Temporal Changes in the Racial Gap in Survival After In-Hospital Cardiac Arrest

Joseph, Lee; Chan, Paul S.; Bradley, Steven M; Zhou, Yunshu; Graham, Garth; Jones, Philip G.; Vaughan-Sarrazin, Mary; Girotra, Saket

doi:10.1001/jamacardio.2017.2403

Cited by 25 publications

(24 citation statements)

References 33 publications

(55 reference statements)

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“…4 AA patients were also less likely to survive in-hospital sudden cardiac arrests based on cardiac and resuscitation registry data, although the differences in survival have decreased during the past 5 years. 9,21 These studies were focused on describing incidence and survival of sudden cardiac arrest, but could not evaluate the reasons for the race differences.…”

Section: Discussionmentioning

confidence: 99%

“…[4][5][6][7][8] In addition, in some but not all studies, survival from sudden cardiac arrest is worse in AAs compared with Whites. [9][10][11] The association between race and SCD has been further examined in clinical studies of participants with pre-existing conditions, such as hypertension. 12 Nevertheless, the racial differences in the cumulative risk of SCD and the reasons for these differences have not been assessed in large-scale community-based cohorts.…”

Section: Introductionmentioning

confidence: 99%

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Racial Differences in Sudden Cardiac Death

et al. 2019

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Background: African Americans (AAs) have a higher incidence of out-of-hospital sudden cardiac death (SCD) compared with Whites. However, the racial differences in the cumulative risk of SCD and the reasons for these differences have not been assessed in large-scale communitybased cohorts. The objective of this study is to compare the lifetime cumulative risk of SCD among AAs and Whites, and to evaluate the risk factors that may explain racial differences in SCD risk in the general population. Methods: Cohort study of 3,832 AAs and 11,237 Whites participating in the Atherosclerosis Risk in Communities (ARIC) Study. Race was self-reported. SCD was defined as a sudden pulseless condition from a cardiac cause in a previously stable individual and SCD cases were adjudicated by an expert committee. Cumulative incidence was computed using competing risk models. Potential mediators included demographic and socioeconomic factors, cardiovascular risk factors, presence of coronary heart disease and electrocardiographic parameters as time-varying factors.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Racial Differences in Sudden Cardiac Death

et al. 2019

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“…86 Studies that investigated the relationship between race and outcomes have found black and Hispanic patients to have lower rates of neurological recovery and survival following in-hospital cardiac arrest compared with white patients. 47,87 Data from the GWTG-R registry have shown that racial disparities in outcomes have narrowed over time, with a reported absolute survival difference between black and white patients of 4.5% in 2000 and 1.8% in 2014. 87 Differing distribution of risk factors 88 or variability in patient- and hospital-level care during and after cardiac arrest may explain why these racial differences exist.…”

Section: Resultsmentioning

confidence: 99%

In-Hospital Cardiac Arrest

Andersen

Holmberg

Berg

et al. 2019

JAMA

596

535

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IMPORTANCE In-hospital cardiac arrest is common and associated with a high mortality rate. Despite this, in-hospital cardiac arrest has received little attention compared with other high-risk cardiovascular conditions, such as stroke, myocardial infarction, and out-of-hospital cardiac arrest. OBSERVATIONS In-hospital cardiac arrest occurs in over 290 000 adults each year in the United States. Cohort data from the United States indicate that the mean age of patients with in-hospital cardiac arrest is 66 years, 58% are men, and the presenting rhythm is most often (81%) nonshockable (ie, asystole or pulseless electrical activity). The cause of the cardiac arrest is most often cardiac (50%-60%), followed by respiratory insufficiency (15%-40%). Efforts to prevent in-hospital cardiac arrest require both a system for identifying deteriorating patients and an appropriate interventional response (eg, rapid response teams). The key elements of treatment during cardiac arrest include chest compressions, ventilation, early defibrillation, when applicable, and immediate attention to potentially reversible causes, such as hyperkalemia or hypoxia. There is limited evidence to support more advanced treatments. Post–cardiac arrest care is focused on identification and treatment of the underlying cause, hemodynamic and respiratory support, and potentially employing neuroprotective strategies (eg, targeted temperature management). Although multiple individual factors are associated with outcomes (eg, age, initial rhythm, duration of the cardiac arrest), a multifaceted approach considering both potential for neurological recovery and ongoing multiorgan failure is warranted for prognostication and clinical decision-making in the Post–cardiac arrest period. Withdrawal of care in the absence of definite prognostic signs both during and after cardiac arrest should be avoided. Hospitals are encouraged to participate in national quality-improvement initiatives. CONCLUSIONS AND RELEVANCE An estimated 290 000 in-hospital cardiac arrests occur each year in the United States. However, there is limited evidence to support clinical decision making. An increased awareness with regard to optimizing clinical care and new research might improve outcomes.

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“…10 Despite the publication of these strategies, inequalities in morbidity and mortality rates between black patients and white patients still persist following AMI. 10,11 …”

Section: Introductionmentioning

confidence: 99%

Racial Disparities in Patient Characteristics and Survival After Acute Myocardial Infarction

et al. 2018

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Key PointsQuestionDoes race serve as a surrogate for socioeconomic and clinical factors, and, after adjusting for those factors, do long-term mortality rates differ between black patients and white patients following acute myocardial infarction?FindingsIn this cohort study of 6402 patients from 2 acute myocardial infarction registries, self-identified black patients and white patients differed in several clinical and socioeconomic characteristics. The higher the prevalence of characteristics associated with being a black patient, the higher the 5-year mortality rate, but no differences were observed between black patients and white patients with similar characteristics.MeaningA greater prevalence of characteristics associated with black race, but not race itself, was associated with higher mortality risk after acute myocardial infarction.

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Temporal Changes in the Racial Gap in Survival After In-Hospital Cardiac Arrest

Cited by 25 publications

References 33 publications

Racial Differences in Sudden Cardiac Death

Racial Differences in Sudden Cardiac Death

In-Hospital Cardiac Arrest

Racial Disparities in Patient Characteristics and Survival After Acute Myocardial Infarction

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