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Multicenter Study
. 2018 Jul:128:31-36.
doi: 10.1016/j.resuscitation.2018.04.032. Epub 2018 Apr 26.

Demographic, social, economic and geographic factors associated with long-term outcomes in a cohort of cardiac arrest survivors

Patrick J Coppler  1 , Jonathan Elmer  2 , Jon C Rittenberger  2 , Clifton W Callaway  2 , David J Wallace  3
Affiliations
Multicenter Study

Demographic, social, economic and geographic factors associated with long-term outcomes in a cohort of cardiac arrest survivors

Patrick J Coppler et al. Resuscitation. 2018 Jul.

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.

Keywords: Cardiac arrest; Epidemiology; Long-term outcomes.

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Conflict of interest statement

Conflict of interest

We wish to confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome.

We confirm that the manuscript has been read and approved by all named authors and that there are no other persons who satisfied the criteria for authorship but are not listed. We further confirm that the order of authors listed in the manuscript has been approved by all of us.

We confirm that we have given due consideration to the protection of intellectual property associated with this work and that there are no impediments to publication, including the timing of publication, with respect to intellectual property. In so doing we confirm that we have followed the regulations of our institutions concerning intellectual property.

We further confirm that any aspect of the work covered in this manuscript that has involved human patients has been conducted with the ethical approval of all relevant bodies and that such approvals are acknowledged within the manuscript.

We understand that the Corresponding Author, Dr. David J Wallace is the sole contact for the Editorial process (including Editorial Manager and direct communications with the office). He is responsible for communicating with the other authors about progress, submissions of revisions and final approval of proofs. We confirm that we have provided a current, correct email address that is accessible by the Corresponding Author.

Figures

Figure 1
Figure 1
A–C. Univariate proportional hazard of long-term outcome after cardiac arrest for patients by race (A), sex (B), and median ZIP code income (C).
Figure 2
Figure 2
A–C. Univariate proportional hazard of long-term outcome after cardiac arrest for patients by residence in a medically underserved area or population (A), residence by drive time to the closest acute care hospital (B), and residence in an urban or rural area (C).
See this image and copyright information in PMC

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