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Huebinger R, Power E, Del Rios M, Schulz K, Gill J, Panczyk M, McNally B, Bobrow B. Factors mediating community race and ethnicity differences in initial shockable rhythm for out-of-hospital cardiac arrests in Texas. Resuscitation 2024; 200:110238. [PMID: 38735360 DOI: 10.1016/j.resuscitation.2024.110238] [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: 03/08/2024] [Revised: 04/23/2024] [Accepted: 05/02/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) patients from minoritized communities have lower rates of initial shockable rhythm, which is linked to favorable outcomes. We sought to evaluate the importance of initial shockable rhythm on OHCA outcomes and factors that mediate differences in initial shockable rhythm. METHODS We performed a retrospective study of the 2013-2022 Texas Cardiac Arrest Registry to Enhance Survival (TX-CARES). Using census tract data, we stratified OHCAs into majority race/ethnicity communities: >50% White, >50% Black, and >50% Hispanic/Latino. We compared logistic regression models between community race/ethnicity and OHCA outcome: (1) unadjusted, (2) adjusting for bystander CPR (bCPR), and (3) adjusting for initial rhythm. Using structural equation modeling, we performed mediation analyses between community race/ethnicity, OHCA characteristics, and initial shockable rhythm. RESULTS We included 22,730 OHCAs from majority White (21.1% initial shockable rhythm), 4,749 from majority Black (15.3% shockable), and 16,054 majority Hispanic/Latino (16.1% shockable) communities. Odds of favorable neurologic outcome were lower for majority Black (0.4 [0.3-0.5]) and Hispanic/Latino (0.6 [0.6-0.7]). While adjusting for bCPR minimally changed outcome odds, adjusting for shockable rhythm increased odds for Black (0.5 [0.4-0.5]) and Hispanic/Latino (0.7 [0.6-0.8]) communities. On mediation analysis for majority Black, the top mediators of initial shockable rhythm were public location (14.6%), bystander witnessed OHCA (11.6%), and female gender (5.7%). The top mediators for majority Hispanic/Latino were bystander-witnessed OHCA (10.2%), public location (3.52%), and bystander CPR (3.49%), CONCLUSION: Bystander-witnessed OHCA and public location were the largest mediators of shockable rhythm for OHCAs from minoritized communities.
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Affiliation(s)
- Ryan Huebinger
- Department of Emergency Medicine, University of New Mexico, Albuquerque, NM, United States.
| | - Eric Power
- Department of Emergency Medicine, McGaw Medical Center of Northwestern, Chicago, IL, United States.
| | - Marina Del Rios
- Department of Emergency Medicine, University of Iowa, Iowa City, IA, United States.
| | - Kevin Schulz
- Texas Emergency Medicine Research Center, McGovern Medical School, Houston, TX, United States; Department of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, United States; Houston Fire Department, Houston, TX, United States.
| | - Joseph Gill
- Texas Emergency Medicine Research Center, McGovern Medical School, Houston, TX, United States; Department of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, United States; Sugar Land Fire Department, Sugar Land, TX, United States.
| | - Micah Panczyk
- Texas Emergency Medicine Research Center, McGovern Medical School, Houston, TX, United States; Department of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, United States.
| | - Bryan McNally
- Department of Emergency Medicine, Emory University, Atlanta, GA, United States; Rollins School of Public Health, Emory University, Atlanta, GA, United States.
| | - Bentley Bobrow
- Texas Emergency Medicine Research Center, McGovern Medical School, Houston, TX, United States; Department of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, United States.
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Merchant RM, Becker LB, Brooks SC, Chan PS, Del Rios M, McBride ME, Neumar RW, Previdi JK, Uzendu A, Sasson C. The American Heart Association Emergency Cardiovascular Care 2030 Impact Goals and Call to Action to Improve Cardiac Arrest Outcomes: A Scientific Statement From the American Heart Association. Circulation 2024; 149:e914-e933. [PMID: 38250800 DOI: 10.1161/cir.0000000000001196] [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] [Indexed: 01/23/2024]
Abstract
Every 10 years, the American Heart Association (AHA) Emergency Cardiovascular Care Committee establishes goals to improve survival from cardiac arrest. These goals align with broader AHA Impact Goals and support the AHA's advocacy efforts and strategic investments in research, education, clinical care, and quality improvement programs. This scientific statement focuses on 2030 AHA emergency cardiovascular care priorities, with a specific focus on bystander cardiopulmonary resuscitation, early defibrillation, and neurologically intact survival. This scientific statement also includes aspirational goals, such as establishing cardiac arrest as a reportable disease and mandating reporting of standardized outcomes from different sources; advancing recognition of and knowledge about cardiac arrest; improving dispatch system response, availability, and access to resuscitation training in multiple settings and at multiple time points; improving availability, access, and affordability of defibrillators; providing a focus on early defibrillation, in-hospital programs, and establishing champions for debriefing and review of cardiac arrest events; and expanding measures to track outcomes beyond survival. The ability to track and report data from these broader aspirational targets will potentially require expansion of existing data sets, development of new data sets, and enhanced integration of technology to collect process and outcome data, as well as partnerships of the AHA with national, state, and local organizations. The COVID-19 (coronavirus disease 2019) pandemic, disparities in COVID-19 outcomes for historically excluded racial and ethnic groups, and the longstanding disparities in cardiac arrest treatment and outcomes for Black and Hispanic or Latino populations also contributed to an explicit focus and target on equity for the AHA Emergency Cardiovascular Care 2030 Impact Goals.
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Huebinger R, Del Rios M, Abella BS, McNally B, Bakunas C, Witkov R, Panczyk M, Boerwinkle E, Bobrow B. Impact of Receiving Hospital on Out-of-Hospital Cardiac Arrest Outcome: Racial and Ethnic Disparities in Texas. J Am Heart Assoc 2023; 12:e031005. [PMID: 37929677 PMCID: PMC10727382 DOI: 10.1161/jaha.123.031005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/28/2023] [Indexed: 11/07/2023]
Abstract
Background Factors associated with out-of-hospital cardiac arrest (OHCA) outcome disparities remain poorly understood. We evaluated the role of receiving hospital on OHCA outcome disparities. Methods and Results We studied people with OHCA who survived to hospital admission from TX-CARES (Texas Cardiac Arrest Registry to Enhance Survival), 2014 to 2021. Using census data, we stratified OHCAs into majority (>50%) strata: non-Hispanic White race and ethnicity, non-Hispanic Black race and ethnicity, and Hispanic or Latino ethnicity. We stratified hospitals into performance quartiles based on the primary outcome, survival with good neurologic outcome. We evaluated the association between race and ethnicity and care at higher-performance hospitals. We compared 3 models evaluating the association between race and ethnicity and outcome: (1) ignoring hospital, (2) adjusting for hospital as a random intercept, and (3) adjusting for hospital performance quartile. We adjusted models for possible confounders. We included 10 434 OHCAs. Hospital performance quartile outcome rates ranged from 11.3% (fourth) to 37.1% (first). Compared with OHCAs in neighborhoods of majority White race, those in neighborhoods of majority Black race (odds ratio [OR], 0.1 [95% CI, 0.1-0.1]) and Hispanic or Latino ethnicity (OR, 0.2 [95% CI, 0.2-0.2]) were less likely to be cared for at higher-performing hospitals. Compared with White neighborhoods (30.1%) and ignoring hospital, outcomes were worse in Black neighborhoods (15.4%; adjusted OR [aOR], 0.5 [95% CI, 0.4-0.5]) and Hispanic or Latino neighborhoods (19.2%; aOR, 0.6 [95% CI, 0.5-0.7]). Adjusting for hospital as a random intercept, outcomes improved for Black neighborhoods (aOR, 0.9 [95% CI, 0.7-1.05]) and Hispanic or Latino neighborhoods (aOR, 0.9 [95% CI, 0.8-0.99]). Adjusting for hospital performance quartile, outcomes improved for Black neighborhoods (aOR, 0.8 [95% CI, 0.7-1.01]) and Hispanic or Latino neighborhoods (aOR, 0.9 [95% CI, 0.8-0.996]). Conclusions In Black and Hispanic or Latino communities, OHCAs were less likely to be cared for at higher-performing hospitals, and adjusting for receiving hospital improved OHCA outcome disparities.
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Affiliation(s)
- Ryan Huebinger
- Texas Emergency Medicine Research CenterMcGovern Medical SchoolHoustonTXUSA
- Department of Emergency MedicineMcGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)HoustonTXUSA
| | - Marina Del Rios
- Department of Emergency MedicineUniversity of IowaIowa CityIAUSA
| | - Benjamin S. Abella
- Department of Emergency Medicine and Center for Resuscitation ScienceUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Bryan McNally
- Department of Emergency MedicineEmory UniversityAtlantaGAUSA
| | - Carrie Bakunas
- Texas Emergency Medicine Research CenterMcGovern Medical SchoolHoustonTXUSA
- Department of Emergency MedicineMcGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)HoustonTXUSA
| | - Richard Witkov
- Texas Emergency Medicine Research CenterMcGovern Medical SchoolHoustonTXUSA
- Department of Emergency MedicineMcGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)HoustonTXUSA
| | - Micah Panczyk
- Texas Emergency Medicine Research CenterMcGovern Medical SchoolHoustonTXUSA
- Department of Emergency MedicineMcGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)HoustonTXUSA
| | | | - Bentley Bobrow
- Texas Emergency Medicine Research CenterMcGovern Medical SchoolHoustonTXUSA
- Department of Emergency MedicineMcGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)HoustonTXUSA
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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.
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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
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Racial and Ethnic Disparities Plague the Chain of Survival Even After Return of Spontaneous Circulation. Resuscitation 2022; 176:21-23. [DOI: 10.1016/j.resuscitation.2022.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 11/19/2022]
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Huebinger R, Chavez S, Abella BS, Al-Araji R, Witkov R, Panczyk M, Villa N, Bobrow B. Race and Ethnicity Disparities in Post-Arrest Care in Texas. Resuscitation 2022; 176:99-106. [DOI: 10.1016/j.resuscitation.2022.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/10/2022] [Accepted: 04/01/2022] [Indexed: 12/24/2022]
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