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Older black patients die sooner after in-hospital cardiac arrest



Older black adults who experienced in-hospital cardiac arrest had a 28% lower relative risk of living to 1 year and a 33% lower relative risk of living to 5 years after discharge, compared with older white adults, suggesting potential racial differences in postdischarge care, according to an article published in Circulation.

The investigators examined data for 8,764 patients in the Get With The Guidelines–Resuscitation registry who were at least 65 years of age and experienced in-hospital cardiac arrest (IHCA) during 2000-2011 and then survived to be discharged. They linked patients to Medicare claims data and tracked survival outcomes for 1 year, 3 years, and 5 years, and evaluated the “proportion of racial differences explained by patient, hospital, and unmeasured factors.”

After discharge and adjustment for hospital site, investigators found older black patients had a 28% lower survival rate, compared with older white patients, at 1 year (43.6% vs. 60.2%), a 29% lower rate at 3 years (31.6% vs. 45.3%), and a 33% lower rate at 5 years (23.5% vs. 35.4%), all statistically significant at P less than .001. While patient factors accounted for 29% and hospital treatment factors accounted for 17% of racial differences at 1 year after discharge, about one-half of the differences remained unexplained. Investigators said these racial differences were potentially “result of differences in care after discharge or unmeasured confounding,” and “generally similar” results were seen in patients at 3 years and 5 years post discharge.

“This finding suggests a need to examine whether racial differences in postdischarge care explain a substantial proportion of racial differences in long-term survival after in-hospital cardiac arrest,” Lena M. Chen, MD, of the University of Michigan, Ann Arbor, and her colleagues wrote in Circulation.

The investigators noted they were unable to determine patient socioeconomic status, income, and social support with the available data, and did not know whether patients used or had an outpatient medical center near them after discharge. Furthermore, the study comprised older adults with fee-for-service Medicare and isn’t necessarily indicative of care for younger adults.

“Further investigation is warranted to better understand whether modifiable aspects of postdischarge care account for the remaining differences and whether interventions can be developed to eliminate racial disparities in care and survival for cardiac arrest survivors,” Dr. Chen and colleagues wrote.

This project was supported by a grant from the American Heart Association Young Investigator Research Seed. Dr. Chen received funding support from the Agency for Healthcare Research and Quality and the National Institute on Aging. Dr. Chen and another investigator received funding support from the National Heart, Lung, and Blood Institute.

SOURCE: Chen LM. Circulation. 2018 Jul 9. doi: 10.1161/circulationaha.117.033211.

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