Abstract 132: The Effect of Social Determinants on Cardiac Arrest and Pre-Arrest Care Patterns

Abstract

Background: More than 300,000 people experience out-of-hospital cardiac arrest (OHCA) and only 11% of patients survive to discharge, calling for a focus on prevention. Understanding the impact of social determinants of health (SDOH) on OHCA, including access to care pre-cardiac arrest (CA) can improve outcomes. Aims: To 1) determine the incidence of CA in a large national database across demographics and 2) characterize the CA patient population’s access to care pre-arrest based on SDOH. Hypothesis: SDOH will have a significant effect on CA incidence and access to pre-arrest care. Methods: Observational retrospective cohort study using Epic Cosmos, a large deidentified electronic health database with 186 million patients. IRB approval was not required. Inclusion criteria was ED visit for CA (ICD-10-CM: I46). Patient demographics included age, gender, race, ethnicity, social vulnerability index (SVI, a composite measure with greater SVI representing more adverse SDOH). The primary outcome was CA incidence between demographic groups, reported as odds ratios (ORs). The secondary outcome was incidence of prior visits within 30 days within each demographic group. Significance was determined using Chi-squared analysis. Results: There were 201,846 ED visits for CA between April 20, 2020, and April 19, 2023 (0.11% incidence). For all ages, the odds of CA were greater in the highest SVI quartile compared to the lowest (OR 1.84, p<0.001). Black patients had higher odds of CA than White patients (OR 1.65, p<0.001). In the cohort of patients with an ED visit for cardiac arrest, 9.1% had a prior ED visit within 30 days, and 9.1% and 6.0% had an office or specialty care visit, respectively. Patients with a higher SVI had a greater incidence of ED visits (10.2% vs. 7.8%, p<0.001), but a lower incidence of office visits (8.1% vs. 9.9%, p<0.001) and specialty visits (5.2% vs. 6.8%, p<0.001) pre-arrest. Similarly, Black patients had more ED visits (11.6% vs. 8.6%, p<0.001) than White patients, but less office visits (8.5% vs. 9.8%, p<0.001) and specialty visits (5.6% vs. 6.5%, p<0.001). Conclusions: The SDOH have a significant impact on the risk of CA and s pre-arrest care patterns. Targeting interventions to address community and individual SDOH can lead to prevention of OHCA.