Sriman Gaddam The University of Texas at Austin Austin, TX 78705

Social Disparities in Pre-Hospital Cardiac Arrest Outcomes Interview with:

Sriman Gaddam The University of Texas at Austin Austin, TX 78705

Sriman Gaddam

Sriman Gaddam
The University of Texas at Austin
Austin, TX 78705 What is the background for this study?

Response: The quality of care that patients receive from the US healthcare system continues to be influenced by socioeconomic status (SES). Given that cardiac arrest is one of the most common causes of death in the US and that the prehospital setting has an especially high mortality for cardiac arrest, we wanted to determine if the socioeconomic disparities found in the overall US healthcare system continued into the prehospital cardiac arrest setting. What are the main findings?

Response: We found that socioeconomic disparities were present in the prehospital cardiac arrest setting. As the SES of a patient declines, so does the patient’s likelihood of achieving return of spontaneous circulation (ROSC). Between the most and least wealthy patients, there was nearly a 13% difference in the probability of achieving ROSC. However, we recognized that not all patients who achieve ROSC are equal as patients can have significantly different neurological functioning depending on the length of time spent in cardiac arrest. Consequently, this paper analyzed cardiac arrest outcomes not only through the occurrence of ROSC but also through the duration of time spent in cardiac arrest. In line with the socioeconomic disparities found in ROSC occurrence, it was found that as a patient’s SES declines, the duration of time spent in cardiac arrest before ROSC is achieved increases. This indicates that patients with a low SES are both more likely to not achieve ROSC and if ROSC is achieved more likely to have neurological impairment due to longer time spent in cardiac arrest compared to patients with a high SES. What should readers take away from your report?

Response: Individuals with a low SES have higher rates of cardiac diseases and are thus more likely to experience an out of hospital cardiac arrest than the general population. Yet, those same individuals have the deck stacked against them when they require prehospital cardiac arrest care. Prior research has found that lower SES is associated with longer EMS wait times potentially delaying lifesaving CPR. Furthermore, low-income neighborhoods have significantly lower rates of CPR trained bystanders than high-income neighborhoods again leading to a critical delay in CPR for patients. What recommendations do you have for future research as a result of this work?

Response: Future research should start to focus on potential solutions to the disparities found in this paper. With the sheer number of prehospital cardiac arrest deaths in the US every year, even a disparity of a few percent in cardiac arrest outcomes can equate to thousands of lives lost due to the SES status of the patient. Is there anything else you would like to add?

Response: There are solutions to help reduce the disparities found by this study. More funding can be allocated for EMS agencies in low-income neighborhoods in order to decrease EMS wait times by increasing the number of units in operation. Additionally, more funding can be given to public health initiatives in low-income neighborhoods that sponsor CPR training to increase the frequency of bystander CPR as CPR training cost was noted as a significant barrier for individuals with a low SES.

Any disclosures? None


The American Journal of Emergency Medicine

Available online 25 June 2020
Socioeconomic disparities in prehospital cardiac arrest outcomes: An analysis of the NEMSIS database 

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Last Updated on June 28, 2020 by Marie Benz MD FAAD