Long-term survival worse for black survivors of in-hospital cardiac arrest

July 9, 2018, American Heart Association

Blacks who survive cardiac arrest during hospitalization have lower odds of long-term survival compared with similar white survivors, according to new research in the American Heart Association's journal Circulation.

Half the difference in 1-year , however, remained unexplained. Nearly one-third of the racial difference in one-year survival was dependent on measured patient factors. Only a small proportion was explained by in hospital care and approximately one-half was due to differences in care after discharge.

Researchers studied 65 and older who suffered in-hospital cardiac arrest and survived until discharge between 2000-2011. Survivors from the Get With The Guidelines—Resuscitation registry whose data could be linked to Medicare claims were either black or white. Their survival was studied at 1-year, 3-year and 5-year intervals.

"Compared with white patients, blacks had substantially lower 1-year, 3-year and 5-year survival rates with 28 percent lower relative likelihood of surviving one year and a 33 percent lower relative likelihood of surviving to five years," said the study's lead author Lena Chen, M.D., M.S., assistant professor of internal medicine at the University of Michigan in Ann Arbor.

The black patients in this study were younger, more often female, and were sicker, with higher rates of kidney and respiratory insufficiency, pneumonia, and more often required dialysis prior to cardiac arrest, compared to studied.

"Notably, black patients were less likely to have had a attack during hospital admission or a prior history of heart attack. As a result, they were more likely to have a non-shockable initial heart rhythm of pulseless electrical activity and to have experienced their heart stoppage in an unmonitored hospital unit," Chen said.

The study did not look into how caregivers may have been different for versus white ones, nor did it look at socioeconomic factors like household income or social support.

"Our study's findings suggest a need to examine to what degree differences in post-discharge care explain racial differences in long-term survival after heart stoppages," Chen said.

Co-authors are Brahmajee K. Nallamothu, M.D., M.P.H.; John A. Spertus, M.D., M.P.H.; Yuanyuan Tang, Ph.D.; Paul S. Chan, M.D., M.Sc.; and the GWTG-R investigators.

Author disclosures are on the manuscript.

The American Heart Association Investigator Research Seed Grant; the Agency for Healthcare Research and Quality; the National Institute on Aging; the VA Health Services Research and Development Study; and the National Heart, Lung, and Blood Institute funded the study.

In another study published in this issue of Circulation, researchers from the University of Michigan Medical School and Veterans Affairs in Ann Arbor, interviewed teams responding to in-hospital cardiac arrests in hospitals participating in the Get With The Guidelines—Resuscitation initiative. They wanted to determine if there were commonalities among hospitals with the highest in-hospital cardiac arrest survival rates that could serve as best practices for other hospitals. Researchers found the best performing hospitals were more likely to:

  • Have team members of diverse disciplines responding to in-hospital cardiac arrests;
  • Establish clear roles and responsibilities of team members;
  • Exhibit better communication and leadership during in-hospital cardiac arrests; and
  • Hold in-depth mock codes.

"These two studies are excellent examples of the valuable findings we garner from our Get With the Guidelines databases, that now have nearly 7 million patient records," said Eric E. Smith, M.D., national chairman of the American Heart Association's Get With The Guidelines steering committee and an associate professor of neurology at the University of Calgary in Alberta, Canada, who was not a part of this study. "Using these data, we can learn so much about the care of heart and stroke patients and work with healthcare providers to improve treatment processes, ultimately improving patient outcomes and saving lives."

Explore further: Racial gap in survival after in-hospital cardiac arrest narrows

More information: Circulation (2018). DOI: 10.1161/CIRCULATIONAHA.117.033211

Related Stories

Racial gap in survival after in-hospital cardiac arrest narrows

August 9, 2017
There has been a substantial reduction in racial differences in survival after in-hospital cardiac arrest, with a greater improvement in survival among black patients compared with white patients, according to a study published ...

Sex and race disparities in cardiovascular health could be reduced

April 10, 2018
Substantial sex and racial gaps exist for cardiac rehabilitation referral at hospital discharge, especially among females, African-Americans, Hispanic and Asian patients leading to less favorable outcomes and/or survival ...

Changes needed to improve in-hospital cardiac arrest care, survival

March 11, 2013
Policy and practice changes by healthcare institutions, providers and others could greatly improve medical care and improve survival for people who have a sudden cardiac arrest in the hospital, according to an American Heart ...

Overall in-hospital cardiac arrest survival improves, lower survival on nights, weekends

January 22, 2018
Overall survival has improved for the approximately 200,000 patients experiencing in-hospital cardiac arrest in the U.S. each year, but patients who arrest during nights or weekends continue to experience lower survival compared ...

New rules on saving kids stricken with cardiac arrest

April 23, 2018
Saving a child with heart disease whose heart has stopped requires a different approach than reviving a child with a healthy heart, according to a new scientific statement from the American Heart Association.

Recommended for you

'Good cholesterol' may not always be good

July 19, 2018
Postmenopausal factors may have an impact on the heart-protective qualities of high-density lipoproteins (HDL) - also known as 'good cholesterol' - according to a study led by researchers in the University of Pittsburgh Graduate ...

Using adrenaline in cardiac arrests results in less than 1 percent more people leaving hospital alive

July 18, 2018
A clinical trial of the use of adrenaline in cardiac arrests has found that its use results in less than 1% more people leaving hospital alive—but almost doubles the risk of severe brain damage for survivors of cardiac ...

Omega 3 supplements have little or no heart or vascular health benefit: review

July 17, 2018
New evidence published today shows there is little or no effect of omega 3 supplements on our risk of experiencing heart disease, stroke or death.

Researchers discover new genes associated with heart function

July 17, 2018
A new study from an international research team, led by Dr. Yalda Jamshidi at St George's, University of London, has identified new genes associated with heart function and development.

Southern diet could be deadly for people with heart disease

July 12, 2018
People with a history of heart disease who eat a traditional Southern diet are more likely to die than those who follow a Mediterranean dietary pattern, according to new research.

Late-life high blood pressure may harm the brain, study says

July 11, 2018
Decades ago, hundreds of nuns and priests made an extraordinary decision: They agreed to donate their brains upon death to science, hoping to help solve mysteries about Alzheimer's and other diseases. Now, a study that used ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.