Racial Disparity in Cardiac Procedures and Mortality Among Long-Term Survivors of Cardiac Arrest

Groeneveld, Peter W.; Heidenreich, Paul A.; Garber, Alan M.

doi:10.1161/01.cir.0000079164.95019.5a

Cited by 98 publications

(59 citation statements)

References 26 publications

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“…In our study, IHCA rates were higher in regions with a greater proportion of nonwhite patients, which may reflect racial disparities in the quality of inpatient care, as reported in several studies. 35,36 Furthermore, a higher proportion of hospitals in the West were medium sized and in urban locations compared with the Midwest (Table 1). Hospital size may be an indirect marker of available resources, with larger hospitals having more resources in place for the early recognition of clinical deterioration and prevention of IHCA.…”

Section: Discussionmentioning

confidence: 99%

Regional Variation in the Incidence and Outcomes of In-Hospital Cardiac Arrest in the United States

et al. 2015

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Background— Regional variation in the incidence and outcomes of in-hospital cardiac arrest (IHCA) is not well studied and may have important health and policy implications. Methods and Results— We used the 2003 to 2011 Nationwide Inpatient Sample databases to identify patients ≥18 years of age who underwent cardiopulmonary resuscitation ( International Classification of Diseases, Ninth Edition, Clinical Modification procedure codes 99.60 and 99.63) for IHCA. Regional differences in IHCA incidence, survival to hospital discharge, and resource use (total hospital cost and discharge disposition among survivors) were analyzed. Of 838 465 patients with IHCA, 162 270 (19.4%) were in the Northeast, 159 581 (19.0%) were in the Midwest, 316 201 (37.7%) were in the South, and 200 413 (23.9%) were in the West. Overall IHCA incidence in the United States was 2.85 per 1000 hospital admissions. IHCA incidence was lowest in the Midwest and highest in the West (2.33 and 3.73 per 1000 hospital admissions, respectively). Compared with the Northeast, risk-adjusted survival to discharge was significantly higher in the Midwest (odds ratio, 1.33; 95% confidence interval, 1.31–1.36), South (odds ratio, 1.21; 95% confidence interval, 1.19–1.23), and West (odds ratio, 1.25; 95% confidence interval, 1.23–1.27). IHCA survival increased significantly from 2003 to 2011 in the United States and in all regions (all P trend <0.001). Total hospital cost was highest in the West, whereas discharge to skilled nursing facility and use of home health care among survivors was highest in the Northeast. Conclusions— We observed significant regional variation in IHCA incidence, survival, and resource use in the United States. This variation was explained only partially by differences in patient and hospital characteristics. Further studies are needed to identify other potential factors responsible for these regional differences to improve outcomes after IHCA.

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Section: Discussionmentioning

confidence: 99%

Regional Variation in the Incidence and Outcomes of In-Hospital Cardiac Arrest in the United States

et al. 2015

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“…1 Much of the evidence about disparities concerns cardiac care, showing that minorities receive lower quality care from lower quality cardiac surgeons 2 and have worse outcomes than Whites. 1,3,4 Controlling for clinical characteristics, Blacks are less likely to be referred for cardiac catheterization, 1 less likely to receive reperfusion therapy, 5 percutaneous transluminal coronary angioplasty (PTCA), 6 and coronary artery bypass graft (CABG) than Whites. 3,6,7 Blacks and other minorities have more limited access to new technologies, with larger disparities in utilization rates compared with Whites when a technology is new, a disparity that diminishes (but does not disappear) as the technology diffuses into regular care.…”

Section: Introductionmentioning

confidence: 99%

Racial variations in the choice of on-pump versus off-pump coronary artery bypass grafting

Mukamel

Glance

Weimer

et al. 2007

J Health Serv Res Policy

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Objective-To examine explanations of differences in utilization rates of a newly reintroduced technique -off-pump coronary artery bypass grafting (CABG) -between racial minorities and Whites.Method-The study was based on 15,313 CABG patients in the New York State Cardiac Surgery Reporting System covering all cardiac surgeons providing off-pump CABG in New York State. We estimated cross sectional, random effect regression models predicting the probability of offpump versus on-pump surgery.Results-Thirty one percent of Blacks, 20.7% of other races, and 23% of Whites underwent offpump CABG (P < 0.0001). The higher rates for Blacks arose mostly from being treated by surgeons performing only a few off-pump procedures rather than from surgeons performing many off-pump surgeries. After adjusting for clinical characteristics and coronary anatomy, Blacks

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“…[1][2][3][4][5][6][7] Compared with white patients, minority patients are found to be treated at hospitals with lower adherence to composite quality measures, and thus are less likely to receive evidence-based care. 8 -10 It is suggested that quality improvement programs can enhance a hospital's adherence to practice guidelines and patients' outcomes.…”

mentioning

confidence: 99%

Care and Outcomes of Asian-American Acute Myocardial Infarction Patients: Findings From the American Heart Association Get With The Guidelines-Coronary Artery Disease Program

Qian

Ling

Deedwania

et al. 2012

Circ: Cardiovascular Quality and Outcomes

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Compared with whites, Asian-American AMI patients were significantly older, more likely to be covered by Medicaid and recruited in the west region, and had a higher prevalence of diabetes, hypertension, heart failure, and smoking. In-hospital unadjusted mortality was higher among Asian-American patients. Overall, Asian-Americans were comparable with whites regarding the baseline quality of care, except that Asian-Americans were less likely to get smoking cessation counseling (65.6% versus 81.5%). Asian-American AMI patients experienced improvement in the 6 individual measures (PՅ0.048), defect-free care (PϽ0.001), and door-to-balloon time (PϽ0.001). The improvement rates were similar for both Asian-Americans and whites. Compared with whites, the adjusted in-hospital mortality rate was higher for Asian-Americans (adjusted relative risk: 1.16; 95% confidence interval: 1.00 -1.35; Pϭ0.04). Conclusions-Evidence

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Racial Disparity in Cardiac Procedures and Mortality Among Long-Term Survivors of Cardiac Arrest

Abstract: Background-It

Cited by 98 publications

References 26 publications

Regional Variation in the Incidence and Outcomes of In-Hospital Cardiac Arrest in the United States

Regional Variation in the Incidence and Outcomes of In-Hospital Cardiac Arrest in the United States

Racial variations in the choice of on-pump versus off-pump coronary artery bypass grafting

Care and Outcomes of Asian-American Acute Myocardial Infarction Patients: Findings From the American Heart Association Get With The Guidelines-Coronary Artery Disease Program

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