Health inequities in out-of-hospital cardiac arrest

Abstract

Purpose of review Out-of-hospital cardiac arrest (OHCA) is a time-critical emergency in which a rapid response following the chain of survival is crucial to save life. Disparities in care can occur at each link in this pathway and hence produce health inequities. This review summarises the health inequities that exist for OHCA patients and suggests how they may be addressed. Recent findings There is international evidence that the incidence of OHCA is increased with increasing deprivation and in ethnic minorities. These groups have lower rates of bystander CPR and bystander-initiated defibrillation, which may be due to barriers in accessing cardiopulmonary resuscitation training, provision of public access defibrillators, and language barriers with emergency call handlers. There are also disparities in the ambulance response and in-hospital care following resuscitation. These disadvantaged communities have poorer survival following OHCA. Summary OHCA disproportionately affects deprived communities and ethnic minorities. These groups experience disparities in care throughout the chain of survival and this appears to translate into poorer outcomes. Addressing these inequities will require coordinated action that engages with disadvantaged communities.

Public attitudes towards bystander CPR and their association with social deprivation: Findings from a cross sectional study in North England

“…Whilst our study was limited with small numbers of individuals from ethnic minorities, the findings support other studies which have identified ethnic minorities encounter barriers accessing BCPR training, exacerbated by language difficulties. 38 Participation in our study was generally reflective of regional ethnicity, but focused studies within the region with ethnic minority study populations would help to better explain these differences.…”

The effect of ethnicity and socioeconomic status on outcomes after resuscitated out-of-hospital cardiac arrest – Findings from a tertiary centre in South London

“… 4 , 5 , 6 , 7 , 8 There are several potential causes for this apparent disparity, including pre-existing chronic health inequalities, 24 OOHCA circumstances, access to public access defibrillation, 25 and also to specialist CAC care. 26 Limiting unwarranted variation in care based on ethnicity and SES is a priority of many healthcare systems across all conditions, including the NHS. 27 Indeed, in 2021, the NHS Race & Health Observatory advocated for people from minority ethnic backgrounds to be trained in CPR, 28 underlining the significant public health challenge and importance of investigating ethnic discrepancies in OOHCA care and outcomes.…”

Post-cardiac arrest care in the intensive care unit

“… 1 Survival after OHCA is poor, with a median survival to hospital discharge of 5.1% 2 . Patients who are underrepresented minorities, of lower socioeconomic status, and live in underserved communities have even lower rates of survival to discharge 3 . While survival after IHCA is generally considered better, studies have shown comparable survival among IHCA and OHCA patients when limited to patients who achieved return of spontaneous circulation (ROSC) and after adjusting for arrest characteristics (witnessed vs. unwitnessed, shockable vs. nonshockable presenting rhythm) 4 …”