Black Patients Experience Worse In-Hospital Cardiac Care

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A study in the Sept. 16 issue of the Journal of the American Medical Association reports black patients are less likely to survive an in-hospital cardiac arrest.

Paul S. Chan, M.D., MSc., a cardiologist at St. Luke’s Mid-America Heart Institute, and colleagues evaluated the care given to 10,011 patients who received defibrillation in hospitals across the United States. The evaluation included the care leading up to and after the defibrillation event. Patients were not always admitted with known heart disease.

The data came from a national registry of in-hospital resuscitation events gathered by the American Heart Association’s National Registry of Cardiopulmonary Resuscitation meant for quality improvement.

Researchers involved in the study are from St Luke’s Mid-America Heart Institute, University of Michigan Health System, University of Washington, Yale University, and Duke University.

Just over half of black patients were successfully revived after an in-hospital cardiac arrest, compared to 67.5 percent of white patients.

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The researchers feel that much of the racial difference was associated with the poor-performing hospitals where black patients received their care. Chan states, “Potential racial differences in access to care or preferences have been used to explain disparities in treatments and patient outcomes. But these are not likely to influence treatment in cardiac arrests since patients were already in the hospital and care of these patients is pretty clear. The differences in survival by race actually appeared to have more to do with the hospitals than the patients themselves.”

The researchers found that black patients are often sicker when admitted to the hospital, but are more likely to stay in a hospital unit that was not monitored. They are often admitted to a hospital with worse patient outcomes for cardiac emergencies.

The black patients who did have a successful resuscitation had a lower rates of survival to discharge. Only 45.2% of blacks survived to be discharged from the hospital after a successful in-hospital resuscitation compared to 55.5% of white patients.

Another senior researcher, Brahmajee K. Nallamothu, M.D., MPH, cardiologist at the U-M Cardiovascular Center, states “The link between the quality of the hospital and lower rates of post resuscitation survival is particularly striking. It suggests that there are important facility-level characteristics at the hospitals where black patients are most commonly treated.”

The researchers feel the differences in care reflect less experienced staff in intensive care units or infrequent use of aggressive therapies like cardiac catheterization or hypothermia.

Authors say reducing the death rate among black cardiac patients may need a new focus. “These findings suggest that strategies to eliminate racial disparities in survival after in-hospital cardiac arrest are not likely to be successful unless they are accompanied by … interventions that improve resuscitation survival in those poorly performing hospitals in which black patients are more likely to receive care,” authors write.

Source
Journal of the American Medical Association, Vol. 302, No.11, Sept. 16, 2009

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