PHILADELPHIA – Black cardiac arrest victims are more likely to die when they're treated in hospitals that care for a large black population than when they're brought to hospitals with a greater proportion of white patients, according to new research from the University of Pennsylvania School of Medicine. The study is published in the April issue of the American Heart Journal.
The Penn team found that, among 68,115 cardiac arrest admissions analyzed through Medicare records, only 31 percent of black patients treated in hospitals that care for a higher proportion of black patients survived to be discharged from the hospital, compared to 46 of those cared for in predominantly white hospitals. Results showed that even white patients were less likely to survive when treated at these hospitals which provide care for higher proportions of black patients.
"Our results also found that black patients were much more likely to be admitted to hospitals with low survival rates," says lead author Raina M. Merchant, MD, MS, an assistant professor of Emergency Medicine. "Since cardiac arrest patients need help immediately and are brought to the nearest hospital, these findings appear to show geographic disparities in which minority patients have limited access to hospitals that have better arrest outcomes. For example, these hospitals may not utilize best practices in post-arrest care, such as therapeutic hypothermia and coronary artery stenting procedures. These findings have implications for patients of all races, since these same hospitals had poor survival rates across the board."
Among factors that may influence the disparities, several include: differences in staff quality and training, patient/family preferences regarding end-of-life care and withdrawal of life support during the post-arrest period where prognosis is often uncertain, and variation in ancillary supports such as laboratory, cardiac testing or pharmacy services. Merchant and her colleagues suggest that further research into how the use of advanced postresuscitation therapies influence survival is necessary to improve outcomes for all patients, perhaps leading to the development of a regionalized care model for cardiac arrest, similar to the system that funnels trauma patients to hospitals that meet strict national standards.
Other authors of the study include Lance B. Becker, MD, Feifei Yang, MS, and Peter W. Groeneveld, MD, MS.
Penn Medicine is one of the world's leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the University of Pennsylvania School of Medicine (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System, which together form a $4 billion enterprise.
Penn's School of Medicine is currently ranked #2 in U.S. News & World Report's survey of research-oriented medical schools and among the top 10 schools for primary care. The School is consistently among the nation's top recipients of funding from the National Institutes of Health, with $507.6 million awarded in the 2010 fiscal year.
The University of Pennsylvania Health System's patient care facilities include: The Hospital of the University of Pennsylvania â€" recognized as one of the nation's top 10 hospitals by U.S. News & World Report; Penn Presbyterian Medical Center; and Pennsylvania Hospital – the nation's first hospital, founded in 1751. Penn Medicine also includes additional patient care facilities and services throughout the Philadelphia region.
Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2010, Penn Medicine provided $788 million to benefit our community.
Journal
American Heart Journal