Incidence of out of hospital cardiac arrest with ethnic disparities in the Wellington region

Abstract Background Variation exists in outcomes following out‐of‐hospital cardiac arrest (OHCA), but whether racial and ethnic disparities exist in post‐arrest provision of targeted temperature management (TTM) is unknown. Methods and Results We performed a retrospective analysis of a prospectively collected cohort of patients who survived to admission following OHCA from the Cardiac Arrest Registry to Enhance Survival, whose catchment area represents ~50% of the United States from 2013‐2019. Our primary exposure was race/ethnicity and primary outcome was utilization of TTM. We built a mixed‐effects model with both state of arrest and admitting hospital modeled as random intercepts to account for clustering. Among 96,695 patients (24.6% Black, 8.0% Hispanic/Latino, 63.4% White), a smaller percentage of Hispanic/Latino patients received TTM than Black or White patients (37.5% vs. 45.0 % vs 43.3%, P < .001) following OHCA. In the mixed‐effects model, Black patients (Odds Ratio [OR] 1.153, 95% Confidence Interval [CI] 1.102‐1.207, P < .001) and Hispanic/Latino patients (OR 1.086, 95% CI 1.017‐1.159, P < .001) were slightly more likely to receive TTM compared to White patients, perhaps due to worse admission neurological status. We did find community level disparity as Hispanic/Latino‐serving hospitals (defined as the top decile of hospitals that cared for the highest proportion of Hispanic/Latino patients) provided less TTM (OR 0.587, 95% CI 0.474 to 0.742, P < .001). Conclusions Reassuringly, we did not find evidence of intrahospital or interpersonal racial or ethnic disparity in the provision of TTM. However, we did find inter‐hospital, community level disparity. Hispanic/Latino‐serving hospitals provided less guideline‐recommended TTM after OHCA.

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Persistent Racial/Ethnic Disparities in Out-of-Hospital Cardiac Arrest

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2021.04.020 ◽

2021 ◽

Vol 78 (2) ◽

pp. 314-316

Author(s):

Aditya C. Shekhar ◽

Christopher Mercer ◽

Robert Ball ◽

Ira Blumen

Keyword(s):

Cardiac Arrest ◽

Ethnic Disparities ◽

Racial Ethnic ◽

Hospital Cardiac Arrest

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Abstract 13193: Hispanics/Latinos Lack Access to Hospitals With Therapeutic Hypothermia Programs Following Out-of-Hospital Cardiac Arrest

Circulation ◽

10.1161/circ.144.suppl_2.13193 ◽

2021 ◽

Vol 144 (Suppl_2) ◽

Author(s):

Nicholas Morris ◽

Michael Mazzeffi ◽

Patrick McArdle ◽

Teresa May ◽

Greer Waldrop ◽

...

Keyword(s):

Cardiac Arrest ◽

Hospital Admission ◽

Therapeutic Hypothermia ◽

Secondary Analysis ◽

Ethnic Disparities ◽

The United States ◽

Black Patients ◽

To Receive ◽

Racial Ethnic ◽

Hospital Cardiac Arrest

Introduction: Variation exists in outcomes following out-of-hospital cardiac arrest (OHCA), but whether racial/ethnic disparities exist in post-arrest provision of therapeutic hypothermia (TH) is unknown. Hypothesis: Racial/ethnic disparities exist in the utilization of guideline-recommended TH following OHCA. Methods: We performed a retrospective analysis of a cohort of 96,695 patients who survived to hospital admission following OHCA from the Cardiac Arrest Registry to Enhance Survival, whose catchment area represents ~40% of the United States, from 2013 through 2019. Our primary exposure was race/ethnicity, and the primary outcome was utilization of TH. We performed a secondary analysis to assess for racial/ethnic disparities in the reasons why TH was not used (supplemental data element data available since 2016). Results: Among 96,695 patients [mean (SD) age 61.4 (16.3) years, 24.6% Black, 8.0% Hispanic/Latino, 63.4% White] that survived to hospital admission following OHCA, 54,687 (56.6%) did not receive TH. Using a mixed-effects model that adjusted for patient, arrest, neighborhood, and hospital factors with state of arrest modeled as a random intercept to account for clustering, we found that Hispanics/Latinos were less likely to receive TH than Whites (Odds Ratio [OR] 0.79, 95 % Confidence Interval [CI] 0.75-0.83). When the clustering variable was changed from the state of arrest to the admitting hospital, Hispanics/Latinos were more likely to receive TH (OR 1.07, 95% CI 1.00 to 1.14). In the 22,896 patients with data regarding why they did not receive TH, a higher percentage of Hispanics/Latinos compared to Blacks and Whites did not receive TH due to lack of a TH program at the hospital (4.0% vs. 2.5 % vs 1.8%, p < .001). No disparity in TH utilization was found for Black patients. Conclusion: We found disparities in access to TH for Hispanics/Latinos following OHCA. Reassuringly, we did not find any disparity in TH utilization for Black patients.

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Treatment and survival following in-hospital cardiac arrest: does patient ethnicity matter?

European Journal of Cardiovascular Nursing ◽

10.1093/eurjcn/zvab079 ◽

2021 ◽

Author(s):

Jens Agerström ◽

Magnus Carlsson ◽

Anders Bremer ◽

Johan Herlitz ◽

Araz Rawshani ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Middle Eastern ◽

Ethnic Disparities ◽

Great Majority ◽

Heart Rhythm ◽

Hospital Staff ◽

Registry Study ◽

The Impact ◽

Hospital Cardiac Arrest

Abstract Aims Previous research on racial/ethnic disparities in relation to cardiac arrest has mainly focused on black vs. white disparities in the USA. The great majority of these studies concerns out-of-hospital cardiac arrest (OHCA). The current nationwide registry study aims to explore whether there are ethnic differences in treatment and survival following in-hospital cardiac arrest (IHCA), examining possible disparities towards Middle Eastern and African minorities in a European context. Methods and results In this retrospective registry study, 24 217 patients from the IHCA part of the Swedish Registry of Cardiopulmonary Resuscitation were included. Data on patient ethnicity were obtained from Statistics Sweden. Regression analysis was performed to assess the impact of ethnicity on cardiopulmonary resuscitation (CPR) delay, CPR duration, survival immediately after CPR, and the medical team’s reported satisfaction with the treatment. Middle Eastern and African patients were not treated significantly different compared to Nordic patients when controlling for hospital, year, age, sex, socioeconomic status, comorbidity, aetiology, and initial heart rhythm. Interestingly, we find that Middle Eastern patients were more likely to survive than Nordic patients (odds ratio = 1.52). Conclusion Overall, hospital staff do not appear to treat IHCA patients differently based on their ethnicity. Nevertheless, Middle Eastern patients are more likely to survive IHCA.

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