Race and survival post cardiac arrest

In-hospital cardiac arrest provides a unique opportunity to examine the influence of race on post-arrest outcomes. As patients are already in hospital, potential differences caused by differences in access to care, or compliance in medications, are less likely to confound outcomes.

In this cohort study of 10,011 patients who suffered cardiac arrest (either ventricular fibrillation or pulseless ventricular tachycardia), 1883 (18.8%) of patients were black and 8128 (81.2%) of patients were white. Overall, rates of survival to discharge were lower for black patients (25.2%) than for white patients (37.4%; relative rate [RR], 0.73). However this difference narrowed after adjustment for both patient characteristics and for hospital site (RR 0.89, p = .002). The survival difference was due both to a lower rate of successful resuscitation for blacks (55.8% vs 67.4%) and postresuscitation survival (45.2% vs 55.5%). However, adjustment for the hospital site eliminated the racial difference in postresuscitation survival.

Conclusions

Black patients who have an in-hospital cardiac arrest are less likely to survive to discharge than white patients. However, much of this racial difference was associated with the hospital center in which black patients were treated. This paper therefore highlights the need to target individual hospitals with low survival rates in order to improve outcomes following in-hospital cardiac arrest.

▸ Chan PS, Nichol G, Krumholz GM, et al. Racial Differences in Survival After In-Hospital Cardiac Arrest. JAMA 2009;302:1195–201.

PPI/clopidogrel combination safe in latest analysis

Proton pump inhibitors (PPIs) are often prescribed in combination with anti-platelet agents in order to reduce the risk of gastro-intestinal bleeding. Recently, concerns have surfaced that many PPIs, in particular omeprazole, can diminish the antiplatelet effects of clopidogrel.

In this study, the authors examined the association between the use of a PPI, platelet function, and clinical outcomes, for patients treated either with clopidogrel or prasurgrel in two major trials: PRINCIPLE (Prasugrel in …