Blacks have worse long-term survival after in-hospital cardiac arrest

Blacks who survive in-hospital cardiac arrest (IHCA) are 28 percent less likely to live to one year after discharge and 33 percent less likely to survive five years when compared to white counterparts, suggesting a disparity in follow-up care.

Lead author Lena M. Chen, MD, MS, and colleagues published these findings July 9 in Circulation after studying 8,764 IHCA survivors from hospitals participating in the Get With the Guidelines-Resuscitation registry. About 87 percent of the study subjects were white and the remaining 13 percent were black; all were 65 or older at the time of IHCA.

Absolute survival rates were more than 10 percentage points lower for blacks at three time points: 43.6 versus 60.2 percent at one year, 31.6 versus 45.3 percent at three years and 23.5 percent versus 35.4 percent at five years. Chen et al. noted black patients were younger on average with a higher comorbidity burden and greater neurological disability upon discharge, but patient differences only accounted for part of the long-term survival gap.

“Nearly one third of the racial difference in one-year survival was not modifiable; only a small proportion was explained by racial differences in hospital treatments and care; and approximately one half was the result of differences in care after discharge or unmeasured confounding,” the authors wrote.

“This finding suggests a need to examine whether racial differences in post-discharge care explain a substantial proportion of racial differences in long-term survival after in-hospital cardiac arrest. Such work would help inform efforts to reduce racial disparities in long-term survival for patients with in-hospital cardiac arrest.”

Black patients have previously been shown to have worse in-hospital survival of cardiac arrest—explained partly by a disproportionate number of them being treated at hospitals with fewer resources or poorer performance—but this study demonstrated that their outcomes continue to lag after discharge. The results also contrast with previous studies of heart failure, which actually point to higher relative survival for blacks six months and one year after hospitalizations for that condition, Chen and colleagues noted.

“It may be that for cardiac arrest, a condition associated with high levels of post-discharge disability, the quality and availability of postacute care matter more than they do for other conditions,” the authors wrote.

The study didn’t account for socioeconomic factors such as caregiver availability or expertise, social support and household income, all of which could play a role in long-term survival.

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