In the Journals

Long-term survival after in-hospital cardiac arrest varies by race

Black patients who survived in-hospital cardiac arrest were less likely to survive long-term compared with white patients, and about half of the difference was not explained by patient treatments or factors after the event, according to a study published in Circulation.

“Notably, black patients were less likely to have had a heart attack during hospital admission or a prior history of heart attack,” Lena M. Chen, MD, MS, assistant professor of internal medicine at University of Michigan in Ann Arbor, said in a press release. “As a result, they were more likely to have a nonshockable initial heart rhythm of pulseless electrical activity and to have experienced their heart stoppage in an unmonitored hospital unit.”

Researchers analyzed data from 8,764 patients (13% black) aged 65 years and older from the Get With the Guidelines-Resuscitation registry who survived an in-hospital cardiac arrest between 2000 and 2012. Data from this registry included hospital paging logs, resuscitation documentation, pharmacy and billing records and checks of code carts, all of which were linked to Medicare claims data.

The primary outcome was survival after discharge at 1 year from the index hospitalization for cardiac arrest. The secondary outcomes of interest were 3- and 5-year survival.

Black patients were more likely to be women, younger and sicker with more comorbidities, in addition to being less likely to have a shockable initial cardiac arrest rhythm and to be evaluated with coronary angiography after the initial resuscitation. These patients were less likely to be discharged home and more likely to have at least a moderate amount of neurological disability.

After adjusting for the hospital site, black patients had a lower rate of 1-year (43.6% vs. 60.2%; RR = 0.72; 95% CI, 0.67-0.78), 3-year (31.6% vs. 45.3%; RR = 0.71; 95% CI, 0.63-0.79) and 5-year survival (23.5% vs. 35.4%; RR = 0.67; 95% CI, 0.57-0.78) compared with white patients.

Adjustment for patient factors showed the explanation for 29% of racial differences in 1-year survival (RR = 0.8; 95% CI, 0.75-0.86). Additional adjustment for hospital treatment factors explained an additional 17% of racial differences (RR = 0.85; 95% CI, 0.8-0.92). About one-half of the racial difference for 1-year survival was unexplained. Racial differences for 3- and 5-year survival were similar when patient and hospital factors were taken into consideration.

“This finding suggests a need to examine whether racial differences in post-discharge care explain a substantial proportion of racial differences in long-term survival after in-hospital cardiac arrest,” Chen and colleagues wrote. “Such work would help inform efforts to reduce racial disparities in long-term survival for patients with in-hospital cardiac arrest.” – by Darlene Dobkowski

Disclosures: Chen reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

Black patients who survived in-hospital cardiac arrest were less likely to survive long-term compared with white patients, and about half of the difference was not explained by patient treatments or factors after the event, according to a study published in Circulation.

“Notably, black patients were less likely to have had a heart attack during hospital admission or a prior history of heart attack,” Lena M. Chen, MD, MS, assistant professor of internal medicine at University of Michigan in Ann Arbor, said in a press release. “As a result, they were more likely to have a nonshockable initial heart rhythm of pulseless electrical activity and to have experienced their heart stoppage in an unmonitored hospital unit.”

Researchers analyzed data from 8,764 patients (13% black) aged 65 years and older from the Get With the Guidelines-Resuscitation registry who survived an in-hospital cardiac arrest between 2000 and 2012. Data from this registry included hospital paging logs, resuscitation documentation, pharmacy and billing records and checks of code carts, all of which were linked to Medicare claims data.

The primary outcome was survival after discharge at 1 year from the index hospitalization for cardiac arrest. The secondary outcomes of interest were 3- and 5-year survival.

Black patients were more likely to be women, younger and sicker with more comorbidities, in addition to being less likely to have a shockable initial cardiac arrest rhythm and to be evaluated with coronary angiography after the initial resuscitation. These patients were less likely to be discharged home and more likely to have at least a moderate amount of neurological disability.

After adjusting for the hospital site, black patients had a lower rate of 1-year (43.6% vs. 60.2%; RR = 0.72; 95% CI, 0.67-0.78), 3-year (31.6% vs. 45.3%; RR = 0.71; 95% CI, 0.63-0.79) and 5-year survival (23.5% vs. 35.4%; RR = 0.67; 95% CI, 0.57-0.78) compared with white patients.

Adjustment for patient factors showed the explanation for 29% of racial differences in 1-year survival (RR = 0.8; 95% CI, 0.75-0.86). Additional adjustment for hospital treatment factors explained an additional 17% of racial differences (RR = 0.85; 95% CI, 0.8-0.92). About one-half of the racial difference for 1-year survival was unexplained. Racial differences for 3- and 5-year survival were similar when patient and hospital factors were taken into consideration.

“This finding suggests a need to examine whether racial differences in post-discharge care explain a substantial proportion of racial differences in long-term survival after in-hospital cardiac arrest,” Chen and colleagues wrote. “Such work would help inform efforts to reduce racial disparities in long-term survival for patients with in-hospital cardiac arrest.” – by Darlene Dobkowski

Disclosures: Chen reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.