Hispanic/Latino-Serving Hospitals Provide Less Targeted Temperature Management Following Out-of-Hospital Cardiac Arrest

• Published in: Journal of the American Heart Association 2021-12, Vol.10 (24), p.e017773-e017773
• Main Authors: Morris, Nicholas A, Mazzeffi, Michael, McArdle, Patrick, May, Teresa L, Waldrop, Greer, Perman, Sarah M, Burke, James F, Bradley, Steven M, Agarwal, Sachin, Figueroa, Jose F, Badjatia, Neeraj
• Format: Article
• Language: English
• Subjects: Cardiac Arrest; Disparities; Healthcare Disparities; Hispanic or Latino; Hospitals - statistics & numerical data; Humans; Hypothermia, Induced - statistics & numerical data; Original Research; Out-of-Hospital Cardiac Arrest - ethnology; Out-of-Hospital Cardiac Arrest - therapy; Race/Ethnicity; Resuscitation Science; Retrospective Studies; Targeted Temperature Management; United States - epidemiology
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.121.023934

Background Variation exists in outcomes following out-of-hospital cardiac arrest (OHCA), but whether racial and ethnic disparities exist in post-arrest provision of targeted temperature management (TTM) is unknown. Methods and Results We performed a retrospective analysis of a prospectively collected cohort of patients who survived to admission following OHCA from the Cardiac Arrest Registry to Enhance Survival, whose catchment area represents ~50% of the United States from 2013-2019. Our primary exposure was race/ethnicity and primary outcome was utilization of TTM. We built a mixed-effects model with both state of arrest and admitting hospital modeled as random intercepts to account for clustering. Among 96,695 patients (24.6% Black, 8.0% Hispanic/Latino, 63.4% White), a smaller percentage of Hispanic/Latino patients received TTM than Black or White patients (37.5% vs. 45.0 % vs 43.3%, P < .001) following OHCA. In the mixed-effects model, Black patients (Odds Ratio [OR] 1.153, 95% Confidence Interval [CI] 1.102-1.207, P < .001) and Hispanic/Latino patients (OR 1.086, 95% CI 1.017-1.159, P < .001) were slightly more likely to receive TTM compared to White patients, perhaps due to worse admission neurological status. We did find community level disparity as Hispanic/Latino-serving hospitals (defined as the top decile of hospitals that cared for the highest proportion of Hispanic/Latino patients) provided less TTM (OR 0.587, 95% CI 0.474 to 0.742, P < .001). Conclusions Reassuringly, we did not find evidence of intrahospital or interpersonal racial or ethnic disparity in the provision of TTM. However, we did find inter-hospital, community level disparity. Hispanic/Latino-serving hospitals provided less guideline-recommended TTM after OHCA.