Trends in Mortality and Healthcare Costs Associated With Ventricular Fibrillation, A Nationwide Emergency Department Study

F.Ventricular fibrillation (VF) is a life-threatening arrhythmia frequently encountered in the emergency department (ED). We examined sociodemographic characteristics, mortality trends, and healthcare costs among patients presenting with VF.

We analyzed 2016–2022 National Emergency Department Sample (NEDS) data for adults aged ≥18 years presenting with VF, identified using International Classification of Diseases codes. Survey-weighted analyses generated national estimates of patient demographics, comorbidities, hospital characteristics, disposition outcomes, mortality trends, and ED and inpatient charges. We also compared mortality during COVID-19 (2020-2022) versus pre-COVID-19 era (2016-2019).

An estimated 496,481 VF cases were identified. Mean age was 64 ± 14.7 years, and 67.5% were male. ED charges increased by 59.3%, from $4,867 in 2016 to $7,753 in 2022, while combined ED and inpatient charges rose by 36.9%, from $153,438 to $210,017. ED charges increased by $453 annually, and combined charges by $9,300 annually. Patients in the lowest income quartile accounted for the highest proportion of cases (30.1%), while the highest income quartile accounted for the fewest (19.7%). Overall survival was 58.5%. Among deaths, 80.7% occurred after inpatient admission. Mortality was significantly higher during the COVID-19 period compared with the pre–COVID-19 period (43.8% vs 39.5%; RR 1.11, 95% CI 1.08–1.14; p < 0.0001). In survey-weighted trend analyses, the odds of overall mortality increased significantly over time (RR per year 1.02, 95% CI 1.02–1.03; p < 0.0001). This increase was driven primarily by rising inpatient mortality (RR per year 1.02, 95% CI 1.02–1.03; p < 0.0001), while ED mortality remained stable across the study period (OR per year 1.01, 95% CI 0.99–1.03; p = 0.48).

Survival among ED patients with VF declined over time, driven by rising inpatient mortality despite stable ED mortality. Healthcare costs increased substantially, with a disproportionate burden among lower-income patients. These findings highlight the growing clinical and economic impact of VF and the need for targeted interventions.