Race Differences in Interventions and Survival After Out-of-Hospital Cardiac Arrest in North Carolina, 2010 to 2014

• Type of Material: Article
• Authors: Sidsel Moeller, Duke Clinical Research Institute; Carolina M HansenDuke Clinical Research Institute, Duke Clinical Research Institute; Kristian Kragholm, Duke Clinical Research Institute; Matt E Dupre, Duke Clinical Research Institute; Comilla Sasson, University of Colorado; David A Pearson, Carolinas Medical Center Charlotte; Clark Tyson, Duke Clinical Research Institute; James G Jollis, Duke Clinical Research Institute; Lisa Monk, Duke Clinical Research Institute; Monique A Starks, Duke Clinical Research Institute; Bryan McNally, Emory University; Kevin L Thomas, Duke Clinical Research Institute; Lance Becker, Hofstra University; Christian Torp-Pedersen, Nordsjaellands Hosp; Christopher B Granger, Duke Clinical Research Institute
• Language: English
• Date: 2021-09-07
• Publisher: WILEY
• Publication Version: Final Published Version
• Copyright Statement: © 2021 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1161/JAHA.120.019082
• Title of Journal or Parent Work: JOURNAL OF THE AMERICAN HEART ASSOCIATION
• Volume: 10
• Issue: 17
• Start Page: e019082
• End Page: e019082
• Grant/Funding Information: Dr Moeller has received grants from Karen Elise Jensen Fonden, Denmark, and the Laerdal Foundation, Norway. Dr Malta Hansen reports to have received grants from TrygFonden, Denmark, Helsefonden, Denmark, and the Laerdal foundation Norway. Dr Kragholm reports to have received grants from The Laerdal Foundation, Norway. Dr McNally received grant funding from the American Red Cross, Washington DC, and American Heart Association, Dallas, Texas. Drs Becker, Jollis and Granger report having received grants from the Medtronic Foundation, Minneapolis, Minnesota.
• Keywords: NEIGHBORHOOD CHARACTERISTICS; SOCIOECONOMIC-STATUS; CARDIOPULMONARY-RESUSCITATION; intervention; RATES; BLACKS; survival; RACIAL-DIFFERENCES; Science & Technology; Cardiovascular System & Cardiology; UNITED-STATES; WHITES; OHCA; ASSOCIATION; race; Life Sciences & Biomedicine; BYSTANDER CPR; Cardiac & Cardiovascular Systems
• Research Categories: Health Sciences, Public Health

Abstract

BACKGROUND: Following the implementation of the HeartRescue project, with interventions in the community, emergency medical services, and hospitals to improve care and outcomes for out-of-hospital cardiac arrests (OHCA) in North Carolina, improved bystander and first responder treatments as well as survival were observed. This study aimed to determine whether these improvements were consistent across Black versus White individuals. METHODS AND RESULTS: Using the Cardiac Arrest Registry to Enhance Survival (CARES), we identified OHCA from 16 counties in North Carolina (population 3 million) from 2010 to 2014. Temporal changes in interventions and outcomes were assessed using multilevel multivariable logistic regression, adjusted for patient and socioeconomic neighborhood-level factors. Of 7091 patients with OHCA, 36.5% were Black and 63.5% were White. Black patients were younger, more females, had more un-witnessed arrests and non-shockable rhythm (Black: 81.0%; White: 75.4%). From 2010 to 2014, the adjusted probabilities of bystander cardiopulmonary resuscitation (CPR) went from 38.5% to 51.2% in White, P<0.001; and 36.9% to 45.6% in Black, P=0.002, and first-responder defibrillation went from 13.2% to 17.2% in White, P=0.002; and 14.7% to 17.3% in Black, P=0.16. From 2010 to 2014, survival to discharge only increased in White (8.0% to 11.4%, P=0.004; Black 8.9% to 9.5%, P=0.60), though, in shockable patients the probability of survival to discharge went from 24.8% to 34.6% in White, P=0.02; and 21.7% to 29.0% in Black, P=0. 10. CONCLUSIONS: After the HeartRescue program, bystander CPR and first-responder defibrillation increased in both patient groups; however, survival only increased significantly for White patients.