Abstract 406: Texas Out of Hospital Cardiac Arrest Disparities for Rural Patient Care From Statewide Out-of-Hospital Cardiac Arrest Data Registry - The Texas Cares Project

Abstract

Introduction: Out-of-hospital cardiac (OHCA) arrest victims from rural settings suffer worse outcomes. We evaluated the association between rural setting and post-arrest care and outcomes. Hypothesis: Receiving treatment for OHCA at a rural hospital will be associated with a lower rate of post OHCA care and lower rate of favorable neurologic outcomes (cerebral performance score 1 or 2). Methods: We performed a retrospective analysis of the Texas Cardiac Arrest Registry to Enhance Survival (CARES) from 2014-2021. We included adult OHCAs not listed as DNR. We defined hospital urbanicity as the proportion of OHCAs originating from rural census tracts. We defined hospitals as rural if more than 25% of included OHCAs were rural. We evaluated the association between rural hospital status and patient and prehospital care characteristics - age, race, initial rhythm, response time, bystander CPR - and hospital care characteristics - targeted temperature management (TTM) and percutaneous coronary intervention (PCI) rates. We evaluated the association between rural hospital status and favorable neurological outcomes with logistic regression, adjusted for patient and prehospital factors, hospital care, and census tract median household income. Results: We included 31,569 encounters with OHCA at 161 unique hospitals. The rural hospital group included 1,213 OHCA encounters (3.8%) at 25 hospitals (15.5%). Patient factors between groups were similar other than a higher rate of white patients in the rural group. Rates of angiography (16.1% non rural, 17.1% rural), PCI (8.2%, 8.7%), and TTM (30.6%,34.7%) were not statistically different. Treatment at rural hospitals was not associated with a statistically significant decreased odds of good neurological outcome (aOR 1.02, 95%ci 0.83-1.24). Conclusion: Treatment for OHCA at rural hospitals was not associated with a lower rate of post OHCA care or lower rate of favorable neurologic outcome