medical technology such as ventilators.

“It’s an uncomfortable way to die, so for that reason alone people should be thinking about whether they want this technique,” she said. “Here’s the rare case where financial interest and best interest converge.

“If people are not going to benefit, and will suffer, and it’s going to be expensive,” she said, “let’s cut the health care that does no good and injures people, instead of cutting the health care that benefits people.”