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Jonsson H, Piscator E, Boström AM, Djärv T. Neurological function before and after an in-hospital cardiac arrest - A nationwide registry-based cohort study. Resuscitation 2024; 201:110284. [PMID: 38901664 DOI: 10.1016/j.resuscitation.2024.110284] [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: 02/01/2024] [Revised: 05/18/2024] [Accepted: 06/11/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND According to the Utstein Registry Template for in-hospital cardiac arrest (IHCA), a good neurological outcome is defined as either Cerebral Performance Category (CPC) 1-2 at discharge from hospital or unchanged CPC compared to baseline. However, the latter alternative has rarely been described in IHCA. This study aimed to examine CPC at admission to hospital, the occurrence of post-arrest neurological deterioration, and the factors associated with such deterioration. METHODS We studied adult IHCA survivors registered in the Swedish Registry of Cardiopulmonary Resuscitation between 2007 and 2022. The CPC was assessed based on information from admission and discharge from hospital. The data were analyzed using descriptive statistics and significance tests. RESULTS One in ten IHCA had a CPC score > 1 at admission to hospital. Out of 7,677 IHCA who survived until hospital discharge and had full CPC data, 6,774 (88%) had preserved CPC, 150 (2%) had improved CPC, and 753 (10%) had deteriorated CPC. Among the factors significantly associated with deteriorated neurological function are IHCA in a general ward or intensive care unit, non-shockable rhythm, no ECG surveillance, and a higher proportion of intra-arrest and post-resuscitation treatments (all p-values < 0,05). CONCLUSION Most patients had preserved neurological function compared to admission. Factors associated with deteriorated neurological function are mainly concordant with established risk factors for adverse outcomes and are primarily intra-arrest and post-resuscitation, making deterioration hard to predict. Further, every tenth survivor was admitted with CPC more than 1, stressing the use of unchanged CPC as an outcome in IHCA.
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Affiliation(s)
- Hanna Jonsson
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Medical Unit Aging, Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden.
| | - Eva Piscator
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Emergency Medicine, Capio S:t Görans Hospital, Stockholm, Sweden
| | - Anne-Marie Boström
- Medical Unit Aging, Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden; Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Research and Development Unit, Stockholms Sjukhem, Stockholm, Sweden
| | - Therese Djärv
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Medical Unit Acute/ Emergency Department, Karolinska University Hospital, Stockholm, Sweden
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Job C, Adenipekun B, Cleves A, Gill P, Samuriwo R. Health professionals implicit bias of patients with low socioeconomic status (SES) and its effects on clinical decision-making: a scoping review. BMJ Open 2024; 14:e081723. [PMID: 38960454 PMCID: PMC11227794 DOI: 10.1136/bmjopen-2023-081723] [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: 11/06/2023] [Accepted: 06/12/2024] [Indexed: 07/05/2024] Open
Abstract
OBJECTIVES Research indicates that people with lower socioeconomic status (SES) receive inferior healthcare and experience poorer health outcomes compared with those with higher SES, in part due to health professional (HP) bias. We conducted a scoping review of the impact of HP bias about SES on clinical decision-making and its effect on the care of adults with lower SES. DESIGN JBI scoping review methods were used to perform a systematic comprehensive search for literature. The scoping review protocol has been published in BMJ Open. DATA SOURCES Medline, Embase, ASSIA, Scopus and CINAHL were searched, from the first available start date of the individual database to March 2023. Two independent reviewers filtered and screened papers. ELIGIBILITY CRITERIA Studies of all designs were included in this review to provide a comprehensive map of the existing evidence of the impact of HP bias of SES on clinical decision-making and its effect on the care for people with lower SES. DATA EXTRACTION AND SYNTHESIS Data were gathered using an adapted JBI data extraction tool for systematic scoping reviews. RESULTS Sixty-seven papers were included from 1975 to 2023. 35 (73%) of the included primary research studies reported an association between HP SES bias and decision-making. Thirteen (27%) of the included primary research studies did not find an association between HP SES bias and decision-making. Stereotyping and bias can adversely affect decision-making when the HP is fatigued or has a high cognitive load. There is evidence of intersectionality which can have a powerful cumulative effect on HP assessment and subsequent decision-making. HP implicit bias may be mitigated through the assertiveness of the patient with low SES. CONCLUSION HP decision-making is at times influenced by non-medical factors for people of low SES, and assumptions are made based on implicit bias and stereotyping, which compound or exacerbate health inequalities. Research that focuses on decision-making when the HP has a high cognitive load, would help the health community to better understand this potential influence.
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Affiliation(s)
- Claire Job
- Cardiff University, Cardiff, UK
- Cardiff University, Cardiff, UK
| | | | | | - Paul Gill
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | - Ray Samuriwo
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
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Gonuguntla K, Chobufo MD, Shaik A, Patel N, Penmetsa M, Sattar Y, Thyagaturu H, Sama C, Alharbi A, Chan PS, Balla S. Impact of Social Vulnerability on Cardiac Arrest Mortality in the United States, 2016 to 2020. J Am Heart Assoc 2024; 13:e033411. [PMID: 38686873 PMCID: PMC11179923 DOI: 10.1161/jaha.123.033411] [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: 11/08/2023] [Accepted: 02/16/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Cardiac arrest is 1 of the leading causes of morbidity and mortality, with an estimated 340 000 out-of-hospital and 292 000 in-hospital cardiac arrest events per year in the United States. Survival rates are lower in certain racial and socioeconomic groups. METHODS AND RESULTS We performed a county-level cross-sectional longitudinal study using the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research multiple causes of death data set between 2016 and 2020 among individuals of all ages whose death was attributed to cardiac arrest. The Social Vulnerability Index is a composite measure that includes socioeconomic vulnerability, household composition, disability, individuals from racial and ethnic minority groups status and language, and housing and transportation domains. We examined the impact of social determinants on cardiac arrest mortality stratified by age, race, ethnicity, and sex in the United States. All age-adjusted mortality rate (cardiac arrest AAMRs) are reported as per 100 000. Overall cardiac arrest AAMR during the study period was 95.6. The cardiac arrest AAMR was higher for men compared with women (119.6 versus 89.9) and for the Black population compared with the White population (150.4 versus 92.3). The cardiac arrest AAMR increased from 64.8 in counties in quintile 1 of Social Vulnerability Index to 141 in quintile 5, with an average increase of 13% (95% CI, 9.8%-16.9%) in AAMR per quintile increase. CONCLUSIONS Mortality from cardiac arrest varies widely, with a >2-fold difference between the counties with the highest and lowest social vulnerability, highlighting the differential burden of cardiac arrest deaths throughout the United States based on social determinants of health.
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Affiliation(s)
- Karthik Gonuguntla
- Division of Cardiology West Virginia University Heart and Vascular Institute Morgantown WV
| | - Muchi Ditah Chobufo
- Division of Cardiology West Virginia University Heart and Vascular Institute Morgantown WV
| | - Ayesha Shaik
- Department of Cardiology Hartford Hospital Hartford CT
| | - Neel Patel
- Department of Medicine New York Medical College/Landmark Medical Center Woonsocket RI
| | - Mouna Penmetsa
- Department of Medicine University of Connecticut Farmington CT
| | - Yasar Sattar
- Division of Cardiology West Virginia University Heart and Vascular Institute Morgantown WV
| | - Harshith Thyagaturu
- Division of Cardiology West Virginia University Heart and Vascular Institute Morgantown WV
| | - Carlson Sama
- Division of Cardiology West Virginia University Heart and Vascular Institute Morgantown WV
| | - Anas Alharbi
- Division of Cardiology West Virginia University Heart and Vascular Institute Morgantown WV
| | - Paul S Chan
- Department of Cardiology Saint Luke's Mid-America Heart Institute Kansas City MO
| | - Sudarshan Balla
- Division of Cardiology West Virginia University Heart and Vascular Institute Morgantown WV
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Agerström J, Andréll C, Bremer A, Strömberg A, Årestedt K, Israelsson J. All Else Being Equal: Examining Treatment Bias and Stereotypes Based on Patient Ethnicity and Socioeconomic Status With In-Hospital Cardiac Arrest Clinical Vignettes. Heart Lung 2024; 63:86-91. [PMID: 37837719 DOI: 10.1016/j.hrtlng.2023.09.011] [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: 06/16/2023] [Revised: 09/08/2023] [Accepted: 09/27/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Research on ethnic and socioeconomic treatment differences following in-hospital cardiac arrest (IHCA) largely draws on register data. Due to the correlational nature of such data, it cannot be concluded whether detected differences reflect treatment bias/discrimination - whereby otherwise identical patients are treated differently solely due to sociodemographic factors. To be able to establish discrimination, experimental research is needed. OBJECTIVE The primary aim of this experimental study was to examine whether simulated IHCA patients receive different treatment recommendations based on ethnicity and socioeconomic status (SES), holding all other factors (e.g., health status) constant. Another aim was to examine health care professionals' (HCP) stereotypical beliefs about these groups. METHODS HCP (N = 235) working in acute care made anonymous treatment recommendations while reading IHCA clinical vignettes wherein the patient's ethnicity (Swedish vs. Middle Eastern) and SES had been manipulated. Afterwards they estimated to what extent hospital staff associate these patient groups with certain traits (stereotypes). RESULTS No significant differences in treatment recommendations for Swedish versus Middle Eastern or high versus low SES patients were found. Reported stereotypes about Middle Eastern patients were uniformly negative. SES-related stereotypes, however, were mixed. High SES patients were believed to be more competent (e.g., respected), but less warm (e.g., friendly) than low SES patients. CONCLUSIONS Swedish HCP do not seem to discriminate against patients with Middle Eastern or low SES backgrounds when recommending treatment for simulated IHCA cases, despite the existence of negative stereotypes about these groups. Implications for health care equality and quality are discussed.
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Affiliation(s)
- Jens Agerström
- Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Växjö 391 3232, Sweden.
| | - Cecilia Andréll
- Department of Clinical Sciences Lund, Anesthesiology and Intensive Care, Center for Cardiac Arrest, Faculty of Medicine, Lund University, Lund, Sweden
| | - Anders Bremer
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Växjö, Sweden
| | - Anna Strömberg
- Department of Health, Medicine and Caring Sciences and Department of Cardiology, Linköping University, Linköping, Sweden
| | - Kristofer Årestedt
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Växjö, Sweden; Department of Research, Region Kalmar County, Kalmar, Sweden
| | - Johan Israelsson
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Växjö, Sweden; Department of Internal Medicine, Division of Cardiology, Kalmar County Hospital, Kalmar, Sweden
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Bowman JK, Tulsky JA, Ouchi K. Mortality and healthcare resource utilization after cardiac arrest in the United States: A decade of unclear progress and stark disparities. Resuscitation 2023; 193:109985. [PMID: 37778616 PMCID: PMC11267241 DOI: 10.1016/j.resuscitation.2023.109985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 09/26/2023] [Indexed: 10/03/2023]
Affiliation(s)
- Jason K Bowman
- Department of Emergency Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychosocial Oncology and Palliative Care. Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
| | - James A Tulsky
- Department of Psychosocial Oncology and Palliative Care. Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA; Division of Palliative Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kei Ouchi
- Department of Emergency Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
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Højstrup S, Thomsen JH, Prescott E. Disparities in cardiovascular disease and treatment in the Nordic countries. THE LANCET REGIONAL HEALTH. EUROPE 2023; 33:100699. [PMID: 37953994 PMCID: PMC10636266 DOI: 10.1016/j.lanepe.2023.100699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/27/2023] [Accepted: 07/10/2023] [Indexed: 11/14/2023]
Abstract
The Nordic countries, including Denmark, Finland, Iceland, Norway, and Sweden have seen a steep decline in cardiovascular mortality in recent decades. They are among the most egalitarian countries by several measures, and all have universal, publicly funded welfare systems providing healthcare for all citizens. However, despite these seemingly ideal conditions, disparities in access to cardiovascular care and outcomes persist. To address this challenge, The Lancet Region Health-Europe convened experts from a broad range of countries to summarize the current state of knowledge on cardiovascular disease disparities across Europe. This Series Paper presents the main challenges in Nordic countries based on evidence from high-quality nationwide registries. Focusing on major cardiovascular health determinants, areas in need of improvement were identified. There is a need for addressing structural causes underlying these disparities, such as poverty and discrimination, but also to improve access to healthcare in deprived neighborhoods and to address underlying social determinants of health that may mitigate disparities in cardiovascular outcomes. Overall, while the Nordic countries have made great strides in promoting egalitarianism and providing universal healthcare, there is still much work to be done to ensure equitable access to care and improved cardiovascular outcomes for all members of society.
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Affiliation(s)
- Signe Højstrup
- Department of Cardiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Jakob Hartvig Thomsen
- Department of Cardiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Eva Prescott
- Department of Cardiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
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Wolfe JD, Waken RJ, Fanous E, Fox DK, May AM, Maddox KEJ. Variation in the Use of Targeted Temperature Management for Cardiac Arrest. Am J Cardiol 2023; 201:25-33. [PMID: 37352661 PMCID: PMC10960656 DOI: 10.1016/j.amjcard.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/27/2023] [Accepted: 06/01/2023] [Indexed: 06/25/2023]
Abstract
Targeted temperature management (TTM) is recommended for patients who do not respond after return of spontaneous circulation after cardiac arrest. However, the degree to which patients with cardiac arrest have access to this therapy on a national level is not known. Understanding hospital- and patient-level factors associated with receipt of TTM could inform interventions to improve access to this treatment among appropriate patients. Therefore, we performed a retrospective analysis using National Inpatient Sample data from 2016 to 2019. We used International Classification of Diseases, Tenth Edition diagnosis and procedure codes to identify adult patients with in-hospital and out-of-hospital cardiac arrest and receipt of TTM. We evaluated patient and hospital factors associated with receiving TTM. We identified 478,419 patients with cardiac arrest. Of those, 4,088 (0.85%) received TTM. Hospital use of TTM was driven by large, nonprofit, urban, teaching hospitals, with less use at other hospital types. There was significant regional variation in TTM capabilities, with the proportion of hospitals providing TTM ranging from >21% in the Mid-Atlantic region to <11% in the East and West South Central and Mountain regions. At the patient level, age >74 years (odds ratio [OR] 0.54, p <0.001), female gender (OR 0.89, p >0.001), and Hispanic ethnicity (OR 0.74, p <0.001) were all associated with decreased odds of receiving TTM. Patients with Medicare (OR 0.75, p <0.001) and Medicaid (OR 0.89, p = 0.027) were less likely than patients with private insurance to receive TTM. Part of these differences was driven by inequitable access to TTM-capable hospitals. In conclusion, TTM is rarely used after cardiac arrest. Hospital use of TTM is predominately limited to a subset of academic hospitals with substantial regional variation. Older age, female gender, Hispanic ethnicity, and Medicare or Medicaid insurance are all associated with a decreased likelihood of receiving TTM.
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Affiliation(s)
| | - R J Waken
- Division of Cardiology, Department of Medicine
| | | | | | - Adam M May
- Division of Cardiology, Department of Medicine
| | - Karen E Joynt Maddox
- Center for Health Economics and Policy, Institute for Public Health, Washington University in St Louis, St. Louis, Missouri.
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Gonuguntla K, Chobufo MD, Shaik A, Patel N, Penmetsa M, Sattar Y, Thyagaturu H, Chan PS, Balla S. Impact of social vulnerability on cardiac arrest mortality in the United States, 2016-2020. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.08.02.23293573. [PMID: 37577503 PMCID: PMC10418559 DOI: 10.1101/2023.08.02.23293573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Importance Cardiac arrest is one of the leading causes of morbidity and mortality, with an estimated 340,000 out-of-hospital and 292,000 in-hospital cardiac arrest events per year in the U.S. Survival rates are lower in certain racial and socioeconomic groups. Objective To examine the impact of social determinants on cardiac arrest mortality among adults stratified by age, race, and sex in the U.S. Design A county-level cross-sectional longitudinal study using death data between 2016 and 2020 from the Centers for Disease Control and Prevention's (CDC) Wide-Ranging Online Data for Epidemiologic Research (WONDER) database. Setting Using the multiple causes of death dataset from the CDC's WONDER database, cardiac arrests were identified using the International Classification of Diseases (ICD), tenth revision, clinical modification codes. Participants Individuals aged 15 years or more whose death was attributed to cardiac arrest. Exposures Social vulnerability index (SVI), reported by the CDC, is a composite measure that includes socioeconomic vulnerability, household composition, disability, minority status and language, and housing and transportation domains. Main outcomes and measures Cardiac arrest mortality per 100,000 adults. Results Overall age-adjusted cardiac arrest mortality (AAMR) during the study period was 95.6 per 100,000 persons. The AAMR was higher for men as compared with women (119.6 vs. 89.9 per 100,000) and for Black, as compared with White, adults (150.4 vs. 92.3 per 100,000). The AAMR increased from 64.8 per 100,000 persons in counties in Quintile 1 (Q1) of SVI to 141 per 100,000 persons in Quintile 5, with an average increase of 13% (95% CI: 9.8-16.9) in AAMR per quintile increase. Conclusion and relevance Mortality from cardiac arrest varies widely, with a more than 2-fold difference between the counties with the highest and lowest social vulnerability, highlighting the differential burden of cardiac arrest deaths throughout the U.S. based on social determinants of health.
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Affiliation(s)
- Karthik Gonuguntla
- Division of Cardiology, West Virginia University Heart & Vascular Institute, Morgantown, WV, USA
| | - Muchi Ditah Chobufo
- Division of Cardiology, West Virginia University Heart & Vascular Institute, Morgantown, WV, USA
| | - Ayesha Shaik
- Department of Cardiology, Hartford Hospital, Hartford, CT, USA
| | - Neel Patel
- Department of Medicine, New York Medical College/Landmark Medical Center, Woonsocket, RI, USA
| | - Mouna Penmetsa
- Department of Medicine, University of Connecticut, Farmington, CT, USA
| | - Yasar Sattar
- Division of Cardiology, West Virginia University Heart & Vascular Institute, Morgantown, WV, USA
| | - Harshith Thyagaturu
- Division of Cardiology, West Virginia University Heart & Vascular Institute, Morgantown, WV, USA
| | - Paul S. Chan
- Department of Cardiology, Saint Luke’s Mid-America Heart Institute, Kansas City, MO
| | - Sudarshan Balla
- Division of Cardiology, West Virginia University Heart & Vascular Institute, Morgantown, WV, USA
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Israelsson J, Carlsson M, Agerström J. A more conservative test of sex differences in the treatment and outcome of in-hospital cardiac arrest. Heart Lung 2023; 58:191-197. [PMID: 36571977 DOI: 10.1016/j.hrtlng.2022.12.008] [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: 10/02/2022] [Revised: 12/07/2022] [Accepted: 12/09/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND Studies investigating sex disparities related to treatment and outcome of in-hospital cardiac arrest (IHCA) have produced divergent findings and have typically been unable to adjust for outstanding confounding variables. OBJECTIVES The aim was to examine sex differences in treatment and survival following IHCA, using a comprehensive set of control variables including e.g., age, comorbidity, and patient-level socioeconomic status. METHODS This retrospective study was based on data from the Swedish Register of Cardiopulmonary Resuscitation and Statistics Sweden. In the primary analyses, logistic regression models and ordinary least square regressions were estimated. RESULTS The study included 24,217 patients and the majority (70.4%) were men. In the unadjusted analyses, women had a lower chance of survival after cardiopulmonary resuscitation (CPR) attempt, at hospital discharge (with good neurological function) and at 30 days (p<0.01). In the adjusted regression models, female sex was associated with a higher chance of survival after the CPR attempt (B = 1.09, p<0.01) and at 30-days (B = 1.09, p<0.05). In contrast, there was no significant association between sex and survival to discharge with good neurological outcome. Except for treatment duration (B=-0.07, p<0.01), no significant associations between sex and treatment were identified. CONCLUSIONS No signs of treatment disparities or discrimination related to sex were identified. However, women had a better chance of surviving IHCA compared to men. The finding that women went from having a survival disadvantage (unadjusted analysis) to a survival advantage (adjusted analysis) attests to the importance of including a comprehensive set of control variables, when examining sex differences.
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Affiliation(s)
- Johan Israelsson
- Department of Health and Caring sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar/Växjö, Sweden; Department of Internal Medicine, Division of Cardiology, Kalmar County Hospital, Kalmar, Sweden.
| | - Magnus Carlsson
- Department of Economics and Statistics, School of Business and Economics, Linnaeus University, Kalmar/Växjö, Sweden
| | - Jens Agerström
- Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Kalmar/Växjö, Sweden
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Hellsén G, Rawshani A, Skoglund K, Bergh N, Råmunddal T, Myredal A, Helleryd E, Taha A, Mahmoud A, Hjärtstam N, Backelin C, Dahlberg P, Hessulf F, Herlitz J, Engdahl J, Rawshani A. Predicting recurrent cardiac arrest in individuals surviving Out-of-Hospital cardiac arrest. Resuscitation 2023; 184:109678. [PMID: 36581182 DOI: 10.1016/j.resuscitation.2022.109678] [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: 10/31/2022] [Revised: 12/16/2022] [Accepted: 12/18/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Despite improvements in short-term survival for Out-of-Hospital Cardiac Arrest (OHCA) in the past two decades, long-term survival is still not well studied. Furthermore, the contribution of different variables on long-term survival have not been fully investigated. AIM Examine the 1-year prognosis of patients discharged from hospital after an OHCA. Furthermore, identify factors predicting re-arrest and/or death during 1-year follow-up. METHODS All patients 18 years or older surviving an OHCA and discharged from the hospital were identified from the Swedish Register for Cardiopulmonary Resuscitation (SRCR). Data on diagnoses, medications and socioeconomic factors was gathered from other Swedish registers. A machine learning model was constructed with 886 variables and evaluated for its predictive capabilities. Variable importance was gathered from the model and new models with the most important variables were created. RESULTS Out of the 5098 patients included, 902 (∼18%) suffered a recurrent cardiac arrest or death within a year. For the outcome death or re-arrest within 1 year from discharge the model achieved an ROC (receiver operating characteristics) AUC (area under the curve) of 0.73. A model with the 15 most important variables achieved an AUC of 0.69. CONCLUSIONS Survivors of an OHCA have a high risk of suffering a re-arrest or death within 1 year from hospital discharge. A machine learning model with 15 different variables, among which age, socioeconomic factors and neurofunctional status at hospital discharge, achieved almost the same predictive capabilities with reasonable precision as the full model with 886 variables.
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Affiliation(s)
- Gustaf Hellsén
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden.
| | - Aidin Rawshani
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Kristofer Skoglund
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Niklas Bergh
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Truls Råmunddal
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Anna Myredal
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Edvin Helleryd
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Amar Taha
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Ahmad Mahmoud
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Nellie Hjärtstam
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Charlotte Backelin
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Pia Dahlberg
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Fredrik Hessulf
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Johan Herlitz
- Research Centre PreHospen, University of Borås, Borås, Sweden
| | - Johan Engdahl
- Karolinska Institutet, Department of Clinical Sciences, Danderyds Hospital, Stockholm, Sweden
| | - Araz Rawshani
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
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Ho AFW, Ting PZY, Ho JSY, Fook-Chong S, Shahidah N, Pek PP, Liu N, Teoh S, Sia CH, Lim DYZ, Lim SL, Wong TH, Ong MEH. The Effect of Building-Level Socioeconomic Status on Bystander Cardiopulmonary Resuscitation: A Retrospective Cohort Study. PREHOSP EMERG CARE 2023; 27:205-212. [PMID: 35363103 DOI: 10.1080/10903127.2022.2061094] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Understanding the social determinants of bystander cardiopulmonary resuscitation (CPR) receipt can inform the design of public health interventions to increase bystander CPR. The association of socioeconomic status with bystander CPR is generally poorly understood. We evaluated the relationship between socioeconomic status and bystander CPR in cases of out-of-hospital cardiac arrest (OHCA). METHODS This was a retrospective cohort study based on the Singapore cohort of the Pan-Asian Resuscitation Outcomes Study registry between 2010 and 2018. We categorized patients into low, medium, and high Singapore Housing Index (SHI) levels-a building-level index of socioeconomic status. The primary outcome was receipt of bystander CPR. The secondary outcomes were prehospital return of spontaneous circulation and survival to discharge. RESULTS A total of 12,730 OHCA cases were included, the median age was 71 years, and 58.9% were male. The bystander CPR rate was 56.7%. Compared to patients in the low SHI category, those in the medium and high SHI categories were more likely to receive bystander CPR (medium SHI: adjusted odds ratio [aOR] 1.48, 95% CI 1.30-1.69; high SHI: aOR 1.93, 95% CI 1.67-2.24). High SHI patients had higher survival compared to low SHI patients on unadjusted analysis (OR 1.79, 95% CI 1.08-2.96), but not adjusted analysis (adjusted for age, sex, race, witness status, arrest time, past medical history of cancer, and first arrest rhythm). When comparing high with low SHI, females had larger increases in bystander CPR rates than males. CONCLUSIONS Lower building-level socioeconomic status was independently associated with lower rate of bystander CPR, and females were more susceptible to the effect of low socioeconomic status on lower rate of bystander CPR.
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Affiliation(s)
- Andrew Fu Wah Ho
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore.,Prehospital and Emergency Research Centre, Duke-NUS Medical School, Singapore, Singapore
| | | | - Jamie Sin Ying Ho
- Academic Foundation Programme, Royal Free London NHS Foundation Trust, London, UK
| | - Stephanie Fook-Chong
- Prehospital and Emergency Research Centre, Duke-NUS Medical School, Singapore, Singapore
| | - Nur Shahidah
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Pin Pin Pek
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore.,Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Nan Liu
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
| | - Seth Teoh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ching-Hui Sia
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Daniel Yan Zheng Lim
- Health Services Research Unit, Medical Board, Singapore General Hospital, Singapore, Singapore
| | - Shir Lynn Lim
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Ting Hway Wong
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.,Department of General Surgery, Singapore General Hospital, Singapore, Singapore
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore.,Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
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12
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Crea F. Physical exercise, inflammation, and hypertension: how to improve cardiovascular prevention. Eur Heart J 2022; 43:4763-4766. [PMID: 36473697 DOI: 10.1093/eurheartj/ehac695] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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13
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Avis SR, Figtree GA. Poorer care for the poor? Having fewer assets is associated with poorer care during, and worse outcomes after, an IHCA. Resuscitation 2022; 180:78-80. [PMID: 36167197 DOI: 10.1016/j.resuscitation.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 11/23/2022]
Affiliation(s)
- Suzanne R Avis
- Cardiovascular Discovery Group, Kolling Institute, University of Sydney, Sydney, Australia; Tasmanian School of Medicine, University of Tasmania, Sydney, Australia.
| | - Gemma A Figtree
- Cardiovascular Discovery Group, Kolling Institute, University of Sydney, Sydney, Australia
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14
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Stankovic N, Holmberg MJ, Granfeldt A, Andersen LW. Socioeconomic status and outcomes after in-hospital cardiac arrest. Resuscitation 2022; 180:140-149. [PMID: 36029912 DOI: 10.1016/j.resuscitation.2022.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 08/13/2022] [Accepted: 08/19/2022] [Indexed: 02/07/2023]
Abstract
AIM To investigate the association between socioeconomic status and outcomes after in-hospital cardiac arrest in Denmark. METHODS We conducted an observational cohort study based on nationwide registries and prospectively collected data on in-hospital cardiac arrest from 2017 and 2018 in Denmark. Unadjusted and adjusted analyses using regression models were performed to assess the association between socioeconomic status and outcomes after in-hospital cardiac arrest. Outcomes included return of spontaneous circulation (ROSC), survival to 30 days, survival to one year, and the duration of resuscitation among patients without ROSC. RESULTS A total of 3,223 patients with in-hospital cardiac arrest were included in the study. In the adjusted analyses, high household assets were associated with 1.20 (95 %CI: 0.96, 1.51) times the odds of ROSC, 1.49 (95 %CI: 1.14, 1.96) times the odds of survival to 30 days, 1.40 (95 %CI: 1.04, 1.90) times the odds of survival to one year, and 2.8 (95 %CI: 0.9, 4.7) minutes longer duration of resuscitation among patients without ROSC compared to low household assets. Similar albeit attenuated associations were observed for education. While high household income was associated with better outcomes in the unadjusted analyses, these associations largely disappeared in the adjusted analyses. CONCLUSIONS In this study of patients with in-hospital cardiac arrest, we found that high household assets were associated with a higher odds of survival and a longer duration of resuscitation among patients without ROSC compared to low household assets. However, the effect size may potentially be small. The results varied based on socioeconomic status measure, outcome of interest, and across adjusted analyses.
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Affiliation(s)
- Nikola Stankovic
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mathias J Holmberg
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Anesthesiology and Intensive Care, Randers Regional Hospital, Randers, Denmark
| | - Asger Granfeldt
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Lars W Andersen
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark; Prehospital Emergency Medical Services, Central Denmark Region, Denmark.
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15
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Pek PP, Blewer AL. Higher socioeconomic status is associated with lower in-hospital cardiac arrest: How can we address this socioeconomic inequality? Resuscitation 2022; 177:52-54. [PMID: 35777705 DOI: 10.1016/j.resuscitation.2022.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 10/17/2022]
Affiliation(s)
- Pin Pin Pek
- Prehospital and Emergency Research Centre , Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore; Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Audrey L Blewer
- Department of Family Medicine and Community Health, Durham, NC, USA; Department of Population Health Sciences, Durham, NC, USA; Duke University School of Medicine, Durham, NC, USA; Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.
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16
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Malik A, Gewarges M, Pezzutti O, Allan KS, Samman A, Akioyamen LE, Ruiz M, Brijmohan A, Basuita M, Tanaka D, Scales D, Luk A, Lawler P, Kalra S, Dorian P. Association between sex and survival after non-traumatic out of hospital cardiac arrest: A systematic review and meta-analysis. Resuscitation 2022; 179:172-182. [PMID: 35728744 DOI: 10.1016/j.resuscitation.2022.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Existing studies have shown conflicting results regarding the relationship of sex with survival after out of hospital cardiac arrest (OHCA). This systematic review evaluates the association of female sex with survival to discharge and survival to 30 days after non-traumatic OHCA. METHODS We searched Medline, Embase, CINAHL, Web of Science, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews from inception through June 2021 for studies evaluating female sex as a predictor of survival in adult patients with non-traumatic cardiac arrest. Random-effects inverse variance meta-analyses were performed to calculate pooled odds ratios (ORs) with 95% confidence intervals (CI). The GRADE approach was used to assess evidence quality. RESULTS Thirty studies including 1,068,788 patients had female proportion of 41%. There was no association for female sex with survival to discharge (OR 1.03, 95% CI 0.95-1.12; I2=89%). Subgroup analysis of low risk of bias studies demonstrated increased survival to discharge for female sex (OR 1.20, 95% CI 1.18-1.23; I2=0%) and with high certainty, the absolute increase in survival was 2.2% (95% CI 0.1%-3.6%). Female sex was not associated with survival to 30 days post-OHCA (OR 1.02, 95% CI 0.92-1.14; I2=79%). CONCLUSIONS In adult patients experiencing OHCA, with high certainty in the evidence from studies with low risk of bias, female sex had a small absolute difference for the outcome survival to discharge and no difference in survival at 30 days. Future models that aim to stratify risk of survival post-OHCA should focus on sex-specific factors as opposed to sex as an isolated prognostic factor.
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Affiliation(s)
- Abdullah Malik
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Mena Gewarges
- Division of Cardiology, St. Michael's Hospital, Toronto, ON, Canada
| | - Olivia Pezzutti
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Anas Samman
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Leo E Akioyamen
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Michael Ruiz
- Division of Cardiology, St. Michael's Hospital, Toronto, ON, Canada
| | - Angela Brijmohan
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Manpreet Basuita
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Dustin Tanaka
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Damon Scales
- Division of Critical Care, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Adriana Luk
- Division of Cardiology, Toronto General Hospital, Toronto, ON, Canada
| | - Patrick Lawler
- Division of Cardiology, Toronto General Hospital, Toronto, ON, Canada
| | - Sanjog Kalra
- Division of Cardiology, Toronto General Hospital, Toronto, ON, Canada
| | - Paul Dorian
- Division of Cardiology, St. Michael's Hospital, Toronto, ON, Canada.
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17
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Clinical characteristics and survival in patients with heart failure experiencing in hospital cardiac arrest. Sci Rep 2022; 12:5685. [PMID: 35383220 PMCID: PMC8983650 DOI: 10.1038/s41598-022-09510-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 03/23/2022] [Indexed: 11/16/2022] Open
Abstract
In patients with heart failure (HF) who suffered in-hospital cardiac arrest (IHCA), little is known about the characteristics, survival and neurological outcome. We used the Swedish Registry of Cardiopulmonary Resuscitation to study this, including patients aged ≥ 18 years suffering IHCA (2008–2019), categorised as HF alone, HF with acute myocardial infarction (AMI), AMI alone, or other. Odds ratios (OR) for 30-day survival, trends in 30-day survival, and the implication of HF phenotype was studied. 6378 patients had HF alone, 2111 had HF with AMI, 4210 had AMI alone. Crude 5-year survival was 9.6% for HF alone, 12.9% for HF with AMI and 34.6% for AMI alone. The 5-year survival was 7.9% for patients with HF and left ventricular ejection fraction (LVEF) ≥ 50%, 15.4% for LVEF < 40% and 12.3% for LVEF 40–49%. Compared with AMI alone, adjusted OR (95% CI) for 30-day survival was 0.66 (0.60–0.74) for HF alone, and 0.49 (0.43–0.57) for HF with AMI. OR for 30-day survival in 2017–2019 compared with 2008–2010 were 1.55 (1.24–1.93) for AMI alone, 1.37 (1.00–1.87) for HF with AMI and 1.30 (1.07–1.58) for HF alone. Survivors with HF had good neurological outcome in 92% of cases.
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18
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Abstract
Providers and health systems should use ethnic differences in risk of harm from healthcare to reimagine their role in reducing health inequalities, write Cian Wade and colleagues
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Affiliation(s)
- Cian Wade
- NHS England and NHS Improvement, London, UK
- Harvard T H Chan School of Public Health, Boston, MA, USA
| | | | | | - Charles Vincent
- Department of Experimental Psychology, University of Oxford, UK
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19
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Dawson LP, Andrew E, Nehme Z, Bloom J, Biswas S, Cox S, Anderson D, Stephenson M, Lefkovits J, Taylor AJ, Kaye D, Smith K, Stub D. Association of Socioeconomic Status With Outcomes and Care Quality in Patients Presenting With Undifferentiated Chest Pain in the Setting of Universal Health Care Coverage. J Am Heart Assoc 2022; 11:e024923. [PMID: 35322681 PMCID: PMC9075482 DOI: 10.1161/jaha.121.024923] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND This study aimed to assess whether there are disparities in incidence rates, care, and outcomes for patients with chest pain attended by emergency medical services according to socioeconomic status (SES) in a universal health coverage setting. METHODS AND RESULTS This was a population‐based cohort study of individually linked ambulance, emergency, hospital admission, and mortality data in the state of Victoria, Australia, from January 2015 to June 2019 that included 183 232 consecutive emergency medical services attendances for adults with nontraumatic chest pain (mean age 62 [SD 18] years; 51% women) and excluded out‐of‐hospital cardiac arrest and ST‐segment–elevation myocardial infarction. Age‐standardized incidence of chest pain was higher for patients residing in lower SES areas (lowest SES quintile 1595 versus highest SES quintile 760 per 100 000 person‐years; P<0.001). Patients of lower SES were less likely to attend metropolitan, private, or revascularization‐capable hospitals and had greater comorbidities. In multivariable models adjusted for clinical characteristics and final diagnosis, lower SES quintiles were associated with increased risks of 30‐day and long‐term mortality, readmission for chest pain and acute coronary syndrome, lower acuity emergency department triage categorization, emergency department length of stay >4 hours, and emergency department or emergency medical services discharge without hospital admission and were inversely associated with use of prehospital ECGs and transfer to a revascularization‐capable hospital for patients presenting to non‐percutaneous coronary intervention centers. CONCLUSIONS In this study, lower SES was associated with a higher incidence of chest pain presentations to emergency medical services and differences in care and outcomes. These findings suggest that substantial disparities for socioeconomically disadvantaged chest pain cohorts exist, even in the setting of universal health care access.
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Affiliation(s)
- Luke P Dawson
- Department of Cardiology The Alfred Hospital Melbourne Victoria Australia.,Department of Epidemiology and Preventive Medicine Monash University Melbourne Victoria Australia.,Department of Cardiology The Royal Melbourne Hospital Melbourne Victoria Australia
| | - Emily Andrew
- Department of Epidemiology and Preventive Medicine Monash University Melbourne Victoria Australia.,Ambulance Victoria Melbourne Victoria Australia
| | - Ziad Nehme
- Department of Epidemiology and Preventive Medicine Monash University Melbourne Victoria Australia.,Ambulance Victoria Melbourne Victoria Australia.,Department of Paramedicine Monash University Melbourne Victoria Australia
| | - Jason Bloom
- Department of Cardiology The Alfred Hospital Melbourne Victoria Australia.,The Baker Institute Melbourne Victoria Australia
| | - Sinjini Biswas
- Department of Epidemiology and Preventive Medicine Monash University Melbourne Victoria Australia
| | - Shelley Cox
- Department of Epidemiology and Preventive Medicine Monash University Melbourne Victoria Australia.,Ambulance Victoria Melbourne Victoria Australia
| | - David Anderson
- Ambulance Victoria Melbourne Victoria Australia.,Department of Intensive Care Medicine The Alfred Hospital Melbourne Victoria Australia
| | - Michael Stephenson
- Department of Epidemiology and Preventive Medicine Monash University Melbourne Victoria Australia.,Ambulance Victoria Melbourne Victoria Australia.,Department of Paramedicine Monash University Melbourne Victoria Australia
| | - Jeffrey Lefkovits
- Department of Epidemiology and Preventive Medicine Monash University Melbourne Victoria Australia.,Department of Cardiology The Royal Melbourne Hospital Melbourne Victoria Australia
| | - Andrew J Taylor
- Department of Cardiology The Alfred Hospital Melbourne Victoria Australia.,Department of Epidemiology and Preventive Medicine Monash University Melbourne Victoria Australia.,Department of Medicine Monash University Melbourne Victoria Australia
| | - David Kaye
- Department of Cardiology The Alfred Hospital Melbourne Victoria Australia.,The Baker Institute Melbourne Victoria Australia
| | - Karen Smith
- Department of Epidemiology and Preventive Medicine Monash University Melbourne Victoria Australia.,Ambulance Victoria Melbourne Victoria Australia.,Department of Paramedicine Monash University Melbourne Victoria Australia
| | - Dion Stub
- Department of Cardiology The Alfred Hospital Melbourne Victoria Australia.,Department of Epidemiology and Preventive Medicine Monash University Melbourne Victoria Australia.,The Baker Institute Melbourne Victoria Australia
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20
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Liblik K, Byun J, Lloyd-Kuzik A, Farina JM, Burgos LM, Howes D, Baranchuk A. The DIVERSE Study: Determining the Importance of Various gEnders, Races, and body Shapes for CPR Education using manikins. Curr Probl Cardiol 2022; 48:101159. [PMID: 35217124 DOI: 10.1016/j.cpcardiol.2022.101159] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 11/26/2022]
Abstract
Certain demographic groups are less likely to receive efficient CPR, and poor representation of these groups in the manikins used for CPR simulation may play a role. The aim of the DIVERSE Study was to survey organizations that teach CPR to determine the demographic characteristics of the manikins they utilize for simulations. Institutions, businesses, and non-governmental organizations which provide CPR certification in North and Latin America were surveyed through a collaboration with the Emerging Leaders group of the Interamerican Society of Cardiology (SIAC). A total of 56 survey responses were received from North America (n=18; 869 total manikins) and Latin America (n=38; 1514 total manikins). Of the total manikins (n=2,383), 12% were non-white, 6% represented women, <1% represented a non-lean body habitus, and 1% represented pregnant individuals. Despite the importance of diverse manikin representation in simulation training, diverse representation is lacking in manikins used in North and Latin America.
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Affiliation(s)
- Kiera Liblik
- Department of Medicine, Kingston Health Science Center, Queen's University, Kingston, Ontario, Canada
| | - Jin Byun
- Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Andrew Lloyd-Kuzik
- Department of Medicine, Kingston Health Science Center, Queen's University, Kingston, Ontario, Canada
| | - Juan M Farina
- Division of Cardiothoracic Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Lucrecia M Burgos
- Department of Heart Failure, Pulmonary Hypertension and Heart Transplant, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Daniel Howes
- Department of Emergency Medicine/Critical Care, Kingston Health Science Center, Queen's University, Kingston, Ontario, Canada
| | - Adrian Baranchuk
- Division of Cardiology, Kingston Health Science Center, Queen's University, Kingston, Ontario, Canada.
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21
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Berglund S, Andreasson A, Rawshani A, Hirlekar G, Lundgren P, Angerås O, Mandalenakis Z, Redfors B, Holm A, Hagberg E, Ricksten SE, Friberg H, Gustafsson L, Dworeck C, Herlitz J, Rawshani A. Cardiorenal Function and Survival in In-Hospital Cardiac Arrest: A Nationwide Study of 22,819 Cases. Resuscitation 2022; 172:9-16. [PMID: 35031390 DOI: 10.1016/j.resuscitation.2021.12.037] [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: 10/12/2021] [Revised: 12/06/2021] [Accepted: 12/30/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND We studied the association between cardiorenal function and survival, neurological outcome and trends in survival after in-hospital cardiac arrest (IHCA). METHODS We included cases aged ≥18 years in the Swedish Cardiopulmonary Resuscitation Registry during 2008 to 2020. The CKD-EPI equation was used to calculate estimated glomerular filtration rate (eGFR). A history of heart failure was defined according to contemporary guideline criteria. Logistic regression was used to study survival. Neurological outcome was assessed using cerebral performance category (CPC). RESULTS We studied 22,819 patients with IHCA. The 30-day survival was 19.3%, 16.6%, 22.5%, 28.8%, 39.3%, 44.8% and 38.4% in cases with eGFR <15, 15-29, 30-44, 45-59, 60-89, 90-130 and 130-150 ml/min/1.73 m2, respectively. All eGFR levels below and above 90 ml/min/1.73 m2 were associated with increased mortality. Probability of survival at 30 days was 62% lower in cases with eGFR <15 ml/min/1.73 m2, compared with normal kidney function. At every level of eGFR, presence of heart failure increased mortality markedly; patients without heart failure displayed higher mortality only at eGFR below 30 ml/min/1.73 m2. Among survivors with eGFR <15 ml/min/1.73 m2, good neurological outcome was noted in 87.2%. Survival increased in most groups over time, but most for those with eGFR <15 ml/min/1.73 m2, and least for those with normal eGFR. CONCLUSIONS All eGFR levels below and above normal range are associated with increased mortality and this association is modified by the presence of heart failure. Neurological outcome is good in the majority of cases, across kidney function levels and survival is increasing.
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Affiliation(s)
- Sara Berglund
- University of Gothenburg, Institute of Medicine, Department of Molecular and Clinical Medicine, Gothenburg, Sweden.
| | - Axel Andreasson
- University of Gothenburg, Institute of Medicine, Department of Molecular and Clinical Medicine, Gothenburg, Sweden
| | - Aidin Rawshani
- University of Gothenburg, Institute of Medicine, Department of Molecular and Clinical Medicine, Gothenburg, Sweden
| | - Geir Hirlekar
- University of Gothenburg, Institute of Medicine, Department of Molecular and Clinical Medicine, Gothenburg, Sweden
| | - Peter Lundgren
- University of Gothenburg, Institute of Medicine, Department of Molecular and Clinical Medicine, Gothenburg, Sweden; The Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Oscar Angerås
- University of Gothenburg, Institute of Medicine, Department of Molecular and Clinical Medicine, Gothenburg, Sweden
| | - Zacharias Mandalenakis
- University of Gothenburg, Institute of Medicine, Department of Molecular and Clinical Medicine, Gothenburg, Sweden; The Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Björn Redfors
- University of Gothenburg, Institute of Medicine, Department of Molecular and Clinical Medicine, Gothenburg, Sweden
| | - Astrid Holm
- University of Gothenburg, Institute of Medicine, Department of Molecular and Clinical Medicine, Gothenburg, Sweden
| | - Eva Hagberg
- University of Gothenburg, Institute of Medicine, Department of Molecular and Clinical Medicine, Gothenburg, Sweden
| | | | - Hans Friberg
- Lund University, Skane University Hospital, Department of Clinical Sciences, Anesthesia & Intensive Care, Malmö, Sweden
| | - Linnea Gustafsson
- University of Gothenburg, Institute of Medicine, Department of Molecular and Clinical Medicine, Gothenburg, Sweden; The Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christian Dworeck
- University of Gothenburg, Institute of Medicine, Department of Molecular and Clinical Medicine, Gothenburg, Sweden; The Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Johan Herlitz
- The Swedish Cardiopulmonary Resuscitation Registry, Centre of Registries, Gothenburg, Sweden; Pre-hospten Research Centre, Borås University, Borås, Sweden
| | - Araz Rawshani
- University of Gothenburg, Institute of Medicine, Department of Molecular and Clinical Medicine, Gothenburg, Sweden; The Swedish Cardiopulmonary Resuscitation Registry, Centre of Registries, Gothenburg, Sweden; The Sahlgrenska University Hospital, Gothenburg, Sweden
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22
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Dafaalla M, Rashid M, Bond RM, Smith T, Parwani P, Thamman R, Moledina SM, Graham MM, Mamas MA. Racial Disparities in Management and Outcomes of Out-of-Hospital Cardiac Arrest Complicating Myocardial Infarction: A National Study From England and Wales. CJC Open 2022; 3:S81-S88. [PMID: 34993437 PMCID: PMC8712673 DOI: 10.1016/j.cjco.2021.09.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 09/26/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Studies of racial disparities in care of patients admitted with an out-of-hospital cardiac arrest (OHCA) in the setting of acute myocardial infarction (AMI) have shown inconsistent results. Whether these differences in care exist in the universal healthcare system in United Kingdom is unknown. METHODS Patients admitted with a diagnosis of AMI and OHCA between 2010 and 2017 from the Myocardial Ischaemia National Audit Project (MINAP) were studied. All patients were stratified based on ethnicity into a Black, Asian, or minority ethnicity (BAME) group vs a White group. We used multivariable logistic regression models to evaluate the predictors of clinical outcomes and treatment strategy. RESULTS From 14,287 patients admitted with AMI complicated by OHCA, BAME patients constituted a minority of patients (1185 [8.3%]), compared with a White group (13,102 [91.7%]). BAME patients were younger (median age [interquartile range]) for BAME group, 58 [50-70] years; for White group, 65 [55-74] years). Cardiogenic shock (BAME group, 33%; White group, 20.7%; P < 0.001) and severe left ventricular impairment (BAME group, 21%; White group, 16.5%; P < 0.003) were more frequent among BAME patients. BAME patients were more likely to be seen by a cardiologist (BAME group, 95.9%; White group, 92.5%; P < 0.001) and were more likely to receive coronary angiography than the White group (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.2-1.88). The BAME group had significantly higher in-hospital mortality (OR 1.26, 95% CI 1.04-1.52) and re-infarction (OR 1.52, 95% CI 1.06-2.18) than the White group. CONCLUSIONS BAME patients were more likely to be seen by a cardiologist and receive coronary angiography than White patients. Despite this difference, the in-hospital mortality of BAME patients, particularly in the Asian population, was significantly higher.
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Affiliation(s)
- Mohamed Dafaalla
- Keele Cardiovascular Research Group, School of Medicine, Keele University, Stoke-on-Trent, United Kingdom.,Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, School of Medicine, Keele University, Stoke-on-Trent, United Kingdom.,Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| | - Rachel M Bond
- Women's Heart Health, Dignity Health, Gilbert, Arizona, USA.,Internal Medicine, Creighton University School of Medicine, Chandler, Arizona, USA
| | - Triston Smith
- Department of Cardiology, Trinity Health System, Steubenville, Ohio, USA
| | - Purvi Parwani
- Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda, California, USA
| | - Ritu Thamman
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Saadiq M Moledina
- Keele Cardiovascular Research Group, School of Medicine, Keele University, Stoke-on-Trent, United Kingdom.,Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| | - Michelle M Graham
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.,Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, School of Medicine, Keele University, Stoke-on-Trent, United Kingdom.,Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom.,Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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23
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Crijns HJ, Sanders P, Albert CM, Lambiase PD. OUP accepted manuscript. Eur Heart J 2022; 43:1191-1197. [PMID: 35137041 PMCID: PMC9313516 DOI: 10.1093/eurheartj/ehac007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 12/22/2021] [Accepted: 01/06/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Prashantan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Christine M. Albert
- Department of Cardiology, Smidt Heart Institute, Cedars Sinai Medical Center (CMA), Los Angeles, CA, USA
| | - Pier D. Lambiase
- Department of Cardiology, University College London and Barts Heart Centre, London, UK
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24
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Agerström J, Carlsson M, Bremer A, Herlitz J, Rawshani A, Årestedt K, Israelsson J. Treatment and survival following in-hospital cardiac arrest: does patient ethnicity matter? Eur J Cardiovasc Nurs 2021; 21:341-347. [PMID: 34524428 DOI: 10.1093/eurjcn/zvab079] [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] [Received: 03/01/2021] [Revised: 06/08/2021] [Accepted: 08/20/2021] [Indexed: 11/13/2022]
Abstract
AIMS Previous research on racial/ethnic disparities in relation to cardiac arrest has mainly focused on black vs. white disparities in the USA. The great majority of these studies concerns out-of-hospital cardiac arrest (OHCA). The current nationwide registry study aims to explore whether there are ethnic differences in treatment and survival following in-hospital cardiac arrest (IHCA), examining possible disparities towards Middle Eastern and African minorities in a European context. METHODS AND RESULTS In this retrospective registry study, 24 217 patients from the IHCA part of the Swedish Registry of Cardiopulmonary Resuscitation were included. Data on patient ethnicity were obtained from Statistics Sweden. Regression analysis was performed to assess the impact of ethnicity on cardiopulmonary resuscitation (CPR) delay, CPR duration, survival immediately after CPR, and the medical team's reported satisfaction with the treatment. Middle Eastern and African patients were not treated significantly different compared to Nordic patients when controlling for hospital, year, age, sex, socioeconomic status, comorbidity, aetiology, and initial heart rhythm. Interestingly, we find that Middle Eastern patients were more likely to survive than Nordic patients (odds ratio = 1.52). CONCLUSION Overall, hospital staff do not appear to treat IHCA patients differently based on their ethnicity. Nevertheless, Middle Eastern patients are more likely to survive IHCA.
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Affiliation(s)
- Jens Agerström
- Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Pedalstråket 13, Kalmar SE-39132, Sweden
| | - Magnus Carlsson
- Department of Economics and Statistics, School of Business and Economics, Linnaeus University, Pedalstråket 13, Kalmar SE-39132, Sweden
| | - Anders Bremer
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Pedalstråket 13, Kalmar SE-39132, Sweden
| | - Johan Herlitz
- Department of Cardiology, Sahlgrenska University Hospital, Blå Stråket 5, Gothenburg SE-41345, Sweden.,PreHospen-Centre for Prehospital Research, University of Borås, Allegatan 1, Borås SE-50332, Sweden
| | - Araz Rawshani
- Institute of Medicine, University of Gothenburg, Medicinaregatan 3, Gothenburg SE-40530, Sweden
| | - Kristofer Årestedt
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Pedalstråket 13, Kalmar SE-39132, Sweden.,The Research Section, Region Kalmar County, Lasarettsvägen 8, Kalmar SE-39244, Sweden
| | - Johan Israelsson
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Pedalstråket 13, Kalmar SE-39132, Sweden.,Division of Cardiology, Department of Internal Medicine, Kalmar County Hospital, Lasarettsvägen, Kalmar SE-39185, Sweden
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25
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Waldemar A, Bremer A, Holm A, Strömberg A, Thylén I. In-hospital family-witnessed resuscitation with a focus on the prevalence, processes, and outcomes of resuscitation: A retrospective observational cohort study. Resuscitation 2021; 165:23-30. [PMID: 34107335 DOI: 10.1016/j.resuscitation.2021.05.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/21/2021] [Accepted: 05/30/2021] [Indexed: 01/10/2023]
Abstract
AIM International and national guidelines support in-hospital, family-witnessed resuscitation, provided that patients are not negatively affected. Empirical evidence regarding whether family presence interferes with resuscitation procedures is still scarce. The aim was to describe the prevalence and processes of family-witnessed resuscitation in hospitalised adult patients, and to investigate associations between family-witnessed resuscitation and the outcomes of resuscitation. METHODS Nationwide observational cohort study based on data from the Swedish Registry of Cardiopulmonary Resuscitation. RESULTS In all, 3257 patients with sudden, in-hospital cardiac arrests were included. Of those, 395 had family on site (12%), of whom 186 (6%) remained at the scene. It was more common to offer family the option to stay during resuscitation if the cardiac arrest occurred in emergency departments, intensive-care units or cardiac-care units, compared to hospital wards (44% vs. 26%, p < 0.001). It was also more common for a staff member to be assigned to take care of family in acute settings (68% vs. 56%, p = 0.017). Mean time from cardiac arrest to termination of resuscitation was longer in the presence of family (20.67 min vs. 17.49 min, p = 0.020), also when controlling for different patient and contextual covariates in a regression model (Stand(β) 0.039, p = 0.027). No differences were found between family-witnessed and non-family-witnessed resuscitation in survival immediately after resuscitation (57% vs. 53%, p = 0.291) or after 30 days (35% vs. 29%, p = 0.086). CONCLUSIONS In-hospital, family-witnessed resuscitation is uncommon, but the processes and outcomes do not seem to be negatively affected, suggesting that staff should routinely invite family to witness resuscitation.
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Affiliation(s)
- Annette Waldemar
- Department of Cardiology in Norrköping, and Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden
| | - Anders Bremer
- Faculty of Health and Life Sciences, Linnaeus University, SE-351 95 Växjö, Sweden; Department of Ambulance Service, Kalmar County Council, SE-392 44 Kalmar, Sweden
| | - Anna Holm
- Department of Cardiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden
| | - Anna Strömberg
- Department of Cardiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden
| | - Ingela Thylén
- Department of Cardiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden.
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26
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Jayawardana S, Mossialos E. The cost of prejudice for poorer people: understanding experiences of discrimination in cardiac arrest care. Eur Heart J 2021; 42:870-872. [PMID: 33374008 DOI: 10.1093/eurheartj/ehaa1068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sahan Jayawardana
- Department of Health Policy, The London School of Economics and Political Science, London, UK
| | - Elias Mossialos
- Department of Health Policy, The London School of Economics and Political Science, London, UK
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27
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Crea F. Light and noise pollution and socioeconomic status: the risk factors individuals cannot change. Eur Heart J 2021; 42:801-804. [PMID: 33611398 DOI: 10.1093/eurheartj/ehab074] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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