Systematic review and meta-analysis of out-of-hospital cardiac arrest and race or ethnicity: black US populations fare worse

Shah, Keval S V; Shah, Anoop; Bhopal, Raj

doi:10.1177/2047487312451815

Cited by 86 publications

(64 citation statements)

References 59 publications

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“…With respect to race, black as opposed to white Americans have been documented to have higher rates of OHCA 42, 43 and SCD 44, 45 , as well as poorer rates of survival from cardiac arrest 46 . Similar to women, blacks of both sexes are more likely to have an unwitnessed arrest or PEA documented at the time of the arrest 42, 46, 47 .…”

Section: Scd/sca: Background Mechanisms and Risksmentioning

confidence: 99%

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The Spectrum of Epidemiology Underlying Sudden Cardiac Death

Hayashi

Shimizu

Chen

2015

Circulation Research

555

393

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Sudden cardiac death (SCD) from cardiac arrest is a major international public health problem accounting for an estimated 15–20% of all deaths. Although resuscitation rates are generally improving throughout the world, the majority of individuals who suffer a sudden cardiac arrest will not survive. SCD most often develops in older adults with acquired structural heart disease, but it also rarely occurs in the young, where it is more commonly due to inherited disorders. Coronary heart disease (CHD) is known to be the most common pathology underlying SCD, followed by cardiomyopathies, inherited arrhythmia syndromes, and valvular heart disease. Over the past three decades, declines in SCD rates have not been as steep as for other causes of CHD deaths, and there is a growing fraction of SCDs not due to CHD and/or ventricular arrhythmias, particularly among certain subsets of the population. The growing heterogeneity of the pathologies and mechanisms underlying SCD present major challenges for SCD prevention, which are magnified further by a frequent lack of recognition of the underlying cardiac condition prior to death. Multifaceted preventative approaches, which address risk factors in seemingly low risk and known high-risk populations will be required to decrease the burden of SCD. In this Compendium, we review the wide-ranging spectrum of epidemiology underlying SCD within both the general population and in high-risk subsets with established cardiac disease placing an emphasis on recent global trends, remaining uncertainties, and potential targeted preventive strategies.

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Section: Scd/sca: Background Mechanisms and Risksmentioning

confidence: 99%

“…Similar to women, blacks of both sexes are more likely to have an unwitnessed arrest or PEA documented at the time of the arrest 42, 46, 47 . These unfavorable arrest characteristics do not entirely account for the poorer survival among blacks.…”

Section: Scd/sca: Background Mechanisms and Risksmentioning

confidence: 99%

The Spectrum of Epidemiology Underlying Sudden Cardiac Death

Hayashi

Shimizu

Chen

2015

Circulation Research

555

393

View full text Add to dashboard Cite

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“…Some immigrant groups have been shown to have greater incidence of AMI, but longer survival after an event, and thus it is difficult to compare incident events with either hospitalization or mortality alone. [49][50][51] Furthermore, studies adjusted for different covariates, and grouped migrants into regions based on different definitions (Supplemental Table S2). Finally, our review did not consider how migration policies or varying access to health care affect the health of immigrants because health care and migration policies change over time.…”

Section: Limitationsmentioning

confidence: 99%

The Risk of Ischemic Heart Disease and Stroke Among Immigrant Populations: A Systematic Review

Sohail

Chu

Rezai

et al. 2015

Canadian Journal of Cardiology

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“…1–5 Out-of-hospital arrest disparities have been explained in part by factors such as increased time to emergency medical services arrival, decreased rate of bystander cardiopulmonary resuscitation (CPR), decreased likelihood of having the arrest be witnessed, and decreased rate of ventricular tachycardia (VT) or ventricular fibrillation (VF). 1, 2, 6, 7 For in-hospital cardiac arrests (IHCA), work elucidating racial differences in outcomes has focused on arrests due to ventricular arrhythmias, where hospital-level factors (i.e. racial clustering in hospitals with worse outcomes) were found to be a large contributor.…”

Section: Introductionmentioning

confidence: 99%

Racial disparities in outcomes following PEA and asystole in-hospital cardiac arrests

et al. 2015

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Aim To define the racial differences present after PEA and asystolic IHCA and explore factors that could contribute to this disparity Methods We analyzed PEA and asystolic IHCA in the Get-With-The-Guidelines-Resuscitation database. Multilevel conditional fixed effects logistic regression models were used to estimate the relationship between race and survival to discharge and return of spontaneous circulation (ROSC), sequentially controlling for hospital, patient demographics, comorbidities, arrest characteristic, process measures, and interventions in place at time of arrest. Results Among the 561 hospitals, there were 76,835 patients who experienced IHCA with an initial rhythm of PEA or asystole (74.8% white, 25.2% black). Unadjusted ROSC rate was 55.1% for white patients and 54.1% for black patients (unadjusted OR: 0.94 [95% CI, 0.90–0.98], p=0.016). Survival to discharge was 12.8% for white patients and 10.4% for black patients (unadjusted OR: 0.83 [95% CI, 0.78–0.87], p<0.001). After adjusting for temporal trends, patient characteristics, hospital, and arrest characteristics, there remained a difference in survival to discharge (OR: 0.85 [95% CI, 0.79–0.92]) and rate of ROSC (OR: 0.88 [95% CI, 0.84–0.92]). Black patients had a worse mental status at discharge after survival. Rates of DNAR placed after survival from were lower in black patients with a rate of 38.3% compared to 44.5% in white patients (p<0.001). Conclusion Black patients are less likely to experience ROSC and survival to discharge after PEA or asystole IHCA. Individual patient characteristics, event characteristics, and hospital characteristics don’t fully explain this disparity. It is possible that disease burden and end-of-life preferences contribute to the racial disparity.

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Systematic review and meta-analysis of out-of-hospital cardiac arrest and race or ethnicity: black US populations fare worse

Cited by 86 publications

References 59 publications

The Spectrum of Epidemiology Underlying Sudden Cardiac Death

The Spectrum of Epidemiology Underlying Sudden Cardiac Death

The Risk of Ischemic Heart Disease and Stroke Among Immigrant Populations: A Systematic Review

Racial disparities in outcomes following PEA and asystole in-hospital cardiac arrests

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