Association between patient race and staff resuscitation efforts after cardiac arrest in outpatient dialysis clinics: A study from the CARES surveillance group.

Abstract

BACKGROUND:Cardiac arrest is the leading cause of death among patients receiving hemodialysis. Despite guidelines recommending CPR training and AED presence in dialysis clinics, rates of CPR and AED use by dialysis staff are suboptimal. Given that racial disparities exist in bystander CPR administration in non-healthcare settings, we examined the relationship between patient race/ethnicity and staff-initiated CPR and AED application within dialysis clinics. METHODS:We analyzed data prospectively collected in the Cardiac Arrest Registry to Enhance Survival across the U.S. from 2013 to 2017 and the Centers for Medicare & Medicaid Services dialysis facility database to identify outpatient dialysis clinic cardiac arrest events. Using multivariable logistic regression models, we examined relationships between patient race/ethnicity and dialysis staff-initiated CPR and AED application. RESULTS:We identified 1568 cardiac arrests occurring in 809 hemodialysis clinics. The racial/ethnic composition of patients was 31.3% white, 32.9% Black, 10.7% Hispanic/Latinx, 2.7% Asian, and 22.5% other/unknown. Overall, 88.0% of patients received CPR initiated by dialysis staff, but rates differed by race: 91% of white patients, 85% of black patients, and 77% of Asian patients (p = 0.005). After adjusting for differences in patient and clinic characteristics, black (OR = 0.41, 95% CI 0.25-0.68) and Asian patients (OR = 0.28, 95% CI 0.12-0.65) were significantly less likely than white patients to receive staff-initiated CPR. No significant difference between staff-initiated CPR rates among white, Hispanic/Latinx, and other/unknown patients was observed. An AED was applied by dialysis staff in 62% of patients. In adjusted models, there was no relationship between patient race/ethnicity and staff AED application. CONCLUSIONS:Black and Asian patients are significantly less likely than white patients to receive CPR from dialysis staff. Further understanding of practices in dialysis clinics and increased awareness of this disparity are necessary to improve resuscitation practices.

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Published Version (Please cite this version)

10.1016/j.resuscitation.2020.07.036

Publication Info

Hofacker, Samuel A, Matthew E Dupre, Kimberly Vellano, Bryan McNally, Monique Anderson Starks, Myles Wolf, Laura P Svetkey, Patrick H Pun, et al. (2020). Association between patient race and staff resuscitation efforts after cardiac arrest in outpatient dialysis clinics: A study from the CARES surveillance group. Resuscitation, 156. pp. 42–50. 10.1016/j.resuscitation.2020.07.036 Retrieved from https://hdl.handle.net/10161/21671.

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Scholars@Duke

Dupre

Matthew E. Dupre

Associate Professor in Population Health Sciences

Dr. Dupre is an Associate Professor in the Department of Population Health Sciences and the Department of Sociology. He is also a Senior Fellow at the Center for Aging and Human Development and member of the Cardiovascular Outcomes Group at the Duke Clinical Research Institute. Dr. Dupre is a medical sociologist who specializes in research on aging and the life course, health disparities, and cardiovascular disease (CVD) outcomes in older adults. As an interdisciplinary researcher, he has focused on several lines of work: (i) race and socioeconomic disparities in trajectories of chronic disease and mortality, (ii) the role of social stressors in the onset and progression of CVD, (iii) the development of adaptive risk-assessment models, and (iv) the social determinants of healthy aging in China. A unifying thread in his program of research is the application of life course theory to clinical outcomes research, the integration of population- and patient-level data, and the use of innovative statistical methods to better understand how exposure to social factors shape inequalities in health and aging. Dr. Dupre is the Editor-in-Chief of the Encyclopedia of Gerontology and Population Aging (2021), co-editor of the book Disability Trends at Older Ages (in press), and has published in the leading journals of medicine, epidemiology, sociology, and public health. He has served as an advisor to the National Academy of Sciences' Committee on Population Aging and currently serves on the editorial boards for multiple journals.

Areas of Expertise:
Medical Sociology; Population Health; Social Epidemiology; Cardiovascular Disease; Aging; and Quantitative Methods

Starks

Monique Anderson Starks

Associate Professor of Medicine
Wolf

Myles Selig Wolf

Charles Johnson, M.D. Distinguished Professor of Medicine

The focus of my research is disordered mineral metabolism across the spectrum of chronic kidney disease, including dialysis, kidney transplantation and earlier stages.

My research has been published in leading general medicine and subspecialty journals, including the New England Journal of Medicine, JAMA, the Journal of Clinical Investigation, Circulation, Cell Metabolism, Journal of the American Society of Nephrology, and Kidney International, among others.

My primary contributions have been in the area of hormonal regulation of phosphate homeostasis. I have helped to characterize the physiological role of fibroblast growth factor 23 in health and in chronic kidney disease, and the impact of elevated fibroblast growth factor 23 levels on adverse clinical outcomes in patients with kidney disease.

Svetkey

Laura Pat Svetkey

Professor of Medicine

Laura P. Svetkey, MD MHS is Professor of Medicine/Nephrology, Vice Chair for Faculty Development and Diversity in the Department of Medicine. She is also the Director of Duke’s CTSA-sponsored internal career development award program (KL2) and the Associate Director of Duke’s REACH Equity Disparities Research Center, in which she also leads the Investigator Development Core.

Dr. Svetkey has over 30 years of experience in the investigation of hypertension, obesity, and related areas, conducting NIH-sponsored clinical research ranging from behavioral intervention trials to metabolomics and genetics, with a consistent focus on prevention, non-pharmacologic intervention, health disparities and minority health. Her research has affected national guidelines, having served on the 2013 national Hypertension Guideline Panel (JNC) and the Lifestyle Guideline Working Group. She is an American Society of Hypertension certified hypertension specialist, and a member of the Association of American Physicians (AAP). She is the Associate Director, Core Director and Project PI of Duke’s NIH-sponsored REACH Equity Disparities Research Center (PI: Kimberly Johnson).

As Department of Medicine Vice Chair for Faculty Development and Diversity, she implements a wide range of programs to enhance the experience and advancement of faculty and trainees, with particular emphasis on those from racial and ethnic groups under-represented in medicine, and women.

Pun

Patrick Hank Pun

Associate Professor of Medicine

My current research interest is in understanding the mechanisms of cardiovascular disease among patients with chronic kidney disease, with a particular focus on the epidemic of sudden cardiac death. The ultimate goal is to reduce the impact of sudden death through improved risk stratification and novel risk mitigation therapies. Current investigations are focused on identifying novel genetic and biomarker risk factors among CKD patients, understanding the interplay of hemodialysis-specific exposures in the development of arrhythmias, and examining the risks and benefits of implantable cardioverter defibrillators among CKD patients using clinical trial and registry data.


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