Out-of-hospital cardiac arrest survival rates remain below pre-pandemic levels
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Key takeaways:
- U.S. out-of-hospital cardiac arrest survival rates have improved since 2020, the first year of the COVID-19 pandemic.
- However, survival rates have not returned to pre-pandemic levels.
CHICAGO — U.S. out-of-hospital cardiac arrest survival rates have improved since the first year of the COVID-19 pandemic, but have not returned to pre-pandemic levels, researchers reported.
“The onset of the COVID-19 pandemic marked an abrupt change in health care delivery systems and imposed a substantial stress on frontline providers. Initial studies during the early phases of the pandemic showed that survival after out-of-hospital cardiac arrest had substantially worsened and largely eroded the survival gains that we had experienced during the past decade,” Eric Hall, MD, a cardiology fellow at UT Southwestern Medical Center, who presented the findings at the American Heart Association Scientific Sessions, told Healio. “Now that COVID-19 is no longer the health care emergency that it was in 2020, we wanted to understand how survival patterns for out-of-hospital cardiac arrest have changed during these years. Specifically, we were interested in determining whether the initial decline in survival with the onset of the pandemic was larger in majority Black or Hispanic communities; whether survival rates have returned back to baseline levels; and if these changes since 2020 were similar across all community types.”
Hall and colleagues analyzed data from 485,079 patients with nontraumatic out-of-hospital cardiac arrest (mean age, 62 years; 64% men; 22% Black; 7% Hispanic) included in the Cardiac Arrest Registry to Enhance Survival (CARES) registry from 2015 to 2022.
The researchers found that risk-adjusted survival rates to hospital discharge fell from 10.1% in 2015-2019 to 8.4% in 2020 (P < .0001).
The relative decrease was similar between predominantly Black and Hispanic communities (–17.2%), predominantly white communities (–17.5%) and integrated communities (–16.8%), according to the researchers.
Risk-adjusted survival rates to hospital discharge improved in 2021 (8.7%) and 2022 (8.9%) but did not return to pre-pandemic levels, Hall and colleagues found.
In 2022, compared with the pre-pandemic years, survival in majority Black and Hispanic communities was 9.7% lower, whereas it was 10.9% lower in integrated communities and 13.6% lower in predominately white communities, the researchers found.
In every time period, survival rates were lower in predominantly Black and Hispanic communities than in predominantly white communities, according to the researchers.
“The initial decline in survival after out-of-hospital cardiac arrest in 2020 was larger in majority Black or Hispanic communities. During 2021 and 2022, overall survival ... remained below where it was before the onset of COVID-19 pandemic,” Hall told Healio. “Although survival improvement after the onset of the pandemic in majority Black and Hispanic communities was larger than in white communities, survival rates in majority Black and Hispanic communities still remained lower at all time points.”
Hall also said “disparities in cardiac arrest survival are likely multifaceted. We know from prior studies that rates of lifesaving bystander CPR are lower in Black and Hispanic individuals, and this may be due in part to limited access and cost of CPR training. Additional barriers include quality and responsiveness of 911 emergency services, language barriers, and limited community investment and resources.”
The ongoing RED-CASO study, in which researchers are visiting emergency medical services (EMS) agencies with high rates of out-of-hospital cardiac arrest survival, has a goal “to better understand how these EMS agencies overcome barriers that most other agencies working in such communities face, and identify best practices for improving cardiac arrest survival and reducing disparities,” Hall told Healio. “We believe that efforts are needed to strengthen every step in the chain of survival for cardiac arrest in all communities, from improving community health (and preventing cardiac arrest), to ensuring that people in the community are trained to perform CPR, to improving hospital care and recovery of cardiac arrest patients.”
For more information:
Eric Hall, MD, can be reached at eric.hall@utsouthwestern.edu.
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Hall E, et al. Abstract Mo2101. Presented at: American Heart Association Scientific Sessions; Nov. 16-18, 2024; Chicago.
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