1
|
Youngstrom DW, Sutton TS, Kabala FS, Rosenzweig IC, Johndro CW, Al-Araji R, Burke-Martindale C, Mather JF, McKay RG. Community-level bystander treatment and outcomes for witnessed out-of-hospital cardiac arrest in the state of Connecticut. Resusc Plus 2024; 19:100727. [PMID: 39171330 PMCID: PMC11338120 DOI: 10.1016/j.resplu.2024.100727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 07/05/2024] [Accepted: 07/08/2024] [Indexed: 08/23/2024] Open
Abstract
Background Prior reports have demonstrated underutilization of bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use in patients with witnessed out-of-hospital cardiac arrest (OHCA) in Connecticut. This study aimed to identify community-level risk factors that contribute to low rates of bystander intervention to improve statewide OHCA outcomes. Methods We analyzed 2,789 adult patients with witnessed, non-traumatic OHCA submitted to the Connecticut Cardiac Arrest Registry to Enhance Survival (CARES) between 2013-2022. Patients were grouped by zip code, and associated municipal characteristics were acquired from 2022 United States Census Bureau data. Use of bystander CPR, attempted bystander AED defibrillation, and patient survival with favorable neurological function were determined for 19 of the 20 most populous cities and towns. Pearson correlation tests and linear regression were used to determine associations between OHCA treatment and outcomes with population size, racial/ethnic demographics, language use, income, and educational level. Results Bystander CPR was lower in municipalities with population size > 100,000 and in communities where > 40% of residents are non-English-speaking. AED use was also lower in these municipalities, as well as those with per capita incomes < $40,000 or > 1/3 Hispanic residents. Communities with populations > 100,000, > 40% non-English-speaking, per capita income < $40,000, and > 1/3 Hispanic residents were all associated with lower survival rates. Conclusions OHCA pre-hospital treatment and outcomes vary significantly by municipality in Connecticut. Community outcomes might be improved by specifically targeting urban population centers and Hispanic communities with culturally sensitive, low, or no-cost CPR and AED educational programs, using instructional languages other than English.
Collapse
Affiliation(s)
- Daniel W. Youngstrom
- Hartford HealthCare Emergency Medical Services Network, 450 West Main Street, Meriden, CT 06451, USA
| | - Trevor S. Sutton
- Department of Anesthesiology, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA
- Hartford HealthCare Heart & Vascular Institute, 85 Jefferson Street, Hartford, CT 06106, USA
- Integrated Anesthesia Associates, 100 Retreat Avenue, Hartford, CT 06106, USA
| | - Fleur S. Kabala
- University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA
| | - Isabella C. Rosenzweig
- Quinnipiac University Frank H. Netter MD School of Medicine, 370 Bassett Road, North Haven, CT 06473, USA
| | - Charles W. Johndro
- Department of Emergency Medicine, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA
| | - Rabab Al-Araji
- Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | | | - Jeff F. Mather
- Department of Research Administration, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA
| | - Raymond G. McKay
- Department of Cardiology, Hartford Hospital, 85 Seymour Street, Hartford, CT 06106, USA
| |
Collapse
|
2
|
Motairek I, Rvo Salerno P, Chen Z, Deo S, Makhlouf MHE, Al-Araji R, Rajagopalan S, Nasir K, Al-Kindi S. Historical neighborhood redlining and bystander CPR disparities in out-of-hospital cardiac arrest. Resuscitation 2024; 201:110264. [PMID: 38851447 DOI: 10.1016/j.resuscitation.2024.110264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 06/01/2024] [Accepted: 06/03/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) is associated with low survival rates. Bystander cardiopulmonary resuscitation (CPR) is essential for improving outcomes, but its utilization remains limited, particularly among racial and ethnic minorities. Historical redlining, a practice that classified neighborhoods for mortgage risk in 1930s, may have lasting implications for social and health outcomes. This study sought to investigate the influence of redlining on the provision of bystander CPR during witnessed OHCA. METHODS We conducted an analysis using data from the comprehensive Cardiac Arrest Registry to Enhance Survival (CARES), encompassing 736,066 non-traumatic OHCA cases across the United States. The Home Owners' Loan Corporation (HOLC) map shapefiles were utilized to categorize census tracts of arrests into four grades (A signifying "best", B "still desirable", C "declining", and D "hazardous"). Multivariable hierarchical logistic regression models were employed to predict the likelihood of CPR provision, adjusting for various factors including age, sex, race/ethnicity, arrest location, calendar year, and state of occurrence. Additionally, we accounted for the percentage of Black residents and residents below poverty levels at the census tract level. RESULTS Among the 43,186 witnessed cases of OHCA in graded HOLC census tracts, 37.2% received bystander CPR. The rates of bystander CPR exhibited a gradual decline across HOLC grades, ranging from 41.8% in HOLC grade A to 35.8% in HOLC grade D. In fully adjusted model, we observed significantly lower odds of receiving bystander CPR in HOLC grades C (OR 0.89, 95% CI 0.81-0.98, p = 0.016) and D (OR 0.86, 95% CI 0.78-0.95, p = 0.002) compared to HOLC grade A. CONCLUSION Redlining, a historical segregation practice, is associated with reduced contemporary rates of bystander CPR during OHCA. Targeted CPR training in redlined neighborhoods may be imperative to enhance survival outcomes.
Collapse
Affiliation(s)
- Issam Motairek
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, United States; Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Pedro Rvo Salerno
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Zhuo Chen
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Salil Deo
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, United States; Surgical Services, Louis Stokes VA Medical Center, Cleveland, OH, United States; Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Mohamed H E Makhlouf
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Rabab Al-Araji
- Department of Global Health, Emory University, Atlanta, GA, United States
| | - Sanjay Rajagopalan
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, United States; Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Khurram Nasir
- Houston Methodist Hospital, Houston, TX, United States
| | | |
Collapse
|
3
|
Juul Grabmayr A, Folke F, Samsoee Kjoelbye J, Andelius L, Krammel M, Ettl F, Sulzgruber P, Krychtiuk KA, Sasson C, Stieglis R, van Schuppen H, Tan HL, van der Werf C, Torp-Pedersen C, Kjær Ersbøll A, Malta Hansen C. Incidence and Survival of Out-of-Hospital Cardiac Arrest in Public Housing Areas in 3 European Capitals. Circ Cardiovasc Qual Outcomes 2024; 17:e010820. [PMID: 38766860 PMCID: PMC11186715 DOI: 10.1161/circoutcomes.123.010820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 04/17/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Strategies to reach out-of-hospital cardiac arrests (called cardiac arrest) in residential areas and reduce disparities in care and outcomes are warranted. This study investigated incidences of cardiac arrests in public housing areas. METHODS This register-based cohort study included cardiac arrest patients from Amsterdam (the Netherlands) from 2016 to 2021, Copenhagen (Denmark) from 2016 to 2021, and Vienna (Austria) from 2018 to 2021. Using Poisson regression adjusted for spatial correlation and city, we compared cardiac arrest incidence rates (number per square kilometer per year and number per 100 000 inhabitants per year) in public housing and other residential areas and examined the proportion of cardiac arrests within public housing and adjacent areas (100-m radius). RESULTS Overall, 9152 patients were included of which 3038 (33.2%) cardiac arrests occurred in public housing areas and 2685 (29.3%) in adjacent areas. In Amsterdam, 635/1801 (35.3%) cardiac arrests occurred in public housing areas; in Copenhagen, 1036/3077 (33.7%); and in Vienna, 1367/4274 (32.0%). Public housing areas covered 42.4 (12.6%) of 336.7 km2 and 1 024 470 (24.6%) of 4 164 700 inhabitants. Across the capitals, we observed a lower probability of 30-day survival in public housing versus other residential areas (244/2803 [8.7%] versus 783/5532 [14.2%]). The incidence rates and rate ratio of cardiac arrest in public housing versus other residential areas were incidence rate, 16.5 versus 4.1 n/km2 per year; rate ratio, 3.46 (95% CI, 3.31-3.62) and incidence rate, 56.1 versus 36.8 n/100 000 inhabitants per year; rate ratio, 1.48 (95% CI, 1.42-1.55). The incidence rates and rate ratios in public housing versus other residential areas were consistent across the 3 capitals. CONCLUSIONS Across 3 European capitals, one-third of cardiac arrests occurred in public housing areas, with an additional third in adjacent areas. Public housing areas exhibited consistently higher cardiac arrest incidences per square kilometer and 100 000 inhabitants and lower survival than other residential areas. Public housing areas could be a key target to improve cardiac arrest survival in countries with a public housing sector.
Collapse
Affiliation(s)
- Anne Juul Grabmayr
- Research Department, Copenhagen University Hospital, Emergency Medical Services Capital Region of Denmark (A.J.G., F.F., J.S.K., L.A., A.K.E., C.M.H.)
- Department of Clinical Medicine (A.J.G., F.F., J.S.K., C.M.H.), University of Copenhagen, Denmark
| | - Fredrik Folke
- Research Department, Copenhagen University Hospital, Emergency Medical Services Capital Region of Denmark (A.J.G., F.F., J.S.K., L.A., A.K.E., C.M.H.)
- Department of Clinical Medicine (A.J.G., F.F., J.S.K., C.M.H.), University of Copenhagen, Denmark
- Department of Cardiology, Gentofte Hospital (F.F., C.M.H.), Copenhagen University, Denmark
| | - Julie Samsoee Kjoelbye
- Research Department, Copenhagen University Hospital, Emergency Medical Services Capital Region of Denmark (A.J.G., F.F., J.S.K., L.A., A.K.E., C.M.H.)
- Department of Clinical Medicine (A.J.G., F.F., J.S.K., C.M.H.), University of Copenhagen, Denmark
| | - Linn Andelius
- Research Department, Copenhagen University Hospital, Emergency Medical Services Capital Region of Denmark (A.J.G., F.F., J.S.K., L.A., A.K.E., C.M.H.)
| | - Mario Krammel
- PULS, Austrian Cardiac Arrest Awareness Association (M.K., F.E., P.S.)
- Emergency Medical Service Vienna, Austria (M.K.)
| | - Florian Ettl
- Department of Emergency Medicine (F.E.) Medical University of Vienna, Austria
- PULS, Austrian Cardiac Arrest Awareness Association (M.K., F.E., P.S.)
| | - Patrick Sulzgruber
- Department of Internal Medicine II, Division of Cardiology (P.S., K.A.K.) Medical University of Vienna, Austria
- PULS, Austrian Cardiac Arrest Awareness Association (M.K., F.E., P.S.)
| | - Konstantin A. Krychtiuk
- Department of Internal Medicine II, Division of Cardiology (P.S., K.A.K.) Medical University of Vienna, Austria
- Duke Clinical Research Institute, Durham, NC (K.A.K.)
| | | | - Remy Stieglis
- Department of Anesthesiology (R.S., H.v.S.), Amsterdam University Medical Center, University of Amsterdam, the Netherlands
| | - Hans van Schuppen
- Department of Anesthesiology (R.S., H.v.S.), Amsterdam University Medical Center, University of Amsterdam, the Netherlands
| | - Hanno L. Tan
- Department of Clinical and Experimental Cardiology (H.L.T.), Amsterdam University Medical Center, University of Amsterdam, the Netherlands
- Netherlands Heart Institute, Utrecht, the Netherlands (H.L.T.)
| | - Christian van der Werf
- Department of Cardiology, Heart Centre, (C.v.d.W.), Amsterdam University Medical Center, University of Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, the Netherlands (C.v.d.W.)
| | - Christian Torp-Pedersen
- Department of Public Health (C.T.-P.), University of Copenhagen, Denmark
- Department of Cardiology, North Zealand Hospital, Denmark (C.T.-P.)
| | - Annette Kjær Ersbøll
- Research Department, Copenhagen University Hospital, Emergency Medical Services Capital Region of Denmark (A.J.G., F.F., J.S.K., L.A., A.K.E., C.M.H.)
- National Institute of Public Health, University of Southern Denmark (A.K.E.)
| | - Carolina Malta Hansen
- Research Department, Copenhagen University Hospital, Emergency Medical Services Capital Region of Denmark (A.J.G., F.F., J.S.K., L.A., A.K.E., C.M.H.)
- Department of Clinical Medicine (A.J.G., F.F., J.S.K., C.M.H.), University of Copenhagen, Denmark
- Department of Cardiology, Gentofte Hospital (F.F., C.M.H.), Copenhagen University, Denmark
- Department of Cardiology, Rigshospitalet (C.M.H.), Copenhagen University, Denmark
| |
Collapse
|
4
|
Zahra SA, Choudhury RY, Naqvi R, Boulton AJ, Chahal CAA, Munir S, Carrington M, Ricci F, Khanji MY. Health inequalities in cardiopulmonary resuscitation and use of automated electrical defibrillators in out-of-hospital cardiac arrest. Curr Probl Cardiol 2024; 49:102484. [PMID: 38401825 DOI: 10.1016/j.cpcardiol.2024.102484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 02/21/2024] [Indexed: 02/26/2024]
Abstract
Out of hospital cardiac arrest (OHCA) outcomes can be improved by strengthening the chain of survival, namely prompt cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED). However, provision of bystander CPR and AED use remains low due to individual patient factors ranging from lack of education to socioeconomic barriers and due to lack of resources such as limited availability of AEDs in the community. Although the impact of health inequalities on survival from OHCA is documented, it is imperative that we identify and implement strategies to improve public health and outcomes from OHCA overall but with a simultaneous emphasis on making care more equitable. Disparities in CPR delivery and AED use in OHCA exist based on factors including sex, education level, socioeconomic status, race and ethnicity, all of which we discuss in this review. Most importantly, we discuss the barriers to AED use, and strategies on how these may be overcome.
Collapse
Affiliation(s)
- Syeda Anum Zahra
- St Marys Hospital, Imperial College NHS Trust, Praed Street, Paddington, London W2 1NY, UK; Imperial College London, Exhibition Rd, South Kensington, London SW7 2BX, UK
| | - Rozina Yasmin Choudhury
- Royal Hampshire County Hospital, Hampshire Hospitals NHS Foundation Trust, Romsey Rd, Winchester SO22 5DG, UK
| | - Rameez Naqvi
- Colchester Hospital, East Suffolk and North Essex NHS Foundation Trust, Turner Rd, Colchester CO4 5JL, UK
| | - Adam J Boulton
- Warwick Clinical Trails Unit, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - C Anwar A Chahal
- Centre for Inherited Cardiovascular Diseases, WellSpan Health, Lancaster, PA, USA; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sabrina Munir
- Department of Cardiology, Newham University Hospital, Barts Health NHS Trust, Glen Road, Plaistow, London E13 8SL, UK
| | | | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University of Chieti-Pescara, Chieti 66100, Italy; Heart Department, SS. Annunziata Hospital, ASL 2 Abruzzo, Chieti 66100, Italy; Department of Clinical Sciences, Lund University, Malmö 21428, Sweden
| | - Mohammed Y Khanji
- Department of Cardiology, Newham University Hospital, Barts Health NHS Trust, Glen Road, Plaistow, London E13 8SL, UK; Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK; NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University, London EC1A 7BE, UK.
| |
Collapse
|
5
|
Levy MJ, Wend CM, Flemming WP, Lazieh A, Rosenblum AJ, Pineda CM, Wolfberg DM, Jenkins JL, Goolsby CA, Margolis AM. Bleeding Control Protections Within US Good Samaritan Laws. Prehosp Disaster Med 2024; 39:156-162. [PMID: 38572644 DOI: 10.1017/s1049023x24000268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
INTRODUCTION In the United States, all 50 states and the District of Columbia have Good Samaritan Laws (GSLs). Designed to encourage bystanders to aid at the scene of an emergency, GSLs generally limit the risk of civil tort liability if the care is rendered in good faith. Nation-wide, a leading cause of preventable death is uncontrolled external hemorrhage. Public bleeding control initiatives aim to train the public to recognize life-threatening external bleeding, perform life-sustaining interventions (including direct pressure, tourniquet application, and wound packing), and to promote access to bleeding control equipment to ensure a rapid response from bystanders. METHODS This study sought to identify the GSLs in each state and the District of Columbia to identify what type of responder is covered by the law (eg, all laypersons, only trained individuals, or only licensed health care providers) and if bleeding control is explicitly included or excluded in their Good Samaritan coverage. RESULTS Good Samaritan Laws providing civil liability qualified immunity were identified in all 50 states and the District of Columbia. One state, Oklahoma, specifically includes bleeding control in its GSLs. Six states - Connecticut, Illinois, Kansas, Kentucky, Michigan, and Missouri - have laws that define those covered under Good Samaritan immunity, generally limiting protection to individuals trained in a standard first aid or resuscitation course or health care clinicians. No state explicitly excludes bleeding control from their GSLs, and one state expressly includes it. CONCLUSION Nation-wide across the United States, most states have broad bystander coverage within GSLs for emergency medical conditions of all types, including bleeding emergencies, and no state explicitly excludes bleeding control interventions. Some states restrict coverage to those health care personnel or bystanders who have completed a specific training program. Opportunity exists for additional research into those states whose GSLs may not be inclusive of bleeding control interventions.
Collapse
Affiliation(s)
- Matthew J Levy
- Johns Hopkins School of Medicine, Baltimore, MarylandUSA
| | | | | | - Antoin Lazieh
- Rutgers New Jersey Medical School, Newark, New JerseyUSA
| | | | | | | | | | | | - Asa M Margolis
- Johns Hopkins School of Medicine, Baltimore, MarylandUSA
| |
Collapse
|
6
|
Dainty KN. Qualitative research in cardiac arrest research: A narrative review. Resusc Plus 2024; 17:100568. [PMID: 38370314 PMCID: PMC10869930 DOI: 10.1016/j.resplu.2024.100568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024] Open
Abstract
Qualitative research is defined as "the study of the nature of phenomena", including "their quality, different manifestations, the context in which they appear or the perspectives from which they can be perceived". It is a methodology which is becoming extremely valuable in resuscitation science, especially in terms of improving our understanding of the true impact of sudden cardiac arrest on survivors, family members, lay responders and health care providers. This narrative review provides a high-level overview of qualitative methods as well as the current state of the qualitative evidence and key knowledge gaps in resuscitation science. It finishes with discussion of the bright future of qualitative research in our field.
Collapse
Affiliation(s)
- Katie N. Dainty
- Research Chair, Patient-Centred Outcomes, North York General Hospital, Canada
- Institute of Health Policy, Management & Evaluation, University of Toronto, Canada
| |
Collapse
|
7
|
Pu Y, Yang G, Chai X. Racial and ethnic disparities in bystander resuscitation for out-of-hospital cardiac arrests. Heart Lung 2024; 64:100-106. [PMID: 38071862 DOI: 10.1016/j.hrtlng.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 11/22/2023] [Accepted: 12/03/2023] [Indexed: 03/18/2024]
Abstract
INTRODUCTION Bystander-provided cardiopulmonary resuscitation (CRP) influences the survival rates of out-of-hospital cardiac arrests (OHCAs). Disparities on bystander resuscitation measures between Black, Hispanic, Asians and Non-Hispanic White OHCAs is unclear. Examining racial and ethnic differences in bystander resuscitations is essential to better target interventions. METHODS 15,542 witnessed OHCAs were identified between April 1, 2011, and June 30, 2015 using the Resuscitation Outcomes Consortium Epidemiologic Registry 3, a multi-center, controlled trial about OHCAs in the United States and Canada. Multivariable logistic regression model was used to analyze the differences in bystander resuscitation (bystander CRP [B-CPR], CPR plus ventilation, automated external defibrillators/defibrillator application [B-AED/D], or delivery of shocks) and clinical outcomes (death at the scene or en route, return of spontaneous circulation upon first arrival at the emergency department [ROSC-ED], survival until ED discharge [S-ED], survival until hospital discharge [S-HOS], and favorable neurological outcome at discharge) between Black, Hispanic, or Asian victims and Non-Hispanic White victims. RESULTS Compared to OHCA victims in Non-Hispanic Whites, Black, Hispanic, and Asians were less likely to receive B-CPR (adjusted OR: 0.79; 95 % CI: 0.63-0.99), and B-AED/D (adjusted OR: 0.80; 95 % CI: 0.65-0.98) in public locations. And, Black, Hispanic, and Asian OHCAs were less likely to receive bystander resuscitation in street/highway locations and public buildings, and less likely to have better clinical outcomes, including ROSC-ED, S-ED and S-HOS. CONCLUSION Black, Hispanic and Asian victims with witnessed OHCAs are less likely to receive bystander resuscitation and more likely to get worse outcomes than Non-Hispanic White victims.
Collapse
Affiliation(s)
- Yuting Pu
- Department of Emergency Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Emergency Medicine and Difficult Disease Institute, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Guifang Yang
- Department of Emergency Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Emergency Medicine and Difficult Disease Institute, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiangping Chai
- Department of Emergency Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Emergency Medicine and Difficult Disease Institute, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
| |
Collapse
|
8
|
Blewer AL, Bigham BL, Kaplan S, Del Rios M, Leary M. Gender, Socioeconomic Status, Race, and Ethnic Disparities in Bystander Cardiopulmonary Resuscitation and Education-A Scoping Review. Healthcare (Basel) 2024; 12:456. [PMID: 38391831 PMCID: PMC10887971 DOI: 10.3390/healthcare12040456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/01/2024] [Accepted: 02/05/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Social determinants are associated with survival from out-of-hospital sudden cardiac arrest (SCA). Because prompt delivery of bystander CPR (B-CPR) doubles survival and B-CPR rates are low, we sought to assess whether gender, socioeconomic status (SES), race, and ethnicity are associated with lower rates of B-CPR and CPR training. METHODS This scoping review was conducted as part of the continuous evidence evaluation process for the 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care as part of the Resuscitation Education Science section. We searched PubMed and excluded citations that were abstracts only, letters or editorials, and pediatric studies. RESULTS We reviewed 762 manuscripts and identified 24 as relevant; 4 explored gender disparities; 12 explored SES; 11 explored race and ethnicity; and 3 had overlapping themes, all of which examined B-CPR or CPR training. Females were less likely to receive B-CPR than males in public locations. Observed gender disparities in B-CPR may be associated with individuals fearing accusations of inappropriate touching or injuring female victims. Studies demonstrated that low-SES neighborhoods were associated with lower rates of B-CPR and CPR training. In the US, predominantly Black and Hispanic neighborhoods were associated with lower rates of B-CPR and CPR training. Language barriers were associated with lack of CPR training. CONCLUSION Gender, SES, race, and ethnicity impact receiving B-CPR and obtaining CPR training. The impact of this is that these populations are less likely to receive B-CPR, which decreases their odds of surviving SCA. These health disparities must be addressed. Our work can inform future research, education, and public health initiatives to promote equity in B-CPR knowledge and provision. As an immediate next step, organizations that develop and deliver CPR curricula to potential bystanders should engage affected communities to determine how best to improve training and delivery of B-CPR.
Collapse
Affiliation(s)
- Audrey L Blewer
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC 27710, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC 27710, USA
| | - Blair L Bigham
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5R 0A3, Canada
- Scarborough Health Network Research Institute, Toronto, ON M1P 2T7, Canada
| | - Samantha Kaplan
- Duke University Medical Center Library & Archives, Duke University School of Medicine, Durham, NC 27710, USA
| | - Marina Del Rios
- Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Marion Leary
- School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA
| |
Collapse
|
9
|
Berg KM, Bray JE, Ng KC, Liley HG, Greif R, Carlson JN, Morley PT, Drennan IR, Smyth M, Scholefield BR, Weiner GM, Cheng A, Djärv T, Abelairas-Gómez C, Acworth J, Andersen LW, Atkins DL, Berry DC, Bhanji F, Bierens J, Bittencourt Couto T, Borra V, Böttiger BW, Bradley RN, Breckwoldt J, Cassan P, Chang WT, Charlton NP, Chung SP, Considine J, Costa-Nobre DT, Couper K, Dainty KN, Dassanayake V, Davis PG, Dawson JA, Fernanda de Almeida M, De Caen AR, Deakin CD, Dicker B, Douma MJ, Eastwood K, El-Naggar W, Fabres JG, Fawke J, Fijacko N, Finn JC, Flores GE, Foglia EE, Folke F, Gilfoyle E, Goolsby CA, Granfeldt A, Guerguerian AM, Guinsburg R, Hatanaka T, Hirsch KG, Holmberg MJ, Hosono S, Hsieh MJ, Hsu CH, Ikeyama T, Isayama T, Johnson NJ, Kapadia VS, Daripa Kawakami M, Kim HS, Kleinman ME, Kloeck DA, Kudenchuk P, Kule A, Kurosawa H, Lagina AT, Lauridsen KG, Lavonas EJ, Lee HC, Lin Y, Lockey AS, Macneil F, Maconochie IK, John Madar R, Malta Hansen C, Masterson S, Matsuyama T, McKinlay CJD, Meyran D, Monnelly V, Nadkarni V, Nakwa FL, Nation KJ, Nehme Z, Nemeth M, Neumar RW, Nicholson T, Nikolaou N, Nishiyama C, Norii T, Nuthall GA, Ohshimo S, Olasveengen TM, Gene Ong YK, Orkin AM, Parr MJ, Patocka C, Perkins GD, Perlman JM, Rabi Y, Raitt J, Ramachandran S, Ramaswamy VV, Raymond TT, Reis AG, Reynolds JC, Ristagno G, Rodriguez-Nunez A, Roehr CC, Rüdiger M, Sakamoto T, Sandroni C, Sawyer TL, Schexnayder SM, Schmölzer GM, Schnaubelt S, Semeraro F, Singletary EM, Skrifvars MB, Smith CM, Soar J, Stassen W, Sugiura T, Tijssen JA, Topjian AA, Trevisanuto D, Vaillancourt C, Wyckoff MH, Wyllie JP, Yang CW, Yeung J, Zelop CM, Zideman DA, Nolan JP. 2023 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Resuscitation 2024; 195:109992. [PMID: 37937881 DOI: 10.1016/j.resuscitation.2023.109992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
The International Liaison Committee on Resuscitation engages in a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation and first aid science. Draft Consensus on Science With Treatment Recommendations are posted online throughout the year, and this annual summary provides more concise versions of the final Consensus on Science With Treatment Recommendations from all task forces for the year. Topics addressed by systematic reviews this year include resuscitation of cardiac arrest from drowning, extracorporeal cardiopulmonary resuscitation for adults and children, calcium during cardiac arrest, double sequential defibrillation, neuroprognostication after cardiac arrest for adults and children, maintaining normal temperature after preterm birth, heart rate monitoring methods for diagnostics in neonates, detection of exhaled carbon dioxide in neonates, family presence during resuscitation of adults, and a stepwise approach to resuscitation skills training. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research. Additional topics are addressed with scoping reviews and evidence updates.
Collapse
|
10
|
Ibrahim R, Shahid M, Srivathsan K, Sorajja D, Deshmukh A, Lee JZ. Mortality trends, disparities, and social vulnerability in cardiac arrest mortality in the young: A cross-sectional analysis. J Cardiovasc Electrophysiol 2024; 35:35-43. [PMID: 37921096 DOI: 10.1111/jce.16112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/26/2023] [Accepted: 10/10/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Cardiac arrest (CA) is a leading cause of death in the United States (US). Social determinants of health may impact CA outcomes. We aimed to assess mortality trends, disparities, and the influence of the social vulnerability index (SVI) on CA outcomes in the young. METHODS We conducted a cross-sectional analysis of age-adjusted mortality rates (AAMRs) related to CA in the United States from the Years 1999 to 2020 in individuals aged 35 years and younger. Data were obtained from death certificates and analyzed using log-linear regression models. We examined disparities in mortality rates based on demographic variables. We also explored the impact of the SVI on CA mortality. RESULTS A total of 4792 CA deaths in the young were identified. Overall AAMR decreased from 0.20 in 1999 to 0.14 in 2020 with an average annual percentage change of -1.3% (p = .001). Black (AAMR: 0.30) and male populations (AAMR: 0.14) had higher AAMR compared with White (AAMR: 0.11) and female (AAMR: 0.11) populations, respectively. Nonmetropolitan (AAMR: 0.29) and Southern (AAMR: 0.26) regions were also impacted by higher AAMR compared with metropolitan (AAMR: 0.11) and other US census regions, respectively. A higher SVI was associated with greater mortality risks related to CA (risk ratio: 1.82 [95% CI, 1.77-1.87]). CONCLUSIONS Our analysis of CA in the young revealed disparities based on demographics, with a decline in AAMR from 1999 to 2020. There is a correlation between a higher SVI and increased CA mortality risk, highlighting the importance of targeted interventions to address these disparities effectively.
Collapse
Affiliation(s)
- Ramzi Ibrahim
- Department of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Mahek Shahid
- Department of Medicine, University of Arizona, Tucson, Arizona, USA
| | | | - Dan Sorajja
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Abhishek Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Justin Z Lee
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| |
Collapse
|
11
|
Berg KM, Bray JE, Ng KC, Liley HG, Greif R, Carlson JN, Morley PT, Drennan IR, Smyth M, Scholefield BR, Weiner GM, Cheng A, Djärv T, Abelairas-Gómez C, Acworth J, Andersen LW, Atkins DL, Berry DC, Bhanji F, Bierens J, Bittencourt Couto T, Borra V, Böttiger BW, Bradley RN, Breckwoldt J, Cassan P, Chang WT, Charlton NP, Chung SP, Considine J, Costa-Nobre DT, Couper K, Dainty KN, Dassanayake V, Davis PG, Dawson JA, de Almeida MF, De Caen AR, Deakin CD, Dicker B, Douma MJ, Eastwood K, El-Naggar W, Fabres JG, Fawke J, Fijacko N, Finn JC, Flores GE, Foglia EE, Folke F, Gilfoyle E, Goolsby CA, Granfeldt A, Guerguerian AM, Guinsburg R, Hatanaka T, Hirsch KG, Holmberg MJ, Hosono S, Hsieh MJ, Hsu CH, Ikeyama T, Isayama T, Johnson NJ, Kapadia VS, Kawakami MD, Kim HS, Kleinman ME, Kloeck DA, Kudenchuk P, Kule A, Kurosawa H, Lagina AT, Lauridsen KG, Lavonas EJ, Lee HC, Lin Y, Lockey AS, Macneil F, Maconochie IK, Madar RJ, Malta Hansen C, Masterson S, Matsuyama T, McKinlay CJD, Meyran D, Monnelly V, Nadkarni V, Nakwa FL, Nation KJ, Nehme Z, Nemeth M, Neumar RW, Nicholson T, Nikolaou N, Nishiyama C, Norii T, Nuthall GA, Ohshimo S, Olasveengen TM, Ong YKG, Orkin AM, Parr MJ, Patocka C, Perkins GD, Perlman JM, Rabi Y, Raitt J, Ramachandran S, Ramaswamy VV, Raymond TT, Reis AG, Reynolds JC, Ristagno G, Rodriguez-Nunez A, Roehr CC, Rüdiger M, Sakamoto T, Sandroni C, Sawyer TL, Schexnayder SM, Schmölzer GM, Schnaubelt S, Semeraro F, Singletary EM, Skrifvars MB, Smith CM, Soar J, Stassen W, Sugiura T, Tijssen JA, Topjian AA, Trevisanuto D, Vaillancourt C, Wyckoff MH, Wyllie JP, Yang CW, Yeung J, Zelop CM, Zideman DA, Nolan JP. 2023 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Circulation 2023; 148:e187-e280. [PMID: 37942682 PMCID: PMC10713008 DOI: 10.1161/cir.0000000000001179] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
The International Liaison Committee on Resuscitation engages in a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation and first aid science. Draft Consensus on Science With Treatment Recommendations are posted online throughout the year, and this annual summary provides more concise versions of the final Consensus on Science With Treatment Recommendations from all task forces for the year. Topics addressed by systematic reviews this year include resuscitation of cardiac arrest from drowning, extracorporeal cardiopulmonary resuscitation for adults and children, calcium during cardiac arrest, double sequential defibrillation, neuroprognostication after cardiac arrest for adults and children, maintaining normal temperature after preterm birth, heart rate monitoring methods for diagnostics in neonates, detection of exhaled carbon dioxide in neonates, family presence during resuscitation of adults, and a stepwise approach to resuscitation skills training. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research. Additional topics are addressed with scoping reviews and evidence updates.
Collapse
|
12
|
Chan PS, McNally B, Al-Araji R, Kennedy K, Kennedy M, Del Rios M, Sperling J, Sasson C, Breathett K, Dukes KC, Girotra S. Survey of resuscitation practices at emergency medical service agencies in the U.S. Resusc Plus 2023; 16:100483. [PMID: 37854286 PMCID: PMC10580039 DOI: 10.1016/j.resplu.2023.100483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023] Open
Abstract
Background Survival for out-of-hospital cardiac arrest (OHCA) varies across emergency medical service (EMS) agencies. Yet, little is known about resuscitation response and quality improvement activities at EMS agencies. We describe herein a novel survey to EMS agencies in a U.S. registry for OHCA. Methods Using data from the Cardiac Arrest Registry to Enhance Survival (CARES), we identified 577 EMS agencies with ≥10 OHCA cases annually between 2015 and 2019 that remained active in CARES. We administered a survey to EMS directors regarding agency characteristics, cardiac arrest response, relationships with first responders and dispatchers, quality improvement activities and perceived barriers in the community. Results Of eligible EMS agencies, 470 (81.5%) completed the survey. The high completion rate was likely due to frequent personalized emails and phone calls, liaising with CARES state coordinators to encourage survey response, and multiple periodic drawings of an automated external defibrillator during the survey period for participating EMS agencies. The survey examined rates of resuscitation training modalities; use of resuscitation equipment and devices in the field; frequency of simulation; non-EMS stakeholder response to OHCA (dispatchers, fire, police); quality improvement; and community factors affecting bystander response to OHCA. Conclusions In this study design paper on the RED-CASO survey, we provide summary data on EMS agency characteristics in the U.S. Upon linkage to CARES patient-level data, this survey will provide critical insights into 'best practices' at EMS agencies with the highest OHCA survival rates as well as provide insights into current disparities in outcomes.
Collapse
Affiliation(s)
- Paul S. Chan
- Saint Luke’s Mid America Heart Institute, United States
| | - Bryan McNally
- Emory University Rollins School of Public Health, United States
- Department of Emergency Medicine, Emory University School of Medicine, United States
| | - Rabab Al-Araji
- Emory University Rollins School of Public Health, United States
| | - Kevin Kennedy
- Saint Luke’s Mid America Heart Institute, United States
| | - Marci Kennedy
- Saint Luke’s Mid America Heart Institute, United States
| | - Marina Del Rios
- University of Iowa Carver College of Medicine, Iowa City, IA, United States
| | - Jessica Sperling
- Social Science Research Institute, Duke University, Durham, NC, United States
| | - Comilla Sasson
- University of Colorado School of Medicine and School of Public Health, Aurora, CO, United States
- The American Heart Association, Dallas, TX, United States
| | - Khadijah Breathett
- Krannert Cardiovascular Research Center, Indiana University, United States
| | - Kimberly C. Dukes
- University of Iowa Carver College of Medicine, Iowa City, IA, United States
| | - Saket Girotra
- University of Texas-Southwestern Medical Center, Dallas, TX, United States
| | - CARES Surveillance Group
- Saint Luke’s Mid America Heart Institute, United States
- Emory University Rollins School of Public Health, United States
- Department of Emergency Medicine, Emory University School of Medicine, United States
- University of Iowa Carver College of Medicine, Iowa City, IA, United States
- Social Science Research Institute, Duke University, Durham, NC, United States
- University of Colorado School of Medicine and School of Public Health, Aurora, CO, United States
- The American Heart Association, Dallas, TX, United States
- Krannert Cardiovascular Research Center, Indiana University, United States
- University of Texas-Southwestern Medical Center, Dallas, TX, United States
| |
Collapse
|
13
|
Newport R, Grey C, Dicker B, Ameratunga S, Harwood M. Ethnic differences of the care pathway following an out-of-hospital cardiac event: A systematic review. Resuscitation 2023; 193:110017. [PMID: 37890578 DOI: 10.1016/j.resuscitation.2023.110017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/25/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023]
Abstract
AIM This systematic review aimed to determine to what extent and why the care pathways for acute cardiac events in the community might differ for minoritised ethnic populations compared to non-minoritised populations. It also sought to identify the barriers and enablers that could influence variations in access to care for minoritised populations. METHODS A multi-database search was conducted for articles published between 1 January 2000 and 1 January 2023. A combination of MeSH terms and keywords was used. Inclusion criteria for papers were published in English, adult population, the primary health condition was an acute cardiac event, and the primary outcomes were disaggregated by ethnicity or race. A narrative review of extracted data was performed, and findings were reported according to the PRISMA 2020 guidelines. RESULTS Of the 3552 articles identified using the search strategy, 40 were deemed eligible for the review. Studies identified a range of variables in the care pathway that differed by ethnicity or race. These could be grouped as time to care, transportation, event related-variables, EMS interactions and symptoms. A meta-analysis was not performed due to heterogeneity across the studies. CONCLUSION The extent and reasons for differences in cardiac care pathways are considerable. There are several remediable barriers and enablers that require attention to achieve equitable access to care for minoritised populations.
Collapse
Affiliation(s)
- Rochelle Newport
- Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, New Zealand.
| | - Corina Grey
- Health New Zealand; Honorary Academic, Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, New Zealand
| | - Bridget Dicker
- Clinical Audit and Research, Hato Hone St John New Zealand, Auckland, New Zealand; Paramedicine Research Unit, Paramedicine Department, Auckland University of Technology, Auckland, New Zealand
| | - Shanthi Ameratunga
- Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, New Zealand; Section of Epidemiology & Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Matire Harwood
- Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, New Zealand
| |
Collapse
|
14
|
Thevathasan T, Paul J, Gaul AL, Degbeon S, Füreder L, Dischl D, Knie W, Girke G, Wurster T, Landmesser U, Skurk C. Mortality and healthcare resource utilisation after cardiac arrest in the United States - A 10-year nationwide analysis prior to the COVID-19 pandemic. Resuscitation 2023; 193:109946. [PMID: 37634860 DOI: 10.1016/j.resuscitation.2023.109946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 08/29/2023]
Abstract
AIM Understanding the public health burden of cardiac arrest (CA) is important to inform healthcare policies, particularly during healthcare crises such as the COVID-19 pandemic. This study aimed to analyse outcomes of in-hospital mortality and healthcare resource utilisation in adult patients with CA in the United States over the last decade prior to the COVID-19 pandemic. METHODS The United States (US) National Inpatient Sample was utilised to identify hospitalised adult patients with CA between 2010 and 2019. Logistic and Poisson regression models were used to analyse outcomes by adjusting for 47 confounders. RESULTS 248,754 adult patients with CA (without "Do Not Resuscitate"-orders) were included in this study, out of which 57.5% were male. In-hospital mortality was high with 51.2% but improved significantly from 58.3% in 2010 to 46.4% in 2019 (P < 0.001). Particularly, elderly patients, non-white patients and patients requiring complex therapy had a higher mortality rate. Although the average hospital LOS decreased by 11%, hospital expenses have increased by 13% between 2010 and 2019 (each P < 0.001), presumably due to more frequent use of mechanical circulatory support (MCS, e.g. ECMO from 2.6% to 8.7% or Impella® micro-axial flow pump from 1.8% to 14.2%). Strong disparities existed among patient age groups and ethnicities across the US. Of note, the number of young adults with CA and opioid-induced CA has almost doubled within the study period. CONCLUSION Over the last ten years prior to the COVID-19 pandemic, CA-related survival has incrementally improved with shorter hospitalisations and increased medical expenses, while strong disparities existed among different age groups and ethnicities. National standards for CA surveillance should be considered to identify trends and differences in CA treatment to allow for standardised medical care.
Collapse
Affiliation(s)
- Tharusan Thevathasan
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany; Berlin Institute of Health, Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung e.V., Potsdamer Str. 58, 10785 Berlin, Germany; Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany.
| | - Julia Paul
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Anna L Gaul
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Sêhnou Degbeon
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Lisa Füreder
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Dominic Dischl
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Wulf Knie
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Georg Girke
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Thomas Wurster
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Ulf Landmesser
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany; Berlin Institute of Health, Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung e.V., Potsdamer Str. 58, 10785 Berlin, Germany
| | - Carsten Skurk
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung e.V., Potsdamer Str. 58, 10785 Berlin, Germany.
| |
Collapse
|
15
|
Rojo MO, Prince LY, Li C, McSweeney JC. Heart Disease Knowledge and Awareness in African American and Hispanic Women. South Med J 2023; 116:783-789. [PMID: 37788811 PMCID: PMC10558080 DOI: 10.14423/smj.0000000000001610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
OBJECTIVES Coronary heart disease (CHD) is the leading cause of morbidity and mortality among US women. Minority women have higher rates of CHD and are more likely to experience adverse outcomes. Because of racial disparities in CHD outcomes, the purpose of this study was to assess CHD knowledge and awareness in African American and Hispanic women. METHODS Using a survey research design, a convenience sample of African American and Hispanic women was surveyed in their local communities. CHD knowledge, awareness, and demographic data were collected using an online survey. The survey was administered in English and Spanish using an iPad. CHD knowledge was assessed using a 7-item survey based on the American Heart Association's Life's Simple 7 brochure. CHD awareness was assessed using a 7-item survey adapted from the American Heart Association's Survey of Women's Cardiovascular Disease Awareness. CHD knowledge was scored on a scale of 0 to 7, and awareness was assessed based on responses to each question. The data analysis consisted of cross-tabulations and multivariable repeated measures analysis. We assessed differences in CHD knowledge and awareness based on race/ethnicity. We hypothesized that there would be statistically significant differences in CHD knowledge and awareness based on specific demographic factors (eg, age, income, education, health literacy). RESULTS A total of 100 African American (n=50) and Hispanic (n = 50) women participated in the study. Results revealed that CHD knowledge and awareness were limited for both groups. Seventy-three percent of participants (African American 66%; Hispanic 80%) did not know that CHD is the leading cause of death in women and 75% (African American 60%; Hispanic 90%) were moderately or not at all informed about CHD. CONCLUSIONS These findings support the need for more research on innovative strategies to improve CHD knowledge and awareness, particularly in African American and Hispanic women who are at highest risk, thereby addressing racial/ethnic and gender disparities in CHD morbidity and mortality.
Collapse
Affiliation(s)
| | | | - Chenghui Li
- the College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | | |
Collapse
|
16
|
Uzendu AI, Spertus JA, Nallamothu BK, Girotra S, Jones PG, McNally BF, Del Rios M, Sasson C, Breathett K, Sperling J, Dukes KC, Chan PS. Cardiac Arrest Survival at Emergency Medical Service Agencies in Catchment Areas With Primarily Black and Hispanic Populations. JAMA Intern Med 2023; 183:1136-1143. [PMID: 37669067 PMCID: PMC10481323 DOI: 10.1001/jamainternmed.2023.4303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 07/12/2023] [Indexed: 09/06/2023]
Abstract
Importance Black and Hispanic patients are less likely to survive an out-of-hospital cardiac arrest (OHCA) than White patients. Given the central importance of emergency medical service (EMS) agencies in prehospital care, a better understanding of OHCA survival at EMS agencies that work in Black and Hispanic communities and White communities is needed to address OHCA disparities. Objective To examine whether EMS agencies serving catchment areas with primarily Black and Hispanic populations (Black and Hispanic catchment areas) have different rates of OHCA survival than agencies serving catchment areas with primarily White populations (White catchment areas). Design, Setting, and Participants A cohort study including adults with nontraumatic OHCA from January 1, 2015, to December 31, 2019, in the Cardiac Arrest Registry to Enhance Survival was conducted. Data analysis was conducted from August 17, 2022, to July 7, 2023. Exposure Emergency medical service agencies, categorized as working in catchment areas where the combination of Black and Hispanic residents made up more than 50% of the population or where White residents made up more than 50% of the population. Main Outcomes and Measures The unit of analysis was the EMS agency. The primary outcome was agency-level risk-standardized survival rates (RSSRs) to hospital admission for OHCA at each EMS agency, which were calculated using hierarchical logistic regression and compared between agencies serving Black and Hispanic and White catchment areas. Whether differences in OHCA survival were explained by EMS and first responder measures was evaluated with additional adjustment for these factors. Results Among 764 EMS agencies representing 258 342 OHCAs, 82 EMS agencies (10.7%) had a Black and Hispanic catchment area. Overall median age of the patients was 63.0 (IQR, 52.0-75.0) years, 36.1% were women, and 63.9% were men. Overall, the mean (SD) RSSR was 27.5% (3.6%), with lower survival at EMS agencies with Black and Hispanic catchment areas (25.8% [3.6%]) compared with agencies with White catchment areas (27.7% [3.5%]; P < .001). Among the 82 EMS agencies with Black and Hispanic catchment areas, a disproportionately higher number (32 [39.0%]) was in the lowest survival quartile, whereas a lower number (12 [14.6%]) was in the highest survival quartile. Additional adjustment for EMS response times, EMS termination of resuscitation rates, and first responder rates of initiating cardiopulmonary resuscitation or applying an automated external defibrillator before EMS arrival did not meaningfully attenuate differences in RSSRs between agencies with Black and Hispanic compared with White catchment areas (mean [SD] RSSRs after adjustment, 25.9% [3.3%] vs 27.7% [3.1%]; P < .001). Conclusions and Relevance Risk-standardized survival rates for OHCA were 1.9% lower at EMS agencies working in Black and Hispanic catchment areas than in White catchment areas. This difference was not explained by EMS response times, rates of EMS termination of resuscitation, or first responder rates of initiating cardiopulmonary resuscitation or applying an automated external defibrillator. These findings suggest there is a need for further assessment of these discrepancies.
Collapse
Affiliation(s)
- Anezi I. Uzendu
- Saint Luke’s Hospital Mid America Heart Institute, Kansas City, Missouri
- Department of Medicine, University of Missouri–Kansas City, Kansas City
| | - John A. Spertus
- Saint Luke’s Hospital Mid America Heart Institute, Kansas City, Missouri
- Department of Medicine, University of Missouri–Kansas City, Kansas City
| | - Brahmajee K. Nallamothu
- Michigan Integrated Center for Health Analytics and Medical Prediction, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - Saket Girotra
- University of Texas–Southwestern Medical Center, Dallas
| | - Philip G. Jones
- Saint Luke’s Hospital Mid America Heart Institute, Kansas City, Missouri
| | - Bryan F. McNally
- Emory University School of Medicine, Rollins School of Public Health, Atlanta, Georgia
| | - Marina Del Rios
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City
| | - Comilla Sasson
- Department of Psychiatry, University of Colorado School of Medicine, Aurora
- Department of Community and Behavioral Health, Colorado School of Public Health, Aurora
- American Heart Association, Dallas, Texas
| | - Khadijah Breathett
- Division of Cardiology, Krannert Cardiovascular Research Center, Indiana University, Indianapolis
| | - Jessica Sperling
- Social Science Research Institute, Duke University, Durham, North Carolina
- Clinical and Translational Science Institute, Durham, North Carolina
| | - Kimberly C. Dukes
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City
- Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center, Iowa City
- University of Iowa College of Public Health, Iowa City
| | - Paul S. Chan
- Saint Luke’s Hospital Mid America Heart Institute, Kansas City, Missouri
- Department of Medicine, University of Missouri–Kansas City, Kansas City
| |
Collapse
|
17
|
Ko YC, Hsieh MJ, Schnaubelt S, Matsuyama T, Cheng A, Greif R. Disparities in layperson resuscitation education: A scoping review. Am J Emerg Med 2023; 72:137-146. [PMID: 37531710 DOI: 10.1016/j.ajem.2023.07.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 07/10/2023] [Accepted: 07/19/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND The aim of this scoping review was to identify factors that would enable or hinder the opportunity for laypersons to undertake resuscitation education. METHODS We searched PubMed, Ovid EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials (CENTRAL) to identify studies published from January 1, 1966 to December 31, 2022 including factors that could influence laypersons to undertake resuscitation education. Data regarding participant characteristics, interventions, and design and outcomes of included studies were extracted. RESULTS Of the initially identified 6627 studies, 23 studies (20 cross-sectional and 3 cohort studies) were finally included. Among them, a wide variety of enablers and barriers were identified. High heterogeneity among studies was observed. We categorized factors into three themes: personal factors (age, sex, race, family status, language, prior experience of resuscitation, and immigration status), socioeconomic and educational factors (income, societal status, occupation and legislation, and educational attainment), and geographic factors (birthplace and habitancy). Several barriers were identified that affect laypersons from participating in resuscitation training, such as personal factors like advanced age, lower socioeconomic and educational status, as well as being part of marginalized groups due to race or language barriers. On the other hand, several enablers identified in the study included prior experiences of witnessing someone collapsing, awareness of automated external defibrillators in public locations, certain occupations, or legal requirements for training. CONCLUSIONS Various barriers and enablers were found to influence laypersons to participate in resuscitation training. To enhance layperson response to cardiac arrest, targeted initiatives that aim to eliminate barriers need to be initiated, and further research is required to explore factors relating to populations with special needs.
Collapse
Affiliation(s)
- Ying-Chih Ko
- Section of Emergency Medicine, Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan; Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Ju Hsieh
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | | | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Adam Cheng
- Departments of Pediatrics and Emergency Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Robert Greif
- University of Bern, Bern, Switzerland; and School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
| |
Collapse
|
18
|
Toy J, Bosson N, Schlesinger S, Gausche-Hill M. Racial and ethnic disparities in the provision of bystander CPR after witnessed out-of-hospital cardiac arrest in the United States. Resuscitation 2023; 190:109901. [PMID: 37442519 DOI: 10.1016/j.resuscitation.2023.109901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/28/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVE To evaluate the association between race/ethnicity and the odds of receiving bystander cardiopulmonary resuscitation (bCPR) after witnessed out-of-hospital cardiac arrest (OHCA). METHODS For this cross-sectional retrospective study, data were obtained from the National Emergency Medical Services Information System database for adults (≥18 years) with a witnessed non-traumatic OHCA in the year 2021. Patients were separated into two groups including Black/Hispanic and White. The primary outcome was the odds of receiving bCPR. We excluded traumatic etiology, do-not-resuscitate orders, and arrest in a healthcare facility or wilderness location. Multiple logistic regression controlling for known covariates was utilized and analyses were stratified by public versus non-public location, median household income, and rural, suburban, or urban setting. RESULTS A total of 64,007 witnessed OHCAs were included. When compared to White, the Black/Hispanic group were younger (62 vs 67 years) and more often female (40% vs 33%), in neighborhoods with the lowest median household income (31% vs 13%) and in an urban setting (92% vs 80%). Overall, bystander CPR rates were 60% and 67% for the Black/Hispanic and White groups, respectively. Multiple logistic regression stratified by OHCA location found that the Black/Hispanic group had a decreased odds of receiving bCPR compared to the White group both in the home (adjusted OR [aOR] 0.77; 95% CI 0.74-0.81) and in public (aOR 0.69; 95% CI 0.64-0.76). This difference persisted throughout neighborhoods of different socioeconomic status and across the rural-urban spectrum. CONCLUSIONS Racial/ethnic disparities exist for Black and Hispanic persons in the odds of receiving bCPR after a witnessed non-traumatic OHCA regardless of public or private setting, neighborhood income level, or population density.
Collapse
Affiliation(s)
- Jake Toy
- University of California Los Angeles, Fielding School of Public Health, 650 Charles E Young Dr S, Los Angeles, CA 90095, USA; Harbor-UCLA Medical Center, Department of Emergency Medicine & The Lundquist Institute, 1000 W Carson Street, Torrance, CA 90502, USA; Los Angeles County EMS Agency, 10100 Pioneer Blvd, Santa Fe Springs, CA 90670, USA; David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA 90095, USA.
| | - Nichole Bosson
- Harbor-UCLA Medical Center, Department of Emergency Medicine & The Lundquist Institute, 1000 W Carson Street, Torrance, CA 90502, USA; Los Angeles County EMS Agency, 10100 Pioneer Blvd, Santa Fe Springs, CA 90670, USA; David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA 90095, USA
| | - Shira Schlesinger
- Harbor-UCLA Medical Center, Department of Emergency Medicine & The Lundquist Institute, 1000 W Carson Street, Torrance, CA 90502, USA; David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA 90095, USA
| | - Marianne Gausche-Hill
- Harbor-UCLA Medical Center, Department of Emergency Medicine & The Lundquist Institute, 1000 W Carson Street, Torrance, CA 90502, USA; Los Angeles County EMS Agency, 10100 Pioneer Blvd, Santa Fe Springs, CA 90670, USA; David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA 90095, USA
| |
Collapse
|
19
|
Murk W, Goralnick E, Brownstein JS, Landman AB. Quality of Layperson CPR Instructions From Artificial Intelligence Voice Assistants. JAMA Netw Open 2023; 6:e2331205. [PMID: 37639274 PMCID: PMC10463098 DOI: 10.1001/jamanetworkopen.2023.31205] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/21/2023] [Indexed: 08/29/2023] Open
Abstract
This case series study evaluates responses from 4 artificial intelligence voice assistance on CPR questions from laypersons.
Collapse
Affiliation(s)
- William Murk
- Department of Emergency Medicine, Albert Einstein College of Medicine, The Bronx, New York
| | - Eric Goralnick
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - John S. Brownstein
- Harvard Medical School, Boston, Massachusetts
- Innovation and Digital Health Accelerator, Boston Children’s Hospital, Boston, Massachusetts
| | - Adam B. Landman
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
20
|
Munot S, Rugel EJ, Bray J, Redfern J, Yang G, Ngo L, Bauman A, Dang QM, Rock Z, Marschner S, Coggins A, Semsarian C, Middleton PM, Jennings G, Angell B, Kumar S, Kovoor P, Chow CK. Examining training and attitudes to basic life support in multi-ethnic communities residing in New South Wales, Australia: A mixed-methods investigation. BMJ Open 2023; 13:e073481. [PMID: 37491098 PMCID: PMC10373670 DOI: 10.1136/bmjopen-2023-073481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Bystander response, including cardiopulmonary resuscitation (CPR), is critical to out-of-hospital cardiac arrest (OHCA) survival. Nearly 30% of Australian residents were born overseas, and little is known about their preparedness to perform CPR. In this mixed-methods study, we examined rates of training and willingness and barriers to performing CPR among immigrants in Australia. METHODS First, we surveyed residents in New South Wales, Australia, using purposeful sampling to enrich immigrant populations. Multivariate logistic regression was used to examine the association between place of birth and willingness to perform CPR. Next, we conducted focus-group discussions with members of the region's largest migrant groups to explore barriers and relevant societal or cultural factors. RESULTS Of the 1267 survey participants (average age 49.6 years, 52% female), 60% were born outside Australia, most in Asia and 73% had lived in Australia for more than 10 years. Higher rates of previous CPR training were reported among Australian-born participants compared with South Asian-born and East Asian-born (77%, 35%, 48%, respectively, p <0.001). In adjusted models, the odds of willingness to perform CPR on a stranger were significantly lower among migrants than Australian-born (adjusted OR: 0.64; 95% CI 0.49 to 0.83); however, this association was mediated by history of training. Themes emerging from the focus-group discussions included concerns about causing harm, fear of liability, and birthplace-specific social and cultural barriers. CONCLUSIONS Targeted awareness and training interventions, which address common and culture-specific barriers to response and improved access to training, may improve confidence and willingness to respond to OHCA in multi-ethnic communities.
Collapse
Affiliation(s)
- Sonali Munot
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Westmead, New South Wales, Australia
| | - Emily J Rugel
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Westmead, New South Wales, Australia
| | - Janet Bray
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Julie Redfern
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Guoyan Yang
- NICM Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Linh Ngo
- Greater Brisbane Clinical School, Faculty of Medicine, The University of Queensland, Chermside, Queensland, Australia
| | - Adrian Bauman
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Quan Minh Dang
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Westmead, New South Wales, Australia
| | - Zoe Rock
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Westmead, New South Wales, Australia
| | - Simone Marschner
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Westmead, New South Wales, Australia
| | - Andrew Coggins
- Department of Emergency Medicine, Westmead Hospital, Westmead, New South Wales, Australia
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at the Centenary Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Paul M Middleton
- South Western Emergency Research Institute, Ingham Institute, Liverpool, New South Wales, Australia
| | - Garry Jennings
- Sydney Health Partners, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Blake Angell
- The George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia
- UNSW Ageing Futures Institute, University of New South Wales, Kensington, New South Wales, Australia
| | - Saurabh Kumar
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Westmead, New South Wales, Australia
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Pramesh Kovoor
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Clara K Chow
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Westmead, New South Wales, Australia
- The George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
21
|
Chugh HS, Sargsyan A, Nakamura K, Uy-Evanado A, Dizon B, Norby FL, Young C, Hadduck K, Jui J, Shepherd D, Salvucci A, Chugh SS, Reinier K. Sudden cardiac arrest during the COVID-19 pandemic: A two-year prospective evaluation in a North American community. Heart Rhythm 2023; 20:947-955. [PMID: 36965652 PMCID: PMC10035806 DOI: 10.1016/j.hrthm.2023.03.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/03/2023] [Accepted: 03/19/2023] [Indexed: 03/27/2023]
Abstract
BACKGROUND Early during the coronavirus disease 2019 (COVID-19) pandemic, higher sudden cardiac arrest (SCA) incidence and lower survival rates were reported. However, ongoing effects on SCA during the evolving pandemic have not been evaluated. OBJECTIVE The purpose of this study was to assess the impact of COVID-19 on SCA during 2 years of the pandemic. METHODS In a prospective study of Ventura County, California (2020 population 843,843; 44.1% Hispanic), we compared SCA incidence and outcomes during the first 2 years of the COVID-19 pandemic to the prior 4 years. RESULTS Of 2222 out-of-hospital SCA cases identified, 907 occurred during the pandemic (March 2020 to February 2022) and 1315 occurred prepandemic (March 2016 to February 2020). Overall age-standardized annual SCA incidence increased from 39 per 100,000 (95% confidence [CI] 37-41) prepandemic to 54 per 100,000 (95% CI 50-57; P <.001) during the pandemic. Among Hispanics, incidence increased by 77%, from 38 per 100,000 (95% CI 34-43) to 68 per 100,000 (95% CI 60-76; P <.001). Among non-Hispanics, incidence increased by 26%, from 39 per 100,000 (95% CI 37-42; P <.001) to 50 per 100,000 (95% CI 46-54). SCA incidence rates closely tracked COVID-19 infection rates. During the pandemic, SCA survival was significantly reduced (15% to 10%; P <.001), and Hispanics were less likely than non-Hispanics to receive bystander cardiopulmonary resuscitation (45% vs 55%; P = .005) and to present with shockable rhythm (15% vs 24%; P = .003). CONCLUSION Overall SCA rates remained consistently higher and survival outcomes consistently lower, with exaggerated effects during COVID infection peaks. This longer evaluation uncovered higher increases in SCA incidence among Hispanics, with worse resuscitation profiles. Potential ethnicity-specific barriers to acute SCA care warrant urgent evaluation and intervention.
Collapse
Affiliation(s)
- Harpriya S Chugh
- Center for Cardiac Arrest Prevention, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, California
| | - Arayik Sargsyan
- Center for Cardiac Arrest Prevention, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, California
| | - Kotoka Nakamura
- Center for Cardiac Arrest Prevention, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, California
| | - Audrey Uy-Evanado
- Center for Cardiac Arrest Prevention, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, California
| | - Bernadine Dizon
- Center for Cardiac Arrest Prevention, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, California
| | - Faye L Norby
- Center for Cardiac Arrest Prevention, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, California
| | | | - Katy Hadduck
- Ventura County Health Care Agency, Ventura, California
| | - Jonathan Jui
- Department of Emergency Medicine, Oregon Health and Science University, Portland, Oregon
| | | | | | - Sumeet S Chugh
- Center for Cardiac Arrest Prevention, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, California.
| | - Kyndaron Reinier
- Center for Cardiac Arrest Prevention, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, California.
| |
Collapse
|
22
|
Sutton TS, Bailey DL, Rizvi A, Al-Araji R, Kasliwala Q, Nero T, Scalzo M, Panza G, Mather JF, Orlando R, Hashim S, McKay RG. Racial and Ethnic Disparities in the Treatment and Outcomes for Witnessed Out-of-Hospital Cardiac Arrest in Connecticut. Resuscitation 2023:109850. [PMID: 37230326 DOI: 10.1016/j.resuscitation.2023.109850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/14/2023] [Accepted: 05/15/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Racial and ethnic disparities in the treatment and outcomes for witnessed out-of-hospital cardiac arrest (OHCA) in the United States have been previously described. We sought to characterize disparities in pre-hospital care, overall survival, and survival with favorable neurological outcomes following witnessed OHCA in the state of Connecticut. METHODS We performed a cross-sectional study to compare pre-hospital treatment and outcomes for White versus Black and Hispanic (Minority) OHCA patients submitted from Connecticut to the Cardiac Arrest Registry to Enhance Survival (CARES) between 2013 and 2021. Primary outcomes included bystander CPR use, bystander automated external defibrillator (AED) use with attempted defibrillation, overall survival, and survival with favorable cerebral function. RESULTS 2,809 patients with witnessed OHCA were analyzed (924 Black or Hispanic; 1885 White). Minorities had lower rates of bystander CPR (31.4% vs 39.1%, P=0.002) and bystander AED placement with attempted defibrillation (10.5% vs 14.4%, P=0.004), with lower rates of survival to hospital discharge (10.3% vs 14.8%, P=0.001) and survival with favorable cerebral function (65.3% vs 80.2%, P=0.003). Minorities were less likely to receive bystander CPR in communities with median annual household income >$80, 000 (OR, 0.56; 95% CI, 0.33 - 0.95; P=0.030) and in integrated neighborhoods (OR, 0.70; 95% CI, 0.52 - 0.95; P=0.020). CONCLUSIONS Black and Hispanic Connecticut patients with witnessed OHCA have lower rates of bystander CPR, attempted AED defibrillation, overall survival, and survival with favorable neurological outcomes compared to White patients. Minorities were less likely to receive bystander CPR in affluent and integrated communities.
Collapse
Affiliation(s)
| | | | - Asad Rizvi
- Department of Cardiology, Hartford Hospital
| | | | | | - Thomas Nero
- Department of Cardiology, St Vincent's Medical Center
| | | | - Gregory Panza
- Department of Research Administration, Hartford Hospital
| | - Jeff F Mather
- Department of Research Administration, Hartford Hospital
| | | | - Sabet Hashim
- Department of Cardiac Surgery, Hartford Hospital
| | | |
Collapse
|
23
|
Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Beaton AZ, Boehme AK, Buxton AE, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Fugar S, Generoso G, Heard DG, Hiremath S, Ho JE, Kalani R, Kazi DS, Ko D, Levine DA, Liu J, Ma J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Virani SS, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation 2023; 147:e93-e621. [PMID: 36695182 DOI: 10.1161/cir.0000000000001123] [Citation(s) in RCA: 1305] [Impact Index Per Article: 1305.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
Collapse
|
24
|
Farquharson B, Dixon D, Williams B, Torrens C, Philpott M, Laidlaw H, McDermott S. The psychological and behavioural factors associated with laypeople initiating CPR for out-of-hospital cardiac arrest: a systematic review. BMC Cardiovasc Disord 2023; 23:19. [PMID: 36639764 PMCID: PMC9840280 DOI: 10.1186/s12872-022-02904-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/17/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Prompt, effective CPR greatly increases the chances of survival in out-of-hospital c ardiac arrest. However, it is often not provided, even by people who have previously undertaken training. Psychological and behavioural factors are likely to be important in relation to CPR initiation by lay-people but have not yet been systematically identified. METHODS Aim: to identify the psychological and behavioural factors associated with CPR initiation amongst lay-people. DESIGN Systematic review Data sources: Cochrane Library, MEDLINE, EMBASE, CINAHL, PsycInfo and Google Scholar. STUDY ELIGIBILITY CRITERIA Primary studies reporting psychological or behavioural factors and data on CPR initiation involving lay-people published (inception to 31 Dec 2021). STUDY APPRAISAL AND SYNTHESIS METHODS Potential studies were screened independently by two reviewers. Study characteristics, psychological and behavioural factors associated with CPR initiation were extracted from included studies, categorised by study type and synthesised narratively. RESULTS One hundred and five studies (150,820 participants) comprising various designs, populations and of mostly weak quality were identified. The strongest and most ecologically valid studies identified factors associated with CPR initiation: the overwhelming emotion of the situation, perceptions of capability, uncertainty about when CPR is appropriate, feeling unprepared and fear of doing harm. Current evidence comprises mainly atheoretical cross-sectional surveys using unvalidated measures with relatively little formal testing of relationships between proposed variables and CPR initiation. CONCLUSIONS Preparing people to manage strong emotions and increasing their perceptions of capability are likely important foci for interventions aiming to increase CPR initiation. The literature in this area would benefit from more robust study designs. SYSTEMATIC REVIEW REGISTRATION PROSPERO: CRD42018117438.
Collapse
Affiliation(s)
- Barbara Farquharson
- grid.11918.300000 0001 2248 4331NMAHP Research Unit, University of Stirling, Stirling, FK9 4LA UK
| | - Diane Dixon
- grid.7107.10000 0004 1936 7291University of Aberdeen, Aberdeen, UK
| | - Brian Williams
- grid.23378.3d0000 0001 2189 1357University of Highlands and Islands, Inverness, UK
| | - Claire Torrens
- grid.11918.300000 0001 2248 4331University of Stirling, Stirling, UK
| | - Melanie Philpott
- grid.11918.300000 0001 2248 4331University of Stirling, Stirling, UK
| | - Henriette Laidlaw
- grid.23378.3d0000 0001 2189 1357University of Highlands and Islands, Inverness, UK
| | | |
Collapse
|
25
|
Stadeli KM, Sonett D, Conrick KM, Moore M, Riesenberg M, Bulger EM, Meischke H, Vavilala MS. Perceptions of Prehospital Care for Patients With Limited English Proficiency Among Emergency Medical Technicians and Paramedics. JAMA Netw Open 2023; 6:e2253364. [PMID: 36705920 DOI: 10.1001/jamanetworkopen.2022.53364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
IMPORTANCE Patients with limited English proficiency (LEP) experience disparities in prehospital care. On-scene interactions between patients with LEP and emergency medical services (EMS) providers (ie, firefighters/emergency medical technicians [EMTs] and paramedics) are critical to high-quality care and have been minimally explored. OBJECTIVE To identify EMS-perceived barriers and facilitators to providing high-quality prehospital care for patients with LEP. DESIGN, SETTING, AND PARTICIPANTS In this qualitative study, semi-structured focus groups were conducted with firefighters/EMTs and paramedics with all levels of experience from urban areas with a high proportion of residents with LEP from July to September 2018. Data were analyzed from July 2018 to May 2019. EXPOSURES Providing prehospital care for patients with LEP. MAIN OUTCOMES AND MEASURES The main outcomes were barriers and facilitators to prehospital care for patients with LEP, assessed using thematic analysis. Four domains of interest were examined: (1) overall impressions of interactions with patients with LEP, (2) barriers and facilitators to communication, (3) barriers and facilitators to providing care, and (4) ideas for improving prehospital care for patients with LEP. RESULTS Thirty-nine EMS providers participated in 8 focus groups: 26 firefighters/EMTs (66%) and 13 paramedics (33%). The median age of participants was 46 years (range, 23-63 years), and 35 (90%) were male. Participants described barriers to optimal care as ineffective interpretation, cultural differences, high-stress scenarios (eg, violent events), unclear acuity of patient's condition, provider bias, and distrust of EMS. Perceived facilitators to optimal care included using an on-scene interpreter, high-acuity disease, relying on objective clinical findings, building trust and rapport, and conservative decision-making regarding treatment and transport. Providers reported transporting most patients with LEP to hospitals regardless of illness severity due to concern for miscommunication and unrecognized problems. Better speed and technology for interpretation, education for communities and EMS providers, and community-EMS interactions outside emergencies were cited as potential strategies for improvement. CONCLUSIONS AND RELEVANCE In this study, EMS providers described many barriers to high-quality care during prehospital emergency response for patients with LEP yet were unaware that these barriers impacted quality of care. Barriers including ineffective interpretation, provider bias, distrust of EMS, and cultural differences may contribute to outcome disparities and overutilization of resources. Future work should focus on the development of targeted interventions to improve modifiable barriers to care, such as improving interpretation and cultural humility and increasing trust.
Collapse
Affiliation(s)
- Kathryn M Stadeli
- Department of Surgery, University of California, Davis, Sacramento
- Department of Surgery, University of Washington, Seattle
- Harborview Injury Prevention and Research Center, University of Washington, Seattle
| | - Dylan Sonett
- Harborview Injury Prevention and Research Center, University of Washington, Seattle
- Physical Sciences Division, University of Washington Bothell, Seattle
| | - Kelsey M Conrick
- Harborview Injury Prevention and Research Center, University of Washington, Seattle
- School of Social Work, University of Washington, Seattle
| | - Megan Moore
- Harborview Injury Prevention and Research Center, University of Washington, Seattle
- School of Social Work, University of Washington, Seattle
| | - Matthew Riesenberg
- King County Medic One, King County Emergency Medical Services, Seattle, Washington
| | - Eileen M Bulger
- Department of Surgery, University of Washington, Seattle
- Harborview Injury Prevention and Research Center, University of Washington, Seattle
| | - Hendrika Meischke
- Department of Health Systems and Population Health, University of Washington, Seattle
| | - Monica S Vavilala
- Harborview Injury Prevention and Research Center, University of Washington, Seattle
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle
| |
Collapse
|
26
|
Uny I, Angus K, Duncan E, Dobbie F. Barriers and facilitators to delivering bystander cardiopulmonary resuscitation in deprived communities: a systematic review. Perspect Public Health 2023; 143:43-53. [PMID: 35100885 PMCID: PMC9912310 DOI: 10.1177/17579139211055497] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND There is a higher incidence of cardiac arrest in economically deprived areas; however, data show that bystander cardiopulmonary resuscitation (CPR) in those areas is lower. This results in lower survival rates, placing those communities at a double disadvantage. This systematic review explored the barriers and facilitators to engaging with bystander CPR in deprived communities. METHODS Studies were eligible for inclusion if they addressed any barrier or facilitator to performing bystander CPR or being trained in CPR or training others. Studies had to either be set in a deprived area or examine a deprived population. Selected studies were published between January 2000 and December 2017 and reported on primary research. No language limitations were applied. Searches were conducted in the following databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, PsycINFO, PubMed, and Web of Science Core Collection. Unpublished 'grey' literature was also searched as well as the reference lists of any relevant studies. RESULTS The systematic review highlighted several main factors acting as barriers or facilitators to engaging with bystander CPR in deprived communities: (1) the willingness to learn or perform CPR, (2) the confidence to perform CPR, and (3) self-reported likelihood of performing CPR. The review also revealed additional barriers to engaging with CPR which are specific to - or more acute for - individuals from socioeconomically deprived backgrounds or areas. DISCUSSION We found little evidence suggesting that the willingness to perform or learn bystander CPR is lower in deprived communities compared to the general population. However, the confidence to perform CPR in deprived communities was affected by some measures of socioeconomic status. The results also crucially highlighted other barriers more acute in deprived communities: the risk to personal safety in administering CPR; the fear of legal consequences; and the lack of community cohesion and other cultural barriers.
Collapse
Affiliation(s)
- I Uny
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling FK9 4LA, UK.
| | - K Angus
- Institute for Social Marketing and Health,
Faculty of Health Sciences and Sport, University of Stirling, Stirling,
UK
| | - E Duncan
- Nursing, Midwifery and Allied Health
Professions Research Unit, Faculty of Health Sciences and Sport, University
of Stirling, Stirling, UK
| | - F Dobbie
- Usher Institute, College of Medicine and
Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
27
|
Lakbar I, Ippolito M, Nassiri A, Delamarre L, Tadger P, Leone M, Einav S. Sex and out-of-hospital cardiac arrest survival: a systematic review. Ann Intensive Care 2022; 12:114. [PMID: 36534195 PMCID: PMC9763524 DOI: 10.1186/s13613-022-01091-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The literature is unresolved on whether female receive advanced cardiac life support less than do male and on whether female have a survival advantage over male after cardiopulmonary resuscitation. METHODS We systematically searched PubMed, Embase and Web of Science databases (from inception to 23-April-2022) for papers reporting outcomes in adult male and female after out-of-hospital cardiac arrest. The main study outcome was the rate of adjusted survival to hospital discharge or 30 days. Secondary outcomes included unadjusted survival to hospital discharge and favourable neurological outcome. RESULTS A total of 28 studies were included, involving 1,931,123 patients. Female were older than male, their cardiac arrests were less likely to be witnessed and less likely to present with a shockable rhythm. Unadjusted analysis showed that females had a lower likelihood of survival than males (OR 0.68 [0.62-0.74], I2 = 97%). After adjustment, no significant difference was identified between male and female in survival at hospital discharge/30 days (OR 1.01 [0.93-1.11], I2 = 87%). Data showed that male had a significantly higher likelihood of favorable neurological outcome in unadjusted analysis but this trend disappeared after adjustment. Both the primary outcome (adjusted for several variables) and the secondary outcomes were associated with substantial heterogeneity. The variables examined using meta-regression, subgroup and sensitivity analyses (i.e., study type, location, years, population, quality of adjustment, risk of bias) did not reduce heterogeneity. CONCLUSIONS The adjusted rate of survival to hospital discharge/30 days was similar for male and female despite an initial seeming survival advantage for male. The validity of this finding is limited by substantial heterogeneity despite in-depth investigation of its causes, which raises concerns regarding latent inequalities in some reports nonetheless. Further study on this topic may require inclusion of factors not reported in the Utstein template and in-depth analysis of decision-making processes.
Collapse
Affiliation(s)
- Ines Lakbar
- grid.5399.60000 0001 2176 4817Aix-Marseille University, Publique Hôpitaux de Marseille, Marseille, France ,grid.414244.30000 0004 1773 6284Department of Anesthesiology and Intensive Care, Hôpital Nord, 13015 Marseille, France ,grid.5399.60000 0001 2176 4817CEReSS, Health Service Research and Quality of Life Centre, School of Medicine – La Timone Medical, Aix-Marseille University, Marseille, France
| | - Mariachiara Ippolito
- grid.10776.370000 0004 1762 5517Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy ,grid.412510.30000 0004 1756 3088Department of Anaesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, Via del Vespro 129, 90127 Palermo, Italy
| | - Aviv Nassiri
- grid.9619.70000 0004 1937 0538Department of Military Medicine and Tzameret, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel ,Medical Corps, Israel Defense Forces, Tel HaShomer, Israel
| | - Louis Delamarre
- grid.5399.60000 0001 2176 4817Aix-Marseille University, Publique Hôpitaux de Marseille, Marseille, France ,grid.414244.30000 0004 1773 6284Department of Anesthesiology and Intensive Care, Hôpital Nord, 13015 Marseille, France
| | | | - Marc Leone
- grid.5399.60000 0001 2176 4817Aix-Marseille University, Publique Hôpitaux de Marseille, Marseille, France ,grid.414244.30000 0004 1773 6284Department of Anesthesiology and Intensive Care, Hôpital Nord, 13015 Marseille, France ,grid.5399.60000 0001 2176 4817CEReSS, Health Service Research and Quality of Life Centre, School of Medicine – La Timone Medical, Aix-Marseille University, Marseille, France
| | - Sharon Einav
- grid.415593.f0000 0004 0470 7791Intensive Care Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| |
Collapse
|
28
|
Mehta NK, Allam S, Mazimba S, Karim S. Racial, ethnic, and socioeconomic disparities in out-of-hospital cardiac arrest within the United States: Now is the time for change. Heart Rhythm O2 2022; 3:857-863. [PMID: 36588995 PMCID: PMC9795269 DOI: 10.1016/j.hroo.2022.07.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
This review highlights the current evidence on racial, ethnic, and socioeconomic disparities in cardiac arrest outcomes within the United States. Several studies demonstrate that patients from Black, Hispanic, or lower socioeconomic status backgrounds suffer the most from disparities at multiple levels of the resuscitation pathway, including in the provision of bystander cardiopulmonary resuscitation, defibrillator usage, and postresuscitation therapies. These gaps in care may altogether lead to lower survival rates and worse neurological outcomes for these patients. A multisystem, culturally sensitive approach to improving cardiac arrest outcomes is suggested in this article.
Collapse
Affiliation(s)
- Nishaki K. Mehta
- Department of Cardiovascular Medicine, William Beaumont Hospital, Oakland University School of Medicine, Royal Oak, Michigan
- Division of Cardiovascular Medicine, University of Virginia Medical Center, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Sahitya Allam
- Department of Internal Medicine, University of Maryland Medical Center, University of Maryland School of Medicine, Baltimore, Maryland
- Address reprint requests and correspondence: Dr Sahitya Allam, 22 S Greene St, Room N3E09, Baltimore, MD 21201.
| | - Sula Mazimba
- Division of Cardiovascular Medicine, University of Virginia Medical Center, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Saima Karim
- Division of Cardiovascular Medicine, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| |
Collapse
|
29
|
Farcas AM, Joiner AP, Rudman JS, Ramesh K, Torres G, Crowe RP, Curtis T, Tripp R, Bowers K, von Isenburg M, Logan R, Coaxum L, Salazar G, Lozano M, Page D, Haamid A. Disparities in Emergency Medical Services Care Delivery in the United States: A Scoping Review. PREHOSP EMERG CARE 2022; 27:1058-1071. [PMID: 36369725 DOI: 10.1080/10903127.2022.2142344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 10/25/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Emergency medical services (EMS) often serve as the first medical contact for ill or injured patients, representing a critical access point to the health care delivery continuum. While a growing body of literature suggests inequities in care within hospitals and emergency departments, limited research has comprehensively explored disparities related to patient demographic characteristics in prehospital care. OBJECTIVE We aimed to summarize the existing literature on disparities in prehospital care delivery for patients identifying as members of an underrepresented race, ethnicity, sex, gender, or sexual orientation group. METHODS We conducted a scoping review of peer-reviewed and non-peer-reviewed (gray) literature. We searched PubMed, CINAHL, Web of Science, Proquest Dissertations, Scopus, Google, and professional websites for studies set in the U.S. between 1960 and 2021. Each abstract and full-text article was screened by two reviewers. Studies written in English that addressed the underrepresented groups of interest and investigated EMS-related encounters were included. Studies were excluded if a disparity was noted incidentally but was not a stated objective or discussed. Data extraction was conducted using a standardized electronic form. Results were summarized qualitatively using an inductive approach. RESULTS One hundred forty-five full-text articles from the peer-reviewed literature and two articles from the gray literature met inclusion criteria: 25 studies investigated sex/gender, 61 studies investigated race/ethnicity, and 58 studies investigated both. One study investigated sexual orientation. The most common health conditions evaluated were out-of-hospital cardiac arrest (n = 50), acute coronary syndrome (n = 36), and stroke (n = 31). The phases of EMS care investigated included access (n = 55), pre-arrival care (n = 46), diagnosis/treatment (n = 42), and response/transport (n = 40), with several studies covering multiple phases. Disparities were identified related to all phases of EMS care for underrepresented groups, including symptom recognition, pain management, and stroke identification. The gray literature identified public perceptions of EMS clinicians' cultural competency and the ability to appropriately care for transgender patients in the prehospital setting. CONCLUSIONS Existing research highlights health disparities in EMS care delivery throughout multiple health outcomes and phases of EMS care. Future research is needed to identify structured mechanisms to eliminate disparities, address clinician bias, and provide high-quality equitable care for all patient populations.
Collapse
Affiliation(s)
- Andra M Farcas
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Anjni P Joiner
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Jordan S Rudman
- Harvard Affiliated Emergency Medicine Residency, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Karthik Ramesh
- School of Medicine, University of California San Diego, San Diego, California
| | | | | | | | - Rickquel Tripp
- Department of Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Karen Bowers
- Atlanta Fire Rescue Department; Department of Emergency Medicine, University of Tennessee-Chattanooga, Chattanooga, Tennessee
| | - Megan von Isenburg
- Duke University Medical Center Library, Duke University, Durham, North Carolina
| | - Robert Logan
- San Diego Fire - Rescue Department, San Diego, California
| | - Lauren Coaxum
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina
| | | | - Michael Lozano
- Division of Emergency Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - David Page
- Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Ameera Haamid
- Section of Emergency Medicine, University of Chicago School of Medicine, Chicago, Illinois
| |
Collapse
|
30
|
Garcia RA, Spertus JA, Girotra S, Nallamothu BK, Kennedy KF, McNally BF, Breathett K, Del Rios M, Sasson C, Chan PS. Racial and Ethnic Differences in Bystander CPR for Witnessed Cardiac Arrest. N Engl J Med 2022; 387:1569-1578. [PMID: 36300973 PMCID: PMC9760357 DOI: 10.1056/nejmoa2200798] [Citation(s) in RCA: 66] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Differences in the incidence of cardiopulmonary resuscitation (CPR) provided by bystanders contribute to survival disparities among persons with out-of-hospital cardiac arrest. It is critical to understand whether the incidence of bystander CPR in witnessed out-of-hospital cardiac arrests at home and in public settings differs according to the race or ethnic group of the person with cardiac arrest in order to inform interventions. METHODS Within a large U.S. registry, we identified 110,054 witnessed out-of-hospital cardiac arrests during the period from 2013 through 2019. We used a hierarchical logistic regression model to analyze the incidence of bystander CPR in Black or Hispanic persons as compared with White persons with witnessed cardiac arrests at home and in public locations. We analyzed the overall incidence as well as the incidence according to neighborhood racial or ethnic makeup and income strata. Neighborhoods were classified as predominantly White (>80% of residents), majority Black or Hispanic (>50% of residents), or integrated, and as high income (an annual median household income of >$80,000), middle income ($40,000-$80,000), or low income (<$40,000). RESULTS Overall, 35,469 of the witnessed out-of-hospital cardiac arrests (32.2%) occurred in Black or Hispanic persons. Black and Hispanic persons were less likely to receive bystander CPR at home (38.5%) than White persons (47.4%) (adjusted odds ratio, 0.74; 95% confidence interval [CI], 0.72 to 0.76) and less likely to receive bystander CPR in public locations than White persons (45.6% vs. 60.0%) (adjusted odds ratio, 0.63; 95% CI, 0.60 to 0.66). The incidence of bystander CPR among Black and Hispanic persons was less than that among White persons not only in predominantly White neighborhoods at home (adjusted odds ratio, 0.82; 95% CI, 0.74 to 0.90) and in public locations (adjusted odds ratio, 0.68; 95% CI, 0.60 to 0.75) but also in majority Black or Hispanic neighborhoods at home (adjusted odds ratio, 0.79; 95% CI, 0.75 to 0.83) and in public locations (adjusted odds ratio, 0.63; 95% CI, 0.59 to 0.68) and in integrated neighborhoods at home (adjusted odds ratio, 0.78; 95% CI, 0.74 to 0.81) and in public locations (adjusted odds ratio, 0.73; 95% CI, 0.68 to 0.77). Similarly, across all neighborhood income strata, the frequency of bystander CPR at home and in public locations was lower among Black and Hispanic persons with out-of-hospital cardiac arrest than among White persons. CONCLUSIONS In witnessed out-of-hospital cardiac arrest, Black and Hispanic persons were less likely than White persons to receive potentially lifesaving bystander CPR at home and in public locations, regardless of the racial or ethnic makeup or income level of the neighborhood where the cardiac arrest occurred. (Funded by the National Heart, Lung, and Blood Institute.).
Collapse
Affiliation(s)
- R Angel Garcia
- From Saint Luke's Mid America Heart Institute (R.A.G., J.A.S., K.F.K., P.S.C.) and University of Missouri-Kansas City (R.A.G., J.A.S., P.S.C.) - both in Kansas City, MO; University of Iowa Carver College of Medicine (S.G., M.D.R.) and the Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center (S.G.) - both in Iowa City; the Michigan Integrated Center for Health Analytics and Medical Prediction, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor (B.K.N.); Rollins School of Public Health, Emory University School of Medicine, Druid Hills, Georgia (B.F.M); the Division of Cardiology, Krannert Cardiovascular Research Center, Indiana University, Bloomington (K.B.); and the American Heart Association, Dallas (C.S.)
| | - John A Spertus
- From Saint Luke's Mid America Heart Institute (R.A.G., J.A.S., K.F.K., P.S.C.) and University of Missouri-Kansas City (R.A.G., J.A.S., P.S.C.) - both in Kansas City, MO; University of Iowa Carver College of Medicine (S.G., M.D.R.) and the Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center (S.G.) - both in Iowa City; the Michigan Integrated Center for Health Analytics and Medical Prediction, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor (B.K.N.); Rollins School of Public Health, Emory University School of Medicine, Druid Hills, Georgia (B.F.M); the Division of Cardiology, Krannert Cardiovascular Research Center, Indiana University, Bloomington (K.B.); and the American Heart Association, Dallas (C.S.)
| | - Saket Girotra
- From Saint Luke's Mid America Heart Institute (R.A.G., J.A.S., K.F.K., P.S.C.) and University of Missouri-Kansas City (R.A.G., J.A.S., P.S.C.) - both in Kansas City, MO; University of Iowa Carver College of Medicine (S.G., M.D.R.) and the Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center (S.G.) - both in Iowa City; the Michigan Integrated Center for Health Analytics and Medical Prediction, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor (B.K.N.); Rollins School of Public Health, Emory University School of Medicine, Druid Hills, Georgia (B.F.M); the Division of Cardiology, Krannert Cardiovascular Research Center, Indiana University, Bloomington (K.B.); and the American Heart Association, Dallas (C.S.)
| | - Brahmajee K Nallamothu
- From Saint Luke's Mid America Heart Institute (R.A.G., J.A.S., K.F.K., P.S.C.) and University of Missouri-Kansas City (R.A.G., J.A.S., P.S.C.) - both in Kansas City, MO; University of Iowa Carver College of Medicine (S.G., M.D.R.) and the Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center (S.G.) - both in Iowa City; the Michigan Integrated Center for Health Analytics and Medical Prediction, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor (B.K.N.); Rollins School of Public Health, Emory University School of Medicine, Druid Hills, Georgia (B.F.M); the Division of Cardiology, Krannert Cardiovascular Research Center, Indiana University, Bloomington (K.B.); and the American Heart Association, Dallas (C.S.)
| | - Kevin F Kennedy
- From Saint Luke's Mid America Heart Institute (R.A.G., J.A.S., K.F.K., P.S.C.) and University of Missouri-Kansas City (R.A.G., J.A.S., P.S.C.) - both in Kansas City, MO; University of Iowa Carver College of Medicine (S.G., M.D.R.) and the Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center (S.G.) - both in Iowa City; the Michigan Integrated Center for Health Analytics and Medical Prediction, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor (B.K.N.); Rollins School of Public Health, Emory University School of Medicine, Druid Hills, Georgia (B.F.M); the Division of Cardiology, Krannert Cardiovascular Research Center, Indiana University, Bloomington (K.B.); and the American Heart Association, Dallas (C.S.)
| | - Bryan F McNally
- From Saint Luke's Mid America Heart Institute (R.A.G., J.A.S., K.F.K., P.S.C.) and University of Missouri-Kansas City (R.A.G., J.A.S., P.S.C.) - both in Kansas City, MO; University of Iowa Carver College of Medicine (S.G., M.D.R.) and the Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center (S.G.) - both in Iowa City; the Michigan Integrated Center for Health Analytics and Medical Prediction, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor (B.K.N.); Rollins School of Public Health, Emory University School of Medicine, Druid Hills, Georgia (B.F.M); the Division of Cardiology, Krannert Cardiovascular Research Center, Indiana University, Bloomington (K.B.); and the American Heart Association, Dallas (C.S.)
| | - Khadijah Breathett
- From Saint Luke's Mid America Heart Institute (R.A.G., J.A.S., K.F.K., P.S.C.) and University of Missouri-Kansas City (R.A.G., J.A.S., P.S.C.) - both in Kansas City, MO; University of Iowa Carver College of Medicine (S.G., M.D.R.) and the Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center (S.G.) - both in Iowa City; the Michigan Integrated Center for Health Analytics and Medical Prediction, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor (B.K.N.); Rollins School of Public Health, Emory University School of Medicine, Druid Hills, Georgia (B.F.M); the Division of Cardiology, Krannert Cardiovascular Research Center, Indiana University, Bloomington (K.B.); and the American Heart Association, Dallas (C.S.)
| | - Marina Del Rios
- From Saint Luke's Mid America Heart Institute (R.A.G., J.A.S., K.F.K., P.S.C.) and University of Missouri-Kansas City (R.A.G., J.A.S., P.S.C.) - both in Kansas City, MO; University of Iowa Carver College of Medicine (S.G., M.D.R.) and the Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center (S.G.) - both in Iowa City; the Michigan Integrated Center for Health Analytics and Medical Prediction, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor (B.K.N.); Rollins School of Public Health, Emory University School of Medicine, Druid Hills, Georgia (B.F.M); the Division of Cardiology, Krannert Cardiovascular Research Center, Indiana University, Bloomington (K.B.); and the American Heart Association, Dallas (C.S.)
| | - Comilla Sasson
- From Saint Luke's Mid America Heart Institute (R.A.G., J.A.S., K.F.K., P.S.C.) and University of Missouri-Kansas City (R.A.G., J.A.S., P.S.C.) - both in Kansas City, MO; University of Iowa Carver College of Medicine (S.G., M.D.R.) and the Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center (S.G.) - both in Iowa City; the Michigan Integrated Center for Health Analytics and Medical Prediction, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor (B.K.N.); Rollins School of Public Health, Emory University School of Medicine, Druid Hills, Georgia (B.F.M); the Division of Cardiology, Krannert Cardiovascular Research Center, Indiana University, Bloomington (K.B.); and the American Heart Association, Dallas (C.S.)
| | - Paul S Chan
- From Saint Luke's Mid America Heart Institute (R.A.G., J.A.S., K.F.K., P.S.C.) and University of Missouri-Kansas City (R.A.G., J.A.S., P.S.C.) - both in Kansas City, MO; University of Iowa Carver College of Medicine (S.G., M.D.R.) and the Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center (S.G.) - both in Iowa City; the Michigan Integrated Center for Health Analytics and Medical Prediction, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor (B.K.N.); Rollins School of Public Health, Emory University School of Medicine, Druid Hills, Georgia (B.F.M); the Division of Cardiology, Krannert Cardiovascular Research Center, Indiana University, Bloomington (K.B.); and the American Heart Association, Dallas (C.S.)
| |
Collapse
|
31
|
Chugh HS, Sargsyan A, Nakamura K, Uy-Evanado A, Dizon B, Norby FL, Young C, Hadduck K, Jui J, Shepherd D, Salvucci A, Chugh SS, Reinier K. Ethnicity-Specific Effects on Cardiac Arrest During the COVID-19 Pandemic: A Two-Year Prospective Evaluation in a North American Community. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2022.10.15.22281071. [PMID: 36299424 PMCID: PMC9603830 DOI: 10.1101/2022.10.15.22281071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
Background Out-of-hospital sudden cardiac arrest (SCA) is a major public health problem with mortality >90%, and incidence has increased during the COVID-19 pandemic. Information regarding ethnicity-specific effects on SCA incidence and survival is lacking. Methods In a prospective, population-based study of Ventura County, CA residents (2020 Pop. 843,843; 44.1% Hispanic), we compared SCA incidence and outcomes during the first two years of the COVID-19 pandemic to the prior four years, overall and by ethnicity (Hispanic vs non-Hispanic). Findings Of 2,222 OHCA cases identified, 907 occurred during the pandemic (March 2020 - Feb 2022) and 1315 occurred pre-pandemic (March 2016 - Feb 2020). Overall age-standardized annual SCA incidence increased from 38.9/100,000 [95% CI 36.8-41.0] pre-pandemic to 53.8/100,00 [95% CI 50.3 - 57.3, p<0.001] during the pandemic. Among Hispanics, incidence increased by 77%, from 38.2/100,00 [95% CI 33.8-42.5] to 67.7/100,00 [95% CI 59.5- 75.8, p<0.001]. Among non-Hispanics, incidence increased by 26% from 39.4/100,000 [95% CI 36.9-41.9, p<0.001] to 49.8/100,00 [95% CI 45.8-53.8]. SCA incidence rates closely tracked COVID-19 infection rates. During the pandemic, SCA survival was significantly reduced (15.3% to 10.0%, p<0.001) and Hispanics were less likely than non-Hispanics to have bystander CPR (44.6% vs. 54.7%, p=0.005) and shockable rhythm (15.3% vs. 24.1%, p=0.003). Interpretation Hispanic residents experienced higher SCA rates during the pandemic with less favorable resuscitation profiles. These findings implicate potential ethnicity-specific barriers to acute care and represent an urgent call to action at the community and health-system levels. Funding National Heart Lung and Blood Institute Grants R01HL145675 and R01HL147358.
Collapse
|
32
|
Neighborhood-level out-of-hospital cardiac arrest risk and the impact of local CPR interventions. Resusc Plus 2022; 11:100274. [PMID: 35865217 PMCID: PMC9294624 DOI: 10.1016/j.resplu.2022.100274] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/13/2022] [Accepted: 07/01/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction Methods Results Conclusions
Collapse
|
33
|
Johnson LM, Devereux PG, Wagner KD. The group-based law enforcement mistrust scale: psychometric properties of an adapted scale and implications for public health and harm reduction research. Harm Reduct J 2022; 19:60. [PMID: 35658873 PMCID: PMC9166459 DOI: 10.1186/s12954-022-00635-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 05/17/2022] [Indexed: 12/03/2022] Open
Abstract
Background Negative encounters with law enforcement—direct and vicarious—fuel mistrust. When considered as part of the ‘risk environment’ in public health and harm reduction research, law enforcement mistrust may have broad implications. For example, fearing arrest may prevent someone from calling 911 when witnessing an overdose or lead to syringe-sharing and community spread of HIV. For people in the US who identify as Black or African American, these effects may compound, given the ways in which communities of color have been overpoliced. The purpose of this study is to investigate the psychometrics of an adapted scale of law enforcement mistrust—the Group-Based Law Enforcement Mistrust Scale (GBLEMS)—and evaluate its associations with racial and ethnic identity and experiences with law enforcement. Methods This cross-sectional survey took place in a small city in the Western United States where only 3% of the population is Black or African American. The sample included Black or African American and Hispanic and Latina women at risk of HIV, and members of their social networks, yielding a diverse sample across racial, ethnic, and gender identities (N = 219). The GBLEMS is a 12-item scale adapted from the Group-Based Medical Mistrust Scale (GBMMS; Thompson et al. 2004). The current analysis evaluated the psychometric properties of the GBLEMS (reliability, exploratory factor analysis) and its associations with demographics, other race-based constructs, and experiences with law enforcement. Results The GBLEMS demonstrated strong reliability (Cronbach’s alpha = 0.92) and exploratory factor analysis indicated that items loaded onto two factors—mistrust and disparities in treatment. There was also support for the scale’s construct validity. As hypothesized, GBLEMS scores were higher among respondents who identify as Black or African American, and among those who reported other experiences of racial discrimination, medical mistrust, and negative encounters with law enforcement. Conclusions This study yielded support for the reliability and validity of the GBLEMS as a multi-item, two-factor scale measuring group-based law enforcement mistrust. When framing public health and harm reduction research in terms of the risk environment, law enforcement mistrust may be important to measure as part of a comprehensive approach that addresses persistent racial disparities.
Collapse
Affiliation(s)
- Laura M Johnson
- School of Public Health, University of Nevada, Reno, 1664 N Virginia Street, Reno, NV, 89557, USA
| | - Paul G Devereux
- School of Public Health, University of Nevada, Reno, 1664 N Virginia Street, Reno, NV, 89557, USA
| | - Karla D Wagner
- School of Public Health, University of Nevada, Reno, 1664 N Virginia Street, Reno, NV, 89557, USA.
| |
Collapse
|
34
|
Abstract
PURPOSE OF REVIEW Out-of-hospital cardiac arrest (OHCA) is a time-critical emergency in which a rapid response following the chain of survival is crucial to save life. Disparities in care can occur at each link in this pathway and hence produce health inequities. This review summarises the health inequities that exist for OHCA patients and suggests how they may be addressed. RECENT FINDINGS There is international evidence that the incidence of OHCA is increased with increasing deprivation and in ethnic minorities. These groups have lower rates of bystander CPR and bystander-initiated defibrillation, which may be due to barriers in accessing cardiopulmonary resuscitation training, provision of public access defibrillators, and language barriers with emergency call handlers. There are also disparities in the ambulance response and in-hospital care following resuscitation. These disadvantaged communities have poorer survival following OHCA. SUMMARY OHCA disproportionately affects deprived communities and ethnic minorities. These groups experience disparities in care throughout the chain of survival and this appears to translate into poorer outcomes. Addressing these inequities will require coordinated action that engages with disadvantaged communities.
Collapse
|
35
|
McDade JE, Deming HC, Jinks-Chang S, Paulsen MR, Bui AL, Vavilala MS, Rivara FP, Bulger EM. Stop the Bleed Training for High School Students: Guardian Attitudes and Their Association with Prior Trauma. THE JOURNAL OF SCHOOL HEALTH 2022; 92:345-352. [PMID: 35098532 DOI: 10.1111/josh.13134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 07/27/2021] [Accepted: 08/22/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Uncontrolled bleeding is the leading preventable cause of death after injury. Stop the Bleed (STB) is a bleeding control training with proposed expansion into schools. However, the attitudes of guardians, specifically those with past trauma/injury, towards expanding STB into schools are unknown. METHODS A cross-sectional survey evaluated guardian attitudes towards STB training in high schools, and compared responses between guardians based on the experience of prior trauma. Logistic regression models evaluated the association between prior trauma and guardian-reported acceptability of STB training. RESULTS Of 750 guardians who received the survey, 484 (64.5%) responded. Most guardians (95.3%) wanted their child trained. Few (4.2%) felt this training would be harmful; 44.9% felt their child might be held responsible if something went wrong, and 28.4% reported it might be too scary for their child. In adjusted models, guardians with prior trauma were more likely to want their child trained (odds ratio [OR] = 3.50, 95% confidence interval [CI] 1.11-15.50), and identify STB as important to them (OR = 4.07, 95% CI 1.66-12.26). CONCLUSION Our results support STB training in high schools, and guardians with a trauma history may be more likely to want their child trained. Further work to understand the perceived potential harm, and work to design trauma-informed first-response trainings is warranted.
Collapse
Affiliation(s)
- Jessica E McDade
- Pediatric Critical Care Medicine Fellow , Division of Pediatric Critical Care Medicine, University of Washington. 4800 Sandpoint Way, Seattle, WA 98105
| | - Hannah C Deming
- Chief Pediatric Resident, , Department of Pediatrics, University of Washington. 4800 Sandpoint Way, Seattle, WA 98105
| | - Samara Jinks-Chang
- Chief Pediatric Resident, , Department of Pediatrics, University of Washington. 4800 Sandpoint Way, 98105, Seattle, WA 98105
| | - Maria R Paulsen
- Trauma Outreach Education Coordinator, , Harborview Injury Prevention and Research Center and Department of Surgery, University of Washington. 325 9th Avenue, MS 359796, Seattle, WA 98104
| | - Anthony L Bui
- Pediatric Resident, , Department of Pediatrics, University of Washington. 4800 Sandpoint Way NE, Seattle, WA 98105
| | - Monica S Vavilala
- Professor, Department of Anesthesiology and Pain Medicine and Pediatrics; Adjunct Professor, , Health Systems and Population Health, School of Public Health; Director, Harborview Injury Prevention and Research Center, University of Washington. 325 9th Avenue, Box 359960, Seattle, WA 98104
| | - Frederick P Rivara
- Professor, Department of Pediatrics; Professor, Department of Epidemiology; Co-director, , Harborview Firearm Injury Policy and Research Program, University of Washington. 325 9th Avenue, Box 359960, Seattle, Washington, 98104; Children's Hospital Guild Association Endowed Chair in Pediatric Health Outcomes Research, Center for Child Health, Behavior and Development, Seattle Children's Hospital; 4800 Sandpoint Way NE, Seattle, WA 98105
| | - Eileen M Bulger
- Professor, Division of Trauma, Burn, and Critical Care Surgery; Chief of Trauma, , Harborview Medical Center; Core Faculty, Harborview Injury Prevention and Research Center, University of Washington; 325 9th Avenue, Seattle, WA 98104
| |
Collapse
|
36
|
Tsao CW, Aday AW, Almarzooq ZI, Alonso A, Beaton AZ, Bittencourt MS, Boehme AK, Buxton AE, Carson AP, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Ferguson JF, Generoso G, Ho JE, Kalani R, Khan SS, Kissela BM, Knutson KL, Levine DA, Lewis TT, Liu J, Loop MS, Ma J, Mussolino ME, Navaneethan SD, Perak AM, Poudel R, Rezk-Hanna M, Roth GA, Schroeder EB, Shah SH, Thacker EL, VanWagner LB, Virani SS, Voecks JH, Wang NY, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association. Circulation 2022; 145:e153-e639. [PMID: 35078371 DOI: 10.1161/cir.0000000000001052] [Citation(s) in RCA: 2499] [Impact Index Per Article: 1249.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2022 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population and an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, and the global burden of cardiovascular disease and healthy life expectancy. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
Collapse
|
37
|
Metcalf SA, Saunders EC, Moore SK, Walsh O, Meier A, Auty S, Bessen SY, Marsch LA. Compassion, stigma, and professionalism among emergency personnel responding to the opioid crisis: An exploratory study in New Hampshire, USA. J Am Coll Emerg Physicians Open 2022; 3:e12641. [PMID: 35059691 PMCID: PMC8758975 DOI: 10.1002/emp2.12641] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/21/2021] [Accepted: 12/06/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Drug overdoses are the leading cause of death in the United States for those under 50 years of age, and New Hampshire has been disproportionately affected, resulting in increased encounters with the emergency response system. The ensuing impact on emergency personnel has received little attention. The present study aimed to explore the experiences and perspectives of emergency personnel responding to the opioid crisis in NH, with a focus on their views toward people who use opioids. METHODS Thirty-six emergency personnel (emergency department clinicians, n = 18; emergency medical service providers, n = 6; firefighters, n = 6; and police officers, n = 6) in 6 New Hampshire counties were interviewed about their experiences responding to overdoses and their perspectives on individuals who use opioids. Directed content analysis was used to identify themes in the transcribed, semistructured interviews. The results were reviewed for consensus. RESULTS Several categories of themes were identified among emergency personnel's accounts of their overdose response experiences and perspectives, including varied degrees of compassion and stigma toward people who use opioids; associations between compassion or stigma and policy- and practice-related themes, such as prehospital emergency care and the role of emergency departments (EDs); and primarily among personnel expressing compassion, a sense of professional responsibility that outweighed personal biases. CONCLUSIONS Despite the magnitude of the ongoing opioid crisis, some emergency personnel in New Hampshire have sustained or increased their compassion for people who use opioids. Others' perspectives remain or have become increasingly stigmatizing. The associations of compassion and stigma with various policy- and practice-related themes warrant further investigation.
Collapse
Affiliation(s)
- Stephen A. Metcalf
- Center for Technology and Behavioral HealthGeisel School of Medicine at Dartmouth CollegeLebanonNew HampshireUSA
- Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
| | - Elizabeth C. Saunders
- Center for Technology and Behavioral HealthGeisel School of Medicine at Dartmouth CollegeLebanonNew HampshireUSA
| | - Sarah K. Moore
- Center for Technology and Behavioral HealthGeisel School of Medicine at Dartmouth CollegeLebanonNew HampshireUSA
| | - Olivia Walsh
- Center for Technology and Behavioral HealthGeisel School of Medicine at Dartmouth CollegeLebanonNew HampshireUSA
- Mandel School of Applied Social SciencesCase Western Reserve UniversityClevelandOhioUSA
| | - Andrea Meier
- Center for Technology and Behavioral HealthGeisel School of Medicine at Dartmouth CollegeLebanonNew HampshireUSA
| | - Samantha Auty
- Center for Technology and Behavioral HealthGeisel School of Medicine at Dartmouth CollegeLebanonNew HampshireUSA
- Boston University School of Public HealthBostonMassachusettsUSA
| | - Sarah Y. Bessen
- Geisel School of Medicine at Dartmouth CollegeHanoverNew HampshireUSA
- Johns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Lisa A. Marsch
- Center for Technology and Behavioral HealthGeisel School of Medicine at Dartmouth CollegeLebanonNew HampshireUSA
| |
Collapse
|
38
|
Gutman CK, Lion KC, Fisher CL, Aronson PL, Patterson M, Fernandez R. Breaking through barriers: the need for effective research to promote language-concordant communication as a facilitator of equitable emergency care. J Am Coll Emerg Physicians Open 2022; 3:e12639. [PMID: 35072163 PMCID: PMC8759339 DOI: 10.1002/emp2.12639] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/10/2021] [Accepted: 12/14/2021] [Indexed: 02/05/2023] Open
Abstract
Individuals with limited English proficiency (LEP) are at high risk for adverse outcomes in the US health care system. This is particularly true for patients with LEP seeking care in the emergency department (ED). Although professional language interpretation improves the quality of care for these patients, it remains underused. The dynamic, discontinuous nature of an ED visit poses distinct challenges and opportunities for providing equitable, high-quality care for patients with LEP. Evidence-based best practices for identifying patients with LEP and using professional interpretation are well described but inadequately implemented. There are few examples in the literature of rigorous interventions to improve quality of care and outcomes for patients with LEP. There is an urgent need for high-quality research to improve communication with patients with LEP along the continuum of emergency care in order to achieve equity in outcomes.
Collapse
Affiliation(s)
- Colleen K Gutman
- Department of Emergency Medicine University of Florida College of Medicine Gainesville Florida USA
| | - K Casey Lion
- Department of Pediatrics University of Washington School of Medicine Seattle, Washington USA
- Center for Child Health, Behavior, and Development Seattle Children's Research Institute Seattle, Washington USA
| | - Carla L Fisher
- STEM Translational Communication Center University of Florida College of Journalism and Communication Gainesville Florida USA
- UF Health Cancer Center, Center for Arts in Medicine University of Florida Gainesville Florida USA
| | - Paul L Aronson
- Department of Pediatrics Yale School of Medicine New Haven Connecticut USA
- Department of Emergency Medicine Yale School of Medicine New Haven Connecticut USA
| | - Mary Patterson
- Department of Emergency Medicine University of Florida College of Medicine Gainesville Florida USA
- Center for Experiential Learning and Simulation University of Florida College of Medicine Gainesville Florida USA
| | - Rosemarie Fernandez
- Department of Emergency Medicine University of Florida College of Medicine Gainesville Florida USA
- Center for Experiential Learning and Simulation University of Florida College of Medicine Gainesville Florida USA
| |
Collapse
|
39
|
Melgoza E, Beltrán-Sánchez H, Bustamante AV. Emergency Medical Service Use Among Latinos Aged 50 and Older in California Counties, Except Los Angeles, During the Early COVID-19 Pandemic Period. Front Public Health 2021; 9:660289. [PMID: 34497790 PMCID: PMC8419352 DOI: 10.3389/fpubh.2021.660289] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 07/26/2021] [Indexed: 12/23/2022] Open
Abstract
The COVID-19 pandemic has disproportionately affected Latino adults aged 50 and older in California. Among adults aged 50-64, Latinos constitute approximately one-third (32%) of the population, but over half (52%) of COVID-19 cases, and more than two-thirds (64%) of COVID-related deaths as of June 2, 2021. These health disparities are also prevalent among Latinos 65 years and older who constitute 22% of the population, but 40% of confirmed COVID-19 cases and 50% of COVID-related deaths. Emergency medical services (EMS) are an essential component of the United States healthcare system and a vital sector in COVID-19 response efforts. Using data from the California Emergency Medical Services Information System (CEMSIS), this study examines racial and ethnic differences in respiratory distress related EMS calls among adults aged 50 and older in all counties except Los Angeles. This study compares the early pandemic period, January to June 2020, to the same time period in 2019. Between January and June 2019, Latinos aged 50 and older had statistically significantly lower odds of respiratory distress related EMS calls compared to Blacks, Asians, and Whites. During the early pandemic period, January to June 2020, Latinos aged 50 and older had statistically significantly lower odds of respiratory distress related EMS calls compared to Blacks but slightly higher odds compared to Whites. Differences by race/ethnicity and region were statistically significant. Understanding EMS health disparities is crucial to inform policies that create a more equitable prehospital care system for the heterogeneous population of middle aged and older adults.
Collapse
Affiliation(s)
- Esmeralda Melgoza
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, United States
- UCLA Latino Policy and Politics Initiative, Los Angeles, CA, United States
| | - Hiram Beltrán-Sánchez
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, United States
- UCLA Latino Policy and Politics Initiative, Los Angeles, CA, United States
- UCLA California Center for Population Research, Los Angeles, CA, United States
| | - Arturo Vargas Bustamante
- UCLA Latino Policy and Politics Initiative, Los Angeles, CA, United States
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, United States
| |
Collapse
|
40
|
Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Cheng S, Delling FN, Elkind MSV, Evenson KR, Ferguson JF, Gupta DK, Khan SS, Kissela BM, Knutson KL, Lee CD, Lewis TT, Liu J, Loop MS, Lutsey PL, Ma J, Mackey J, Martin SS, Matchar DB, Mussolino ME, Navaneethan SD, Perak AM, Roth GA, Samad Z, Satou GM, Schroeder EB, Shah SH, Shay CM, Stokes A, VanWagner LB, Wang NY, Tsao CW. Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation 2021; 143:e254-e743. [PMID: 33501848 DOI: 10.1161/cir.0000000000000950] [Citation(s) in RCA: 3101] [Impact Index Per Article: 1033.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2021 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors related to cardiovascular disease. RESULTS Each of the 27 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
Collapse
|
41
|
Magid KH, Ranney ML, Risica PM. Using the theory of planned behavior to understand intentions to perform bystander CPR among college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2021; 69:47-52. [PMID: 31483211 DOI: 10.1080/07448481.2019.1651729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 03/10/2019] [Accepted: 07/17/2019] [Indexed: 06/10/2023]
Abstract
The purpose of this study was to determine the extent to which the Theory of Planned Behavior (TPB) accounts for variability in intention to perform cardiopulmonary resuscitation (CPR) and to explore which constructs in the TPB most strongly predict intention to perform CPR among college students. Participants: Undergraduate college students (N = 588, 51% women) recruited between September and November 2016. Methods: A cross-sectional survey design. Results: Attitude was the strongest predictor of intention to perform CPR (β = 0.381, p < .001), followed by subjective norm (β = 0.303, p < .001), and perceived behavioral control (β = 0.167, p < .001). The TPB accounted for 51% of the variance in intention to perform CPR (F[3, 536] = 186, p < .001). Conclusion: Attitude and subjective norm are the strongest predictors of intention to perform CPR among college students. Resuscitation trainings that highlight positive outcomes and social norms associated with performing CPR may help bystanders form intentions to perform CPR in an emergency.
Collapse
Affiliation(s)
- Kate H Magid
- From Brown University School of Public Health, Providence, Rhode Island, USA
| | - Megan L Ranney
- From Brown University School of Public Health, Providence, Rhode Island, USA
- Department of Emergency Medicine, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Patricia M Risica
- From Brown University School of Public Health, Providence, Rhode Island, USA
- Department of Epidemiology and Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
| |
Collapse
|
42
|
Salhi RA, Fouche S, Mendel P, Nelson C, Fetters MD, Guetterman T, Forman J, Nham W, Goldstick JE, Lehrich J, Forbush B, Iovan S, Hsu A, Shields TA, Domeier R, Setodji CM, Neumar RW, Nallamothu BK, Abir M. Enhancing Prehospital Outcomes for Cardiac Arrest (EPOC) study: sequential mixed-methods study protocol in Michigan, USA. BMJ Open 2020; 10:e041277. [PMID: 33247025 PMCID: PMC7703417 DOI: 10.1136/bmjopen-2020-041277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/30/2020] [Accepted: 11/02/2020] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Out-of-hospital cardiac arrest (OHCA) is a common, life-threatening event encountered routinely by first responders, including police, fire and emergency medical services (EMS). Current literature suggests that there is significant regional variation in outcomes, some of which may be related to modifiable factors. Yet, there is a persistent knowledge gap regarding strategies to guide quality improvement efforts in OHCA care and, by extension, survival. The Enhancing Prehospital Outcomes for Cardiac Arrest (EPOC) study aims to fill these gaps and to improve outcomes. METHODS AND ANALYSIS This mixed-methods study includes three aims. In aim I, we will define variation in OHCA survival to the emergency department (ED) among EMS agencies that participate in the Michigan Cardiac Arrest Registry to Enhance Survival (CARES) in order to sample EMS agencies with high-survival and low-survival outcomes. In aim II, we will conduct site visits to emergency medical systems-including 911/dispatch, police, non-transport fire, and EMS agencies-in approximately eight high-survival and low-survival communities identified in aim I. At each site, key informant interviews and a multidisciplinary focus group will identify themes associated with high OHCA survival. Transcripts will be coded using a structured codebook and analysed through thematic analysis. Results from aims I and II will inform the development of a survey instrument in aim III that will be administered to all EMS agencies in Michigan. This survey will test the generalisability of factors associated with increased OHCA survival in the qualitative work to ultimately build an EPOC Toolkit which will be distributed to a broad range of stakeholders as a practical 'how-to' guide to improve outcomes. ETHICS AND DISSEMINATION The EPOC study was deemed exempt by the University of Michigan Institutional Review Board. Findings will be compiled in an 'EPOC Toolkit' and disseminated in the USA through partnerships including, but not limited to, policymakers, EMS leadership and health departments.
Collapse
Affiliation(s)
- Rama A Salhi
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Sydney Fouche
- Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | | | | | - Michael D Fetters
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Timothy Guetterman
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Jane Forman
- Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
- Center for Clinical Management Research, Veterans Affairs Health System, Ann Arbor, Michigan, USA
| | - Wilson Nham
- Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Jason E Goldstick
- Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Jessica Lehrich
- Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Bill Forbush
- City of Alpena Fire Department, Alpena County EMS, City of Alpena, Alpena, Michigan, USA
| | - Samantha Iovan
- Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Antony Hsu
- Department of Emergency Medicine, Saint Joseph Mercy Health System, Ann Arbor, Michigan, USA
| | - Theresa A Shields
- Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Robert Domeier
- Department of Emergency Medicine, Saint Joseph Mercy Health System, Ann Arbor, Michigan, USA
| | | | - Robert W Neumar
- Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Brahmajee K Nallamothu
- Division of Cardiovascular Diseases and the Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Mahshid Abir
- Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
- Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA
| |
Collapse
|
43
|
Riccò M, Berrone M, Vezzosi L, Gualerzi G, Canal C, De Paolis G, Schallenberg G. Factors influencing the willingness to perform bystander cardiopulmonary resuscitation on the workplace: a study from North-Eastern Italy. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020180. [PMID: 33525292 PMCID: PMC7927506 DOI: 10.23750/abm.v91i4.8593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 07/11/2019] [Indexed: 11/23/2022]
Abstract
Background: Early bystander cardiopulmonary resuscitation (CPR) improves the chances of successful resuscitation and survival. However, few data are available regarding the willingness to perform CPR among First Aid Attendants on the Workplace (FAAWs) in Italy. The present study was performed in order to identify current attitudes of Italian FAAWs towards CPR. Methods: Between February and June 2017, FAAWs from the Autonomous Province of Trento were asked about their willingness to perform CPR through a structured questionnaire assessing their knowledge about CPR, and the reasons for hesitancy. A cumulative knowledge score (KS) was eventually calculated. Results: A total of 123 FAAWs (male 57.7%, mean age 45.2 years ± 10.1) completed the questionnaire. About 1/3 of participants (32.5%) had previously performed First Aid procedures. Overall, 77.2% exhibited willingness to perform CPR, and such attitude was more frequently reported by subjects younger than 40 years (29.5% vs. 10.7% in older subjects; p=0.045), perceiving First Aid training as useful (98.9% vs. 84.7%, p=0.002), and exhibiting a better knowledge of CPR (KS≥75%: 47.4% vs. 15.3%). The reasons for the unwillingness were inadequate knowledge and doubt regarding whether they could perform the techniques effectively. Eventually, KS was identified as the main predictor for willingness to perform CPR (OR 4.450, 95%CI 1.442-14.350). Conclusions: Willingness to perform CPR was seemingly high, and knowledge of CPR techniques was its main predictor. These findings emphasize the importance for an accurate CPR training, as well as for the surveillance of the quality of qualification courses.(www.actabiomedica.it)
Collapse
Affiliation(s)
- Matteo Riccò
- Azienda USL di Reggio EmiliaV.le Amendola n.2 - 42122 REServizio di Prevenzione e Sicurezza negli Ambienti di Lavoro (SPSAL)Dip. di Prevenzione.
| | - Mirco Berrone
- Provincial Agency for Health Services (APSS) of the Autonomous Province of Trento Department of Prevention, Operative Unit for Health and Safety in the Workplaces, Trento (TN).
| | - Luigi Vezzosi
- Azienda Socio Sanitaria Territoriale di Cremona, Direzione Medica Ospedale di Cremona.
| | - Giovanni Gualerzi
- School of Medicine and Surgery, Department of Medicine and Surgery, University of Parma, Parma (PR).
| | - Chiara Canal
- Provincial Agency for Health Services (APSS) of the Autonomous Province of Trento Department of Prevention, Operative Unit for Health and Safety in the Workplaces, Trento (TN).
| | - Giuseppe De Paolis
- Provincial Agency for Health Services (APSS) of the Autonomous Province of Trento Department of Prevention, Operative Unit for Health and Safety in the Workplaces, Trento (TN).
| | - Gert Schallenberg
- Provincial Agency for Health Services (APSS) of the Autonomous Province of Trento Department of Prevention, Operative Unit for Health and Safety in the Workplaces, Trento (TN).
| |
Collapse
|
44
|
Cheng A, Magid DJ, Auerbach M, Bhanji F, Bigham BL, Blewer AL, Dainty KN, Diederich E, Lin Y, Leary M, Mahgoub M, Mancini ME, Navarro K, Donoghue A. Part 6: Resuscitation Education Science: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2020; 142:S551-S579. [PMID: 33081527 DOI: 10.1161/cir.0000000000000903] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
45
|
Merchant RM, Topjian AA, Panchal AR, Cheng A, Aziz K, Berg KM, Lavonas EJ, Magid DJ. Part 1: Executive Summary: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2020; 142:S337-S357. [DOI: 10.1161/cir.0000000000000918] [Citation(s) in RCA: 190] [Impact Index Per Article: 47.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
46
|
Dobbie F, Uny I, Eadie D, Duncan E, Stead M, Bauld L, Angus K, Hassled L, MacInnes L, Clegg G. Barriers to bystander CPR in deprived communities: Findings from a qualitative study. PLoS One 2020; 15:e0233675. [PMID: 32520938 PMCID: PMC7286503 DOI: 10.1371/journal.pone.0233675] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 05/10/2020] [Indexed: 12/17/2022] Open
Abstract
STUDY AIM Rates of out of hospital cardiac arrest are higher in deprived communities. Bystander Cardiopulmonary Resuscitation (BCPR) can double the chance of survival but occurs less often in these communities in comparison to more affluent communities. People living in deprived communities are, therefore, doubly disadvantaged and there is limited evidence to explain why BCPR rates are lower. The aim of this paper is to examine the barriers to administering BCPR in deprived communities. METHOD Mixed method qualitative study with ten single sex focus groups (n = 61) conducted in deprived communities across central Scotland and 18 semi-structured interviews with stakeholders from the UK, Europe and the USA. RESULTS Two key themes related to confidence and environmental factors were identified to summarise the perceived barriers to administering BCPR in deprived communities. Barriers related to confidence included: self-efficacy; knowledge and awareness of how, and when, to administer CPR; accessing CPR training; having previous experience of administering BCPR; who required CPR; and whether the bystander was physically fit to give CPR. Environmental barriers focused on the safety of the physical environment in which people lived, and fear of reprisal from gangs or the police. CONCLUSIONS Barriers to administering BCPR identified in the general population are relevant to people living in deprived communities but are exacerbated by a range of contextual, individual and environmental factors. A one-size-fits-all approach is not sufficient to promote 'CPR readiness' in deprived communities. Future approaches to working with disadvantaged communities should be tailored to the local community.
Collapse
Affiliation(s)
- Fiona Dobbie
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom
- * E-mail:
| | - Isa Uny
- Institute for Social Marketing and Health, School of Health Sciences, University of Stirling, Stirling, United Kingdom
| | - Douglas Eadie
- Institute for Social Marketing and Health, School of Health Sciences, University of Stirling, Stirling, United Kingdom
| | - Edward Duncan
- Nursing Midwifery and Allied Health Professionals Research Unit, Faculty of Health Sciences and Sport, University of Stirling, Stirling, United Kingdom
| | - Martine Stead
- Institute for Social Marketing and Health, School of Health Sciences, University of Stirling, Stirling, United Kingdom
| | - Linda Bauld
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Kathryn Angus
- Institute for Social Marketing and Health, School of Health Sciences, University of Stirling, Stirling, United Kingdom
| | - Liz Hassled
- Resuscitation Research Group, The University of Edinburgh, Edinburgh, United Kingdom
| | - Lisa MacInnes
- Resuscitation Research Group, The University of Edinburgh, Edinburgh, United Kingdom
| | - Gareth Clegg
- Resuscitation Research Group, The University of Edinburgh, Edinburgh, United Kingdom
| |
Collapse
|
47
|
Risk and ROSC - Legal implications of bystander CPR. Resuscitation 2020; 151:99-102. [PMID: 32259608 DOI: 10.1016/j.resuscitation.2020.03.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 03/11/2020] [Accepted: 03/21/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Early bystander cardiopulmonary resuscitation (CPR) has been associated with better patient outcomes in cardiac arrest. Despite this, not all cases of cardiac arrest receive bystander intervention. Reasons for this gap include disparities in provision of bystander CPR between race, gender and age groups. Concern of legal liability for responders has also been described. We propose that bystanders are more likely to face litigation for lack of intervention compared to providing bystander CPR due to the presence of 'Good Samaritan' statutes in all 50 states. This review of the legal literature seeks to quantify the number of cases brought against bystanders in the US over the past 30 years and explore the reasons behind them. METHODS The Westlaw legal research database was searched for jury verdicts, settlements, and appellate opinions from all 50 states from 1989 to 2019 for personal injury or wrongful death lawsuits involving CPR. Of 506 cases manually reviewed by the authors, 170 were directly related to CPR. Case details including jurisdiction, location, date, plaintiff and defendant demographics, level of training of CPR provider, relationship to patient, motivation for the lawsuit, and case outcomes were recorded. RESULTS Our data show a significant difference in the number of cases of cases alleging battery versus negligence regarding provision of CPR. Of 170 cases, 167 were due to inadequate or untimely bystander CPR. Three cases alleging harm due to providing CPR were identified. CONCLUSIONS This study represents the largest single study of legal cases involving bystander CPR in the medical literature. The likelihood of litigation is significantly higher in cases with bystander CPR absent or delayed. The authors propose the inclusion of this data and reiteration of 'Good Samaritan' statutes in all 50 states during CPR training to reassure and encourage public response to cardiac arrests.
Collapse
|
48
|
Stadeli KM, Abdullahi D, Ali A, Conrick KM, Paulsen M, Bulger EM, Vavilala MS, Mohamed FB, Ali A, Ibrahim A. Working toward Equity in Emergencies (WE) through Stop the Bleed: A pilot collaborative health program with the Somali community in Seattle. Am J Surg 2020; 219:756-763. [PMID: 32204848 DOI: 10.1016/j.amjsurg.2020.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 02/28/2020] [Accepted: 03/04/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND We developed a culturally-adapted program (WE Stop the Bleed) to increase bleeding control knowledge and self-efficacy among Somali individuals, and to build trust between Somali individuals and first responders. METHODS WE Stop the Bleed was piloted in the Seattle Somali community with first responders as skills coaches. The program included: 1) adapted ACS Stop the Bleed program; 2) cultural exchange. We evaluated knowledge, self-efficacy, and trust between Somali participants and first responders using a pre/post survey. RESULTS Attendance exceeded a priori goals (27 community participants, 13 first responders). 96% of participants would recommend the training. Knowledge and self-efficacy improved pre/post (62%-72%, 65%-93% respectively). First responders indicated increased comfort with Somali individuals, and participants reported positive changes in perceptions of first responders. CONCLUSIONS WE Stop the Bleed is a feasible and acceptable program to increase bleeding control knowledge and self-efficacy among participants and build trust between participants and first responders.
Collapse
Affiliation(s)
- Kathryn M Stadeli
- Department of Surgery, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA.
| | - Dirir Abdullahi
- School of Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA; Somali Health Board, 625 Strander Blvd Building B, Tukwila, Washington, 98188, USA.
| | - Abdifatah Ali
- Somali Health Board, 625 Strander Blvd Building B, Tukwila, Washington, 98188, USA.
| | - Kelsey M Conrick
- School of Social Work, University of Washington, Seattle, WA, USA; Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA.
| | - Maria Paulsen
- Department of Surgery, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA.
| | - Eileen M Bulger
- Department of Surgery, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA.
| | - Monica S Vavilala
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA; Department of Anesthesiology, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA.
| | - Farah Bille Mohamed
- Somali Health Board, 625 Strander Blvd Building B, Tukwila, Washington, 98188, USA; Seattle and King County Public Health, 401 5th Ave, Seattle, WA, 98104, USA; Department of Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA.
| | - Ahmed Ali
- Somali Health Board, 625 Strander Blvd Building B, Tukwila, Washington, 98188, USA; Department of Global Health, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA.
| | - Anisa Ibrahim
- Somali Health Board, 625 Strander Blvd Building B, Tukwila, Washington, 98188, USA; Department of Pediatrics, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA.
| |
Collapse
|
49
|
Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Shay CM, Spartano NL, Stokes A, Tirschwell DL, VanWagner LB, Tsao CW. Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. Circulation 2020; 141:e139-e596. [PMID: 31992061 DOI: 10.1161/cir.0000000000000757] [Citation(s) in RCA: 4861] [Impact Index Per Article: 1215.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports on the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2020 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, metrics to assess and monitor healthy diets, an enhanced focus on social determinants of health, a focus on the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors, implementation strategies, and implications of the American Heart Association's 2020 Impact Goals. RESULTS Each of the 26 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, healthcare administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
Collapse
|
50
|
Blewer AL, Schmicker RH, Morrison LJ, Aufderheide TP, Daya M, Starks MA, May S, Idris AH, Callaway CW, Kudenchuk PJ, Vilke GM, Abella BS. Variation in Bystander Cardiopulmonary Resuscitation Delivery and Subsequent Survival From Out-of-Hospital Cardiac Arrest Based on Neighborhood-Level Ethnic Characteristics. Circulation 2019; 141:34-41. [PMID: 31887076 PMCID: PMC6993941 DOI: 10.1161/circulationaha.119.041541] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Bystander cardiopulmonary resuscitation (B-CPR) delivery and survival after out-of-hospital cardiac arrest vary at the neighborhood level, with lower survival seen in predominantly black neighborhoods. Although the Hispanic population is the fastest-growing minority population in the United States, few studies have assessed whether the proportion of Hispanic residents in a neighborhood is associated with B-CPR delivery and survival from out-of-hospital cardiac arrest. We assessed whether B-CPR rates and survival vary by neighborhood-level ethnicity. We hypothesized that neighborhoods with a higher proportion of Hispanic residents have lower B-CPR rates and lower survival. METHODS We conducted a retrospective cohort study using data from the Resuscitation Outcomes Consortium Epistry at US sites. Neighborhoods were classified by census tract based on percentage of Hispanic residents: <25%, 25% to 50%, 51% to 75%, or >75%. We independently modeled the likelihood of receipt of B-CPR and survival by neighborhood-level ethnicity controlling for site and patient-level confounding characteristics. RESULTS From 2011 to 2015, the Resuscitation Outcomes Consortium collected 27 481 US arrest events; after excluding pediatric arrests, emergency medical services-witnessed arrests, or arrests occurring in a healthcare or institutional facility, 18 927 were included. B-CPR was administered in 37% of events. In neighborhoods with <25% Hispanic residents, B-CPR was administered in 39% of events, whereas it was administered in 27% of events in neighborhoods with >75% Hispanic residents. Compared with <25% Hispanic neighborhoods in a multivariable analysis, out-of-hospital cardiac arrest in predominantly Hispanic neighborhoods had lower B-CPR rates (51% to 75% Hispanic: odds ratio, 0.79 [CI, 0.65-0.95], P=0.014; >75% Hispanic: odds ratio, 0.72 [CI, 0.55-0.96], P=0.025) and lower survival rates (global P value 0.029; >75% Hispanic: odds ratio, 0.56 [CI, 0.34-0.93], P=0.023). CONCLUSIONS Individuals with out-of-hospital cardiac arrest in predominantly Hispanic neighborhoods were less likely to receive B-CPR and had lower likelihood of survival. These findings suggest a need to understand the underlying disparities in cardiopulmonary resuscitationdelivery and an unmet cardiopulmonary resuscitationtraining need in Hispanic communities.
Collapse
Affiliation(s)
- Audrey L Blewer
- Department of Family Medicine and Community Health (A.L.B.), Duke University, Durham, NC
| | - Robert H Schmicker
- The Clinical Trial Center (R.H.S., S.M.), University of Washington, Seattle
| | - Laurie J Morrison
- Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Emergency Medicine, Department of Medicine, University of Toronto, Canada (L.J.M.)
| | - Tom P Aufderheide
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee (T.P.A.)
| | - Mohamud Daya
- Department of Emergency Medicine, Oregon Health and Science University, Portland (M.D.)
| | - Monique A Starks
- Duke Clinical Research Institute (M.A.S.), Duke University, Durham, NC
| | - Susanne May
- The Clinical Trial Center (R.H.S., S.M.), University of Washington, Seattle
| | - Ahamed H Idris
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas (A.H.I.)
| | | | | | - Gary M Vilke
- Department of Emergency Medicine, University of California San Diego, La Jolla (G.M.V.)
| | - Benjamin S Abella
- Department of Emergency Medicine and Center for Resuscitation Science, University of Pennsylvania, Philadelphia (B.S.A.)
| | | |
Collapse
|