Racial and Ethnic Disparities in Management and Outcomes of Cardiac Arrest Complicating Acute Myocardial Infarction.

Published on Jun 1, 2021in Journal of the American Heart Association4.605
· DOI :10.1161/JAHA.120.019907
Anna V. Subramaniam3
Estimated H-index: 3
(Mayo Clinic),
Sri Harsha Patlolla7
Estimated H-index: 7
(Mayo Clinic)
+ 6 AuthorsSaraschandra Vallabhajosyula23
Estimated H-index: 23
(Mayo Clinic)
Sources
Abstract
Background The role of race and ethnicity in the outcomes of cardiac arrest (CA) complicating acute myocardial infarction (AMI) is incompletely understood. Methods and Results This was a retrospective cohort study of adult admissions with AMI-CA from the National Inpatient Sample (2012-2017). Self-reported race/ethnicity was classified as White, Black, and others (Hispanic, Asian or Pacific Islander, Native American, Other). Outcomes of interest included in-hospital mortality, coronary angiography, percutaneous coronary intervention, palliative care consultation, do-not-resuscitate status use, hospitalization costs, hospital length of stay, and discharge disposition. Of the 3.5 million admissions with AMI, CA was noted in 182 750 (5.2%), with White, Black, and other races/ethnicities constituting 74.8%, 10.7%, and 14.5%, respectively. Black patients admitted with AMI-CA were more likely to be female, with more comorbidities, higher rates of non-ST-segment-elevation myocardial infarction, and higher neurological and renal failure. Admissions of patients of Black and other races/ethnicities underwent coronary angiography (61.9% versus 70.2% versus 73.1%) and percutaneous coronary intervention (44.6% versus 53.0% versus 58.1%) less frequently compared to patients of white race (p<0.001). Admissions of patients with AMI-CA had significantly higher unadjusted mortality (47.4% and 47.4%) as compared with White patients admitted (40.9%). In adjusted analyses, Black race was associated with lower in-hospital mortality (odds ratio [OR], 0.95; 95% CI, 0.91-0.99; P=0.007) whereas other races had higher in-hospital mortality (OR, 1.11; 95% CI, 1.08-1.15; P<0.001) compared with White race. Admissions of Black patients with AMI-CA had longer length of hospital stay, higher rates of palliative care consultation, less frequent do-not-resuscitate status use, and fewer discharges to home (all P<0.001). Conclusions Racial and ethnic minorities received less frequent guideline-directed procedures and had higher in-hospital mortality and worse outcomes in AMI-CA.
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Newest
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#2Abhiram PrasadH-Index: 67
Last. Gregory W. BarsnessH-Index: 37
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AIMS: There are limited data on the trends and outcomes of mechanical circulatory support (MCS)-assisted early percutaneous coronary intervention (PCI) in acute myocardial infarction with cardiogenic shock (AMI-CS). METHODS AND RESULTS: Using the National Inpatient Sample database from 2005-2014 a retrospective cohort of AMI-CS admissions receiving early PCI (hospital day zero) was identified. MCS use was defined as intra-aortic balloon pump (IABP), percutaneous left ventricular assist device (p...
37 CitationsSource
#1Gaurav Aggarwal (Jersey City Medical Center)H-Index: 10
#2Sri Harsha Patlolla (Mayo Clinic)H-Index: 7
Last. M Cohen (RU: Rutgers University)H-Index: 10
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Background There are limited contemporary data prevalence and outcomes of acute ischemic stroke (AIS) complicating acute myocardial infarction (AMI). Methods and Results Adult (>18 years) AMI admissions using the National Inpatient Sample database (2000-2017) were evaluated for in-hospital AIS. Outcomes of interest included in-hospital mortality, hospitalization costs, length of stay, discharge disposition, and use of tracheostomy and percutaneous endoscopic gastrostomy. The discharge destinatio...
3 CitationsSource
#1Sri Harsha Patlolla (Mayo Clinic)H-Index: 7
#2Pranathi R. Sundaragiri (Mayo Clinic)H-Index: 8
Last. Saraschandra Vallabhajosyula (Mayo Clinic)H-Index: 23
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Background: There is a paucity of contemporary data on the burden of intracranial hemorrhage (ICH) complicating acute myocardial infarction (AMI). This study sought to evaluate the temporal trends, predictors, and outcomes of ICH in AMI. Methods: The National Inpatient Sample (2000–2017) was used to identify adult (>18 years) AMI admissions with ICH. In-hospital mortality, hospitalization costs, length of stay, and measure of functional ability were the outcomes of interest. The discharge destin...
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AbstractINTRODUCTION: Telecommunicator Assisted Cardiopulmonary Resuscitation (T-CPR) is independently associated with improved survival and improved functional outcome after adult Out of Hospital ...
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#1Saraschandra Vallabhajosyula (Mayo Clinic)H-Index: 8
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Abstract Background There are limited data on the outcomes of acute myocardial infarction with cardiogenic shock (AMI-CS) in patients with prior coronary artery bypass grafting (CABG). Methods A retrospective cohort of AMI-CS admissions during 2000–2016 from the National Inpatient Sample was created and prior CABG status was identified. Outcomes of interest included in-hospital mortality and resource utilization in the two cohorts. Temporal trends of prevalence, in-hospital mortality, and cardia...
23 CitationsSource
#1Saraschandra Vallabhajosyula (Mayo Clinic)H-Index: 23
#2Sri Harsha Patlolla (Mayo Clinic)H-Index: 7
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There are limited data on arrhythmias in acute myocardial infarction with cardiogenic shock (AMI-CS). Using a 17-year AMI-CS population from the National Inpatient Sample, we identified common arrhythmias - atrial fibrillation (AF), atrial flutter, supraventricular tachycardia, ventricular tachycardia, ventricular fibrillation, and atrioventricular blocks (AVB). Admissions with concomitant cardiac surgery were excluded. Outcomes of interest included temporal trends, predictors, in-hospital morta...
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#1Saraschandra Vallabhajosyula (Mayo Clinic)H-Index: 23
#2Aditi Shankar (NewYork–Presbyterian Hospital)H-Index: 1
Last. Gregory W. Barsness (Mayo Clinic)H-Index: 37
view all 13 authors...
AIMS: The aim of this study is to evaluate the contemporary use of a pulmonary artery catheter (PAC) in acute myocardial infarction-cardiogenic shock (AMI-CS). METHODS AND RESULTS: A retrospective cohort of AMI-CS admissions using the National Inpatient Sample (2000-2014) was identified. Admissions with concomitant cardiac surgery or non-AMI aetiology for cardiogenic shock were excluded. The outcomes of interest were in-hospital mortality, resource utilization, and temporal trends in cohorts wit...
26 CitationsSource
#1Kenneth K. Woo (UCLA: University of California, Los Angeles)H-Index: 1
#2Argun Can (UCLA: University of California, Los Angeles)H-Index: 1
Last. Dong W. Chang (UCLA: University of California, Los Angeles)H-Index: 1
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Background Racial and ethnic minorities are at risk for disparities in quality of care after out-of-hospital cardiopulmonary arrest (OHCA). As such, we examined associations between race and ethnicity and use of guideline-recommended and life-sustaining procedures during hospitalizations for OHCA.
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#1Saraschandra Vallabhajosyula (Mayo Clinic)H-Index: 23
#2Saarwaani Vallabhajosyula (Mayo Clinic)H-Index: 13
Last. Jacob C. Jentzer (Mayo Clinic)H-Index: 21
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Abstract In the period between 2000 and 2014, 584,704 admissions with non-ST-segment elevation myocardial infarction that received early coronary angiography (day zero) were identified from the National Inpatient Sample. In-hospital cardiac arrest was noted in 4349 (0.8%), of which ~47% were from ventricular arrhythmias and ~90% of occurred within ≤4 days. Non-ST-segment elevation myocardial infarction admissions with in-hospital cardiac arrest had higher in-hospital mortality compared to those ...
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