Black Patients Face Poorer Long-term Outcomes After In-Hospital Cardiac Arrest

That health disparities exist between black and white patients during their hospital stays will come as no surprise to clinicians. New research on in-hospital cardiac arrest, however, shows that these differences in outcomes can persist for years, with black patients being more than 10% less likely to survive at 1, 3, and 5 years after discharge.

Racial disparities in short-term survival after in-hospital cardiac arrest have been evaluated in previous studies, but Lena Chen, MD, MS (University of Michigan, Ann Arbor), and colleagues wanted to see what happens over the long term and what might be driving any differences.

“Understanding the source of racial differences in survival could guide efforts to narrow disparities and care and improve outcome,” Chen et al say. “If racial differences are explained by differences in treatment during postresuscitation care, neurological status at discharge, discharge destination, or postdischarge care, these may represent targets for reducing racial disparities in treatment and long-term survival amount patients with in-hospital cardiac arrest.”

In an email to TCTMD, Chen said she “was surprised that long-term survival for blacks was substantially and persistently lower than long-term survival for whites after in-hospital cardiac arrest. The magnitude and persistence of the difference in long-term survival is sobering."

The retrospective study, which looked at nearly 9,000 patients treated over a decade, was published earlier this month in Circulation.

The magnitude and persistence of the difference in long-term survival is sobering. Lena Chen

The researchers obtained data from Get With The Guidelines (GWTG)-Resuscitation, a national registry for in-hospital cardiac arrests. To determine long-term outcomes, they matched patients in the GWTG database to Medicare files using patient age, sex, admitting hospital, admission and discharge dates, as well as diagnosis and procedure codes. They ultimately evaluated survival rates of 8,764 patients who had an in-hospital cardiac arrest between 2001 and 2011 and were discharged from the hospital. The study included 7,652 white patients and 1,112 black patients, with a mean age of 76 and 75, respectively.

White patients had higher rates of survival at all time intervals.

Survival Rates After In-Hospital Cardiac Arrest

Black patients were 28% less likely than white patients to live to 1 year after hospital discharge (RR 0.72; 95% CI 0.67-0.78). The pattern was similar after 3 years (RR 0.71; 95% CI 0.63-0.79) and 5 years (RR 0.67; 95% CI 0.57-0.78). At discharge, black patients were more likely to have moderate to severe neurological disability. Black patients were also more likely to be discharged to skilled nursing or long-term care facility than white patients.

Unexplained Differences

Differences in patient-related factors, including age, sex, initial rhythm and location of cardiac arrest, and clinical comorbidities such as diabetes and heart failure, explained 29% of the disparity between 1-year survival in the two patient groups. Interventions before and after the cardiac arrest explained a further 17% of survival disparities. Adjusting for these factors narrowed the 1-year survival gap (RR 0.85, 95% CI 0.80-0.92); however, the authors could not account more than half of the disparity of 1-year survival between black and white patients. Over 37% of racial disparities in survival remained unexplained at years three and five.

The remaining differences could potentially be caused by postdischarge factors such as the quality of care in longer-term care facilities, the authors say. It has previously been reported that black patients are “less likely to be admitted to high-quality skilled nursing facilities and nursing homes,” and tend to have more isolated outpatient providers with fewer access to resources, they note.

Additionally, factors such as social support and health insurance could have an impact, Chen told TCTMD. She and her co-authors hope that additional research can reveal other influential factors in postdischarge care and investigate “whether interventions can be developed to eliminate racial disparities in care and survival for cardiac arrest survivors.”

Beyond future research, Chen advised that physicians should prioritize clear communication between care teams as patients transfer out of the hospital. “When patients move from the inpatient setting to a rehab facility and back to their primary care provider, sometimes information can get lost or miscommunicated,” she said. “That ultimately effects care, whether you are a cardiac arrest survivor or another type of patient.”