Introduction: Sex, race and socioeconomic status may affect long-term mortality after cardiac arrest (CA). It is unknown if this is mediated by differential access to cardiac catheterization (cath), implanted cardioverter-defibrillator (ICD) placement, and/or geographic proximity to care.
Hypothesis: 1) Female sex, black race and residence in a low income neighborhood independently predict reduced odds of undergoing cath and ICD placement after CA. 2) These demographics predict worse long-term survival. 3) The protective effects of cath and ICD differs across demographics.
Methods: We included CA patients surviving to hospital discharge at five hospitals in Pennsylvania from 2005 to 2013, with follow-up through 2014. We obtained sex, race, arrest location, initial rhythm, median ZIP code income, post-arrest illness severity, cath, ICD placement, urban residence and drive time from residence to the nearest acute care hospital. We used logistic regression to test if demographic features predict ICD and cath, and Cox proportional hazard models identify predictors of survival.
Results: We included 891 patients followed for 2,081 patient-yrs. There were 340 deaths with median survival 6 yrs. Female sex, black race and low income were independently associated with reduced odds of cath after controlling for rhythm, arrest location and illness severity. Black race and residence >30 minutes from a hospital predicted worse survival (black race hazards ratio (HR) 1.16; 95%CI 1.02 - 1.31), residence HR 1.50; 95%CI 1.15 - 2.59). In adjusted models, female sex predicted better survival (adjusted HR (aHR) 0.83; 95%CI 0.75 - 0.91) whereas residing >30 minutes from a hospital predicted worse survival (aHR 1.86; 95%CI 1.15 - 3.00). The protective effects of cath and ICD were lower in poor and female subjects, respectively.
Conclusions: Race, proximity to hospital and sex predict long-term outcome after CA. Female and low-income subjects benefited less from ICD and cath.