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Survival rates after in-hospital cardiac arrest improve for black patients
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The rate of survival after in-hospital cardiac arrest improved over time, especially in black patients, reducing racial differences, according to a study published in JAMA Cardiology.
Lee Joseph, MD, MS , of the division of cardiovascular diseases at the University of Iowa Carver College of Medicine in Iowa City, and colleagues reviewed data from 112,139 patients with in-hospital cardiac arrest who received CPR from 2000 to 2014. The group comprised black (n = 30,241; mean age, 62 years) and white patients (n = 81,898; mean age, 68 years).
Survival through resuscitation
Survival to hospital discharge was the primary outcome. Secondary outcomes were postresuscitation survival and acute resuscitation survival. Resuscitation quality measures were also evaluated as secondary outcomes, including a monitored cardiac arrest event, confirmation of correct endotracheal tube placement, time to first defibrillation of 2 minutes or less, time to first chest compression of 1 minute or less and administration of vasopressin or epinephrine within 5 minutes.
Mechanisms of improvement were reviewed, such as the underlying mechanism of survival improvement, temporal trends in rates of defect-free care and improvement in acute resuscitation survival, postresuscitation survival or both. Hospitals were also classified by the proportion of black patients who were treated.
Risk-adjusted survival improved in white patients from 15.8% in 2000 to 23.2% in 2014 (P for trend < .001). This improvement was also seen in black patients from 2000 (11.3%) to 2014 (21.4%; P for trend < .001). Black patients had a greater survival improvement on both an absolute (P for trend = .02) and relative scale (P for interaction = .01), according to the data.
From 2000 to 2014, acute resuscitation survival increased in black (from 44.7% to 64.1%) and white patients (from 47.1% to 64%; P for trend for both < .001), but to a greater degree in black patients (P for interaction < .001), according to Joseph and colleagues.
There was a similar magnitude of improvement for defect-free care from 2000 to 2014 among black (from 68.9% to 79.5%) and white patients (from 73.3% to 79.6%; P for trend for both groups < .001; P for interaction = .26), the researchers wrote.
Hospital improvements
Hospitals with a higher proportion of black patients had a greater increase in overall risk-adjusted survival (11.9% to 21.2%) compared with those with a lower proportion of black patients (16.7% to 23.4%), the researchers wrote.
“Although survival improved at both hospital groups over time, survival increases were larger at hospitals with a higher proportion of black patients than at hospitals with a lower proportion of black patients, suggesting that reductions in racial differences over time were mediated, at least in part, by greater improvement in survival outcomes at hospitals that disproportionately serve black patients with cardiac arrest,” Joseph and colleagues wrote.
In a related editorial, Myron L. Weisfeldt, MD, university distinguished service professor and professor of medicine at Johns Hopkins University School of Medicine, and Lance B. Becker, MD, FAHA, chair and professor of emergency medicine at Hofstra Northwell School of Medicine in Hempstead, New York, wrote: “Despite the well-known limitations in generalizability of the [Get With the Guidelines] data, it is good news that rates of survival from in-hospital cardiac arrest have become identical for black and white individuals while overall survival has increased in both groups. The exact mechanism for this improvement remains unclear and should be a priority for research in the coming decade.” – by Darlene Dobkowski
Disclosures: Becker, Joseph and Weisfeldt report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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