The following is a summary of “Impact of Receiving Hospital on Out‐of‐Hospital Cardiac Arrest Outcome: Racial and Ethnic Disparities in Texas,” published in the November 2023 issue of Cardiology by Huebinger et al.

Understanding the factors contributing to disparities in out‐of‐hospital cardiac arrest (OHCA) outcomes remains a critical area of investigation. Their study aimed to elucidate the impact of the receiving hospital on OHCA outcome disparities.

The researchers conducted an analysis using data from the Texas Cardiac Arrest Registry to Enhance Survival (TX‐CARES) from 2014 to 2021, focusing on individuals with OHCA who survived hospital admission. By utilizing census data, the study group categorized OHCA incidents into strata based on racial and ethnic majorities: non‐Hispanic White, non‐Hispanic Black, and Hispanic or Latino populations. Hospitals were stratified into quartiles based on their performance regarding the primary outcome, survival with good neurologic outcomes. Their evaluation centered on the association between race/ethnicity and receiving care at higher‐performing hospitals. The investigators compared three models assessing the link between race/ethnicity and outcome: disregarding hospital influence, incorporating hospital as a random intercept, and adjusting for hospital performance quartile while considering possible confounders. 

Their analysis encompassed 10,434 OHCA incidents. Notably, hospital performance quartile outcome rates varied from 11.3% (fourth quartile) to 37.1% (first quartile). Compared to OHCA incidents in neighborhoods predominantly composed of the White population, those occurring in neighborhoods predominantly composed of the Black population (odds ratio [OR], 0.1 [95% CI, 0.1–0.1]) and Hispanic or Latino ethnicity (OR, 0.2 [95% CI, 0.2–0.2]) were less likely to receive care at higher‐performing hospitals. When adjusted for confounders, outcomes for OHCA incidents in Black (adjusted OR [aOR], 0.5 [95% CI, 0.4–0.5]) and Hispanic or Latino neighborhoods (aOR, 0.6 [95% CI, 0.5–0.7]) were comparatively worse than those in White neighborhoods (30.1%). Notably, adjusting for the hospital as a random intercept demonstrated improved outcomes for Black (aOR, 0.9 [95% CI, 0.7–1.05]) and Hispanic or Latino neighborhoods (aOR, 0.9 [95% CI, 0.8–0.99]). 

Moreover, when considering the hospital performance quartile, outcomes were enhanced for Black (aOR, 0.8 [95% CI, 0.7–1.01]) and Hispanic or Latino neighborhoods (aOR, 0.9 [95% CI, 0.8–0.996]), addressing some of the observed disparities in OHCA outcomes.

The study reveals that OHCA incidents in Black and Hispanic or Latino communities were less likely to be managed in higher‐performing hospitals. Importantly, adjusting for receiving hospital substantially improved disparities in OHCA outcomes, highlighting the significance of hospital care in mitigating these disparities.

Source: ahajournals.org/doi/10.1161/JAHA.123.031005