Abstract Sun407: Race and ethnicity based disparities in hypotension and treatment after OHCA

Abstract

Introduction: Minority out-of-hospital cardiac arrest (OHCA) patients suffer from worse outcomes, and research suggests that differences in hospital care may significantly contribute to outcome variations. However, less is known about disparities in post-arrest care. We sought to evaluate the association of hypotension and treatments with patient race and ethnicity after OHCA. Methodology: We retrospectively studied OHCAs from the Trinetx research database from 2013-2024. Trinetx is a Real-World Database of EHR data from numerous hospitals primarily in the US with treatment data from over 100 million patients. We defined our cohort as patients who had an ED visit for cardiac arrest and subsequent hospitalization. We included adult patients who had at least one episode of hypotension (systolic blood pressure <80 mmHg or diastolic blood pressure <50 mmHg) in the first two days after arrest. The primary outcome was untreated hypotension, defined as hypotension without the initiation of vasopressors. Other outcomes were arterial and central line placements. We evaluated the association between race/ethnicity and outcomes. Analyses were adjusted for age, sex, and year of the OHCA and White was the reference group. Results: We included 46,791 White, Black, or Hispanic/Latino patients who had blood pressure recorded. The rates of hypotension were 63.1% (N=19,888) for White, 55.4% (N=6,824) for Black, and 57.2% (N=1,702) for Hispanic/Latino patients. Black patients had higher odds of untreated hypotension (30.0% v 28.8% for White, aOR 1.2 [1.1-1.2]). Hispanic/Latino patients had similar odds of untreated hypotension (26.0%, aOR 1.0 [0.9-1.1]). Compared to White patients with hypotension (49.9%), Black (60.0%, aOR 1.4 [1.3-1.5]) and Hispanic/Latino (59.4%, aOR 1.3 [1.2-1.5]) patients had higher odds of arterial line placement. Hispanic/Latino patients also had higher odds of central line placement (40.8% v 33.8% for White, aOR 1.2, [1.1-1.3]). Conclusion: Although minority OHCA patients had higher rates of resuscitative procedures, Black patients had higher odds of untreated hypotension compared to White patients.