Out-of-hospital cardiac arrest survival in Black & Hispanic communities since the COVID-19 pandemic

Abstract

Background

Survival after out-of-hospital cardiac arrest (OHCA) decreased sharply in 2020 during the COVID-19 pandemic. It is unknown if survival recovered to pre-pandemic levels, or how recovery varied by community racial and ethnic composition.

Methods

We analyzed adults with non-traumatic OHCA from 2015 to 2022 in the Cardiac Arrest Registry to Enhance Survival using multivariable regression models with generalized estimation equations to calculate risk-adjusted rates of survival to discharge during 2015–2019 (pre-pandemic period) versus 2020, 2021, and 2022. We also examined survival rates based on community racial/ethnic composition, defined as predominantly White (≥80% White residents), majority Black or Hispanic (≥50% Black or Hispanic residents), or integrated (neither).

Results

The cohort included 506,419 OHCA patients (mean age 61.9y; 64% male, 22% Black race, 7% Hispanic ethnicity). Pre-pandemic survival was 9.9%, with lower survival in majority Black/Hispanic (7.9%) and integrated (10.7%) versus predominantly White communities (11.1%). In 2020, survival decreased to 9.0% overall (relative change −9.1% vs pre-pandemic; P < 0.001), with a larger decrease in majority Black/Hispanic (−16.5%) than predominantly White (−8.1%) or integrated (−6.5%) communities (P for interaction: 0.07). Overall, survival rates remained largely unchanged in 2021–2022 (9.1%), with modest improvements in majority Black/Hispanic communities. However, absolute survival remained lower in these communities at all times compared to other communities.

Conclusions

OHCA survival improved minimally in 2021 and 2022 following a significant decline in 2020. The initial decline was larger in majority Black or Hispanic communities; despite some improvement in 2021 and 2022, absolute survival in these communities remained lower throughout the study period.