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Survival to Discharge After Cardiac Arrest

"Hospital characteristics explain much of the lower survival rate that was noted for black patients compared with white patients.

Survival to discharge after in-hospital cardiac arrest provides a useful test case for exploring racial disparities in medical care: Patients already are hospitalized, and interventions are relatively standard. Researchers enrolled 10,011 patients (19 per cent black) with ventricular fibrillation or pulseless ventricular tachycardia who were treated in 274 hospitals.

On average, black patients were younger, were more likely to have chronic diseases, and were more likely to be admitted to large teaching hospitals than white patients. Overall, survival to discharge was less likely for blacks (25 per cent vs. 37 per cent); this difference reflected a 27 per cent relative reduction in survival, in an analysis of estimated effects across hospitals. The relative difference in survival was 19 per cent after adjustment for patient factors (e.g., age, comorbidities) and 11 per cent after adjustment for hospital factors (e.g., specific cardiac arrest location, use of code teams). Among roughly 6500 patients who survived initial resuscitation, blacks had a lower rate of survival to discharge (45 per cent vs. 56 per cent), but the difference was eliminated entirely after adjustment for hospital factors.

Comment: These data suggest that racial differences in outcomes after cardiac resuscitation are better explained by clustering of care for black patients in lower-performing hospitals than by patient-specific racial or clinical factors. Previous studies showed delays in defibrillation time for black patients, but such delays probably were based on hospital performance rather than on race-based decision making. The authors suggest that efforts to narrow differences in outcomes will have to be directed toward lower-performing hospitals."

— Thomas L. Schwenk, MD

Dr. Harlan Krumholz, Editor-in-Chief of Journal Watch Cardiology, was an author on this paper but was not involved in its selection or summation by Journal Watch.

Published in Journal Watch General Medicine September 29, 2009

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