Association of Neighborhood Demographics With Out-of-Hospital Cardiac Arrest Treatment and Outcomes

Starks, Monique Anderson; Schmicker, Robert H.; Peterson, Eric D.; May, Susanne; Buick, Jason E.; Kudenchuk, Peter J.; Drennan, Ian R.; Herren, Heather; Jasti, Jamie; Sayre, Michael R.; Stub, Dion; Vilke, Gary M.; Stephens, Shannon W.; Chang, Anna Marie; Nuttall, Jack; Nichol, Graham

doi:10.1001/jamacardio.2017.2671

Cited by 97 publications

(92 citation statements)

References 33 publications

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“…However, our calculated survival rates did not indicate a statistically significant difference in OHCA survival for blacks compared with other groups. This contrasts with other studies and may be related to our relatively small sample size, our single‐city analysis, lack of geographic analysis, and limited availability of clinical and social variables 28, 33. In the future, our ongoing data collection will allow us a thorough exploration of this issue.…”

Section: Discussionmentioning

confidence: 79%

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Improvement in Non‐Traumatic, Out‐Of‐Hospital Cardiac Arrest Survival in Detroit From 2014 to 2016

May

Zhang

Foley

et al. 2018

JAHA

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BackgroundIn 2002, the out‐of‐hospital cardiac arrest (OHCA) survival rate in Detroit was the lowest in the nation. Concerted efforts sought to improve the city's chain of survival with a focus on emergency medical services (EMS). This study assesses the impact on OHCA survival rates and describe factors associated with survival.Methods and ResultsData for non‐traumatic OHCA cases in Detroit from 2014 to 2016 were extracted from CARES (Cardiac Arrest Registry to Enhance Survival). Chi‐squared tests, non‐parametric tests, and a multivariable logistic regression analysis were employed to examine the associations between overall survival and its covariates. A total of 2359 non‐traumatic OHCA cases were examined. The overall survival rate increased from 3.7% in 2014 to 5.4% in 2015, and 6.4% in 2016 (P<0.01), reflecting a 73% improvement in survival over the 3‐year period. EMS median on‐scene time decreased over the study period, while the rate at which EMS initiated cardiopulmonary resuscitation and applied an automated external defibrillator (AED) greatly increased (P<0.001). The factors significantly associated with survival were female sex (odds ratio=1.70, P<0.05), a public setting (odds ratio=2.31, P<0.01), an EMS witness (odds ratio=6.18, P<0.01), and the presence of an initial shockable rhythm (odds ratio=1.88, P<0.05).ConclusionsFrom 2014 to 2016, the overall survival rate for OHCA patients in Detroit, MI significantly improved. Our results suggest that an improved chain of survival may explain this progress. This study is an example of how OHCA data analysis and EMS improvement can improve end OHCA outcomes in a resource‐limited urban setting.

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Section: Discussionmentioning

confidence: 79%

“…One recent study by Starks et al found that OHCA patients living in majority‐black neighborhoods had lower survival rates to hospital discharge 28. Residential segregation between blacks and other groups is extremely high in Detroit, and this segregation is associated with racial health disparities and high black mortality 29, 30, 31, 32.…”

Section: Discussionmentioning

confidence: 99%

Improvement in Non‐Traumatic, Out‐Of‐Hospital Cardiac Arrest Survival in Detroit From 2014 to 2016

May

Zhang

Foley

et al. 2018

JAHA

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“…A large US cohort study (n = 14,225) showed that patients who had an OHCA in low-income black neighbourhoods were less likely to receive bystander-initiated CPR than those in highincome white neighbourhoods [21]. This was confirmed in a recent study which documented that the lowest rates of bystander CPR and AED use occurred in predominantly black neighbourhoods, and that these neighbourhoods had a significantly lower likelihood for OHCA survival compared with predominantly white neighbourhoods [22]. Improving bystander interventions in these neighbourhoods may improve cardiac arrest survival.…”

Section: Variations In Community Responsementioning

confidence: 81%

The present and future of cardiac arrest care: international experts reach out to caregivers and healthcare authorities

et al. 2018

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“…The mechanisms of the observed variation in our study are likely multifactorial, including unmeasured patient-level factors (eg, comorbidity 9 and first-responder interventions), EMS-level factors (eg, experience and training of EMS personnel), 28 hospital-level factors (eg, practice variation in timing of withdrawal of life-sustaining therapy 29 and receiving hospital characteristics 30 ), and neighborhood-level factors (eg, racial/ethnic composition). 31 We found that in all survival quartiles of EMS agencies, median chest compression fraction exceeded 0.80, and median chest compression rate was between 100 and 120 compressions per minute. Both metrics conform with current evidence-based practice guidelines.…”

Section: Discussionmentioning

confidence: 69%

Variation in Survival After Out-of-Hospital Cardiac Arrest Between Emergency Medical Services Agencies

et al. 2018

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; for the Resuscitation Outcomes Consortium Investigators IMPORTANCE Emergency medical services (EMS) deliver essential initial care for patients with out-of-hospital cardiac arrest (OHCA), but the extent to which patient outcomes vary between different EMS agencies is not fully understood. OBJECTIVE To quantify variation in patient outcomes after OHCA across EMS agencies. DESIGN, SETTING, AND PARTICIPANTS This observational cohort study was conducted in the Resuscitation Outcomes Consortium (ROC) Epistry, a prospective multicenter OHCA registry at 10 sites in North America. Any adult with OHCA treated by an EMS from April 2011 through June 2015 was included. Data analysis occurred from May 2017 to March 2018. EXPOSURE Treating EMS agency. MAIN OUTCOMES AND MEASURES The primary outcome was survival to hospital discharge. Secondary outcomes were return of spontaneous circulation at emergency department arrival and favorable functional outcome at hospital discharge (defined as a modified Rankin scale score Յ3). Multivariable hierarchical logistic regression models were used to adjust confounders and clustering of patients within EMS agencies, and calculated median odds ratios (MORs) were used to quantify the extent of residual variation in outcomes between EMS agencies. RESULTS We identified 43 656 patients with OHCA treated by 112 EMS agencies. At EMS agency level, we observed large variations in survival to hospital discharge (range, 0%-28.9%; unadjusted MOR, 1.43 [95% CI, 1.34-1.54]), return of spontaneous circulation on emergency department arrival (range, 9.0%-57.1%; unadjusted MOR, 1.53 [95% CI, 1.43-1.65]), and favorable functional outcome (range, 0%-20.4%; unadjusted MOR, 1.54 [95% CI, 1.40-1.73]). This variation persisted despite adjustment for patient-level and EMS agency-level factors known to be associated with outcomes (adjusted MOR for survival 1.56 [95% CI 1.44-1.73]; adjusted MOR for return of spontaneous circulation at emergency department arrival, 1.50 [95% CI, 1.41-1.62]; adjusted MOR for functionally favorable survival, 1.53 [95% CI, 1.37-1.78]). After restricting analysis to those who survived more than 60 minutes after hospital arrival and including hospital treatment characteristics, the variation persisted (adjusted MOR for survival, 1.49 [95% CI, 1.36-1.69]; adjusted MOR for functionally favorable survival, 1.34 [95% CI, 1.20-1.59]). CONCLUSIONS AND RELEVANCE We found substantial variations in patient outcomes after OHCA between a large group of EMS agencies in North America that were not explained by documented patient-level and EMS agency-level variables.

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Association of Neighborhood Demographics With Out-of-Hospital Cardiac Arrest Treatment and Outcomes

Cited by 97 publications

References 33 publications

Improvement in Non‐Traumatic, Out‐Of‐Hospital Cardiac Arrest Survival in Detroit From 2014 to 2016

Improvement in Non‐Traumatic, Out‐Of‐Hospital Cardiac Arrest Survival in Detroit From 2014 to 2016

The present and future of cardiac arrest care: international experts reach out to caregivers and healthcare authorities

Variation in Survival After Out-of-Hospital Cardiac Arrest Between Emergency Medical Services Agencies

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