By Will Boggs MD
(Reuters Health) – After a cardiac arrest in the hospital, older black patients don’t survive as long as older white patients, new data show.
“The magnitude and persistence of the difference in long-term survival is sobering,” Dr. Lena M. Chen from University of Michigan, Ann Arbor, told Reuters Health in an email interview.
Earlier studies have shown that black patients who have a cardiac arrest in the hospital are 27 percent less likely to survive their hospitalization, compared with white patients. The current study looked at nationwide data on longer-term survival among 1,112 blacks and 7,652 whites, all over the age of 65, who left the hospital alive.
One year later, the survival rate was much lower among black patients than among white patients, at 43.6 percent versus 60.2 percent. At three years after cardiac arrest, the survival rate was 31.6 percent among blacks versus 45.3 percent among whites, and after five years, it was 23.5 percent versus 35.4 percent.
After accounting for other factors that might contribute to these differences, black survivors of in-hospital cardiac arrest were still 28 percent less likely to survive one year, compared with white patients, the researchers reported in the journal Circulation.
Only a small proportion of the difference in survival could be explained by racial differences in hospital treatments and care. About half could be explained by differences in care after discharge.
“There are a number of potential causes for the disparities we observed,” Dr. Chen said. “There may be differences in the quality of post-discharge care at a skilled nursing or rehabilitation facility, or differences in social support or resources to care for patients in the community, or differences in insurance coverage that affect access to high-quality post-acute care, or something else altogether. We did not have the data to identify the biggest factors contributing to disparities.”
“Let providers know what your wishes are regarding resuscitation before you get sick and are hospitalized,” she said. “This will help providers give you the type of care that you want should you suffer from a cardiac arrest.”
“Families and friends, who are often the link between different care settings and multiple providers, should ask questions if the care plan at any point after cardiac arrest (for example, on hospital discharge) is unclear,” Dr. Chen said.
Dr. David J. Wallace from University of Pittsburgh School of Medicine in Pennsylvania, who recently examined factors associated with long-term outcomes among survivors of cardiac arrest, told Reuters Health by email, “There is still work to be done in improving the quality and consistency of medical care for patients after cardiac arrest. It’s 2018, and we shouldn’t have long-term outcome differences between white and black patients that appear to be driven (in part) by the frequency of standard of care application.”
“Clearly, most patients who experience cardiac arrest have multiple medical problems,” he said. “The care they receive in the hospital is critically important, but their post-acute care (after hospital discharge) is equally so.”
SOURCE: http://bit.ly/2KJX2Qj Circulation, online July 9, 2018.