Abstract:
BACKGROUND:Demographic, social, economic and geographic factors are associated with increased short-term mortality after cardiac arrest. We sought to determine if these factors are additionally associated with long-term outcome differences using a detailed clinical database linked to state-wide administrative data. METHODS:We included cardiac arrest patients surviving to hospital discharge from five hospitals in the United States from 2005 to 2013, with follow-up through 2015. We obtained information on sex, race, arrest location, initial rhythm, median ZIP code income, post-arrest illness severity, cardiac catheterization, internal cardioverter-defibrillator insertion, rural residence and drive time from residence to the nearest acute care hospital. We used Cox proportional hazard models identify predictors of mortality. RESULTS:We included 891 patients followed for 2081 patient-years. There were 340 deaths with median survival 6 years. In adjusted models we identified an interaction effect between median ZIP code income and cardiac catheterization. Among patients who had cardiac catheterization there was an attenuated benefit from cardiac catheterization at progressively lower neighborhood incomes (adjusted HR: 0.21 to 0.46 to 0.56). Residence more than 20 min from the nearest acute care hospital was associated with increased hazard of death (adjusted HR: 1.48; 95%CI: 1.35-1.62), after controlling for rural residence and residence in a Medically Underserved Area/Population. Female patients showed less benefit following ICD placement (male adjusted HR: 0.49; female adjusted HR: 0.66). CONCLUSIONS:There are persistent long-term outcome differences in cardiac arrest survival based on sex, income, and geographic access acute care.
journal_name
Resuscitationjournal_title
Resuscitationauthors
Coppler PJ,Elmer J,Rittenberger JC,Callaway CW,Wallace DJdoi
10.1016/j.resuscitation.2018.04.032subject
Has Abstractpub_date
2018-07-01 00:00:00pages
31-36eissn
0300-9572issn
1873-1570pii
S0300-9572(18)30193-Xjournal_volume
128pub_type
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