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Original Investigation
August 9, 2017

Temporal Changes in the Racial Gap in Survival After In-Hospital Cardiac Arrest

Author Affiliations
  • 1Division of Cardiovascular Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City
  • 2Saint Luke's Mid America Heart Institute, Kansas City, Missouri
  • 3Department of Medicine, University of Missouri, Kansas City
  • 4Minneapolis Heart Institute, Minneapolis, Minnesota
  • 5Institute for Clinical and Translational Science, University of Iowa, Iowa City
  • 6Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City
JAMA Cardiol. Published online August 9, 2017. doi:10.1001/jamacardio.2017.2403
Key Points

Question  Have recent improvements in survival after in-hospital cardiac arrest been accompanied by a reduction in racial differences in survival?

Finding  In this study of 30 241 black and 81 898 white patients with in-hospital cardiac arrest at 289 hospitals in Get With the Guidelines–Resuscitation, risk-adjusted survival improved over time in both groups and differences in survival narrowed significantly.

Meaning  Racial differences in survival after in-hospital cardiac arrest have decreased substantially at hospitals in a national resuscitation quality improvement program.

Abstract

Importance  Previous studies have found marked differences in survival after in-hospital cardiac arrest by race. Whether racial differences in survival have narrowed as overall survival has improved remains unknown.

Objectives  To examine whether racial differences in survival after in-hospital cardiac arrest have narrowed over time and if such differences could be explained by acute resuscitation survival, postresuscitation survival, and/or greater temporal improvement in survival at hospitals with higher proportions of black patients.

Design, Setting, and Participants  In this cohort study from Get With the Guidelines–Resuscitation, performed from January 1, 2000, through December 31, 2014, a total of 112 139 patients with in-hospital cardiac arrest who were hospitalized in intensive care units or general inpatient units were studied. Data analysis was performed from April 7, 2015, to May 24, 2017.

Exposure  Race (black or white).

Main Outcomes and Measures  The primary outcome was survival to discharge. Secondary outcomes were acute resuscitation survival and postresuscitation survival. Multivariable hierarchical (2-level) regression models were used to calculate calendar-year rates of survival for black and white patients after adjusting for baseline characteristics.

Results  Among 112 139 patients with in-hospital cardiac arrest, 30 241 (27.0%) were black (mean [SD] age, 61.6 [16.4] years) and 81 898 (73.0%) were white (mean [SD] age, 67.5 [15.2] years). Risk-adjusted survival improved over time in black (11.3% in 2000 and 21.4% in 2014) and white patients (15.8% in 2000 and 23.2% in 2014; P for trend <.001 for both), with greater survival improvement among black patients on an absolute (P for trend = .02) and relative scale (P for interaction = .01). A reduction in survival differences between black and white patients was attributable to elimination of racial differences in acute resuscitation survival (black individuals: 44.7% in 2000 and 64.1% in 2014; white individuals: 47.1% in 2000 and 64.0% in 2014; P for interaction <.001). Compared with hospitals with fewer black patients, hospitals with a higher proportion of black patients with in-hospital cardiac arrest achieved larger survival gains over time.

Conclusions and Relevance  A substantial reduction in racial differences in survival after in-hospital cardiac arrest has occurred that has been largely mediated by elimination of racial differences in acute resuscitation survival and greater survival improvement at hospitals with a higher proportion of black patients. Further understanding of the mechanisms of this improvement could provide novel insights for the elimination of racial differences in survival for other conditions.

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