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Black Patients have lower Rate of Survival after
In-Hospital Cardiac Arrest
Newswise — Compared with white patients,
black patients who have an in-hospital
cardiac arrest are significantly less likely
to survive to hospital discharge, having
lower rates of successful resuscitation and
postresuscitation survival, although much of
this survival difference was associated with
the hospital in which black patients
received care, according to a study in the
September 16 issue of JAMA.
“Survival following in-hospital cardiac
arrest represents a unique opportunity to
examine racial disparities in medical care
and outcomes.
" In-hospital
cardiac arrest is an emergency condition
tightly linked to processes of care and for
which there is little debate regarding
clinical appropriateness of treatment in
eligible patients,” according to background
information in the article.
“Racial differences in survival have not
been previously studied after in-hospital
cardiac arrest, an event for which access to
care is not likely to influence treatment.”
Paul S. Chan, M.D., M.Sc., of Saint Luke’s
Mid America Heart Institute, Kansas City,
Mo., and colleagues used data from the
National Registry of Cardiopulmonary
Resuscitation (NRCPR) to examine whether
racial differences exist in survival for
patients with in-hospital cardiac arrest.
The study included 10,011 patients from 274
hospitals who underwent defibrillation for a
cardiac arrest.
The average age in the study population was
67 years, 6,021 were men (60.1 percent), and
1,883 were black (18.8 percent).
Several patient and hospital factors
differed by race, including white cardiac
arrest patients being older and more likely
to be male; black patients were more likely
to have ventricular fibrillation as their
initial presenting arrest rhythm, were
sicker at the time of cardiac arrest (higher
rates of renal insufficiency, diabetes
mellitus, central nervous system depression,
acute stroke, pneumonia, sepsis, major
trauma, and requirement for hemodialysis),
and were more likely to be admitted to a
hospital unit not monitored, to a hospital
with greater than 500 beds, and in the
southeastern United States.
The researchers found that black patients
had a 27 percent lower overall rate, and a
12 percent lower absolute rate, of survival
to hospital discharge, compared with white
patients.
“These unadjusted survival differences by
race were, in large part, attributable to
black patients being more likely to receive
treatment at hospitals with worse outcomes.”
These differences narrowed after adjusting
for patient characteristics and for the
hospital to which the patient was admitted.
“However, further adjustment for hospital
process variables did not meaningfully
[diminish] residual differences, and black
patients remained 10 percent less likely to
survive to hospital discharge,” the authors
note.
“Lower rates of survival to discharge for
blacks reflected lower rates of both
successful resuscitation (55.8 percent vs.
67.4 percent for whites) and
postresuscitation survival (45.2 percent vs.
55.5 percent for whites),” they write.
“The
racial difference in postresuscitation
survival was eliminated after multivariable
adjustment, and was largely explained by the
hospital site at which patients received
postresuscitation care.”
“Collectively, these findings suggest that
strategies to eliminate racial disparities
in survival after in-hospital cardiac arrest
are not likely to succeed unless they are
accompanied by successful identification and
implementation of interventions that improve
resuscitation survival in those poorly
performing hospitals in which black patients
are more likely to receive care.”
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