Ethnic Differences in Direct Transport to PCI-Capable Hospitals Following OHCA

Abstract

Background: Ethnic disparities exist in survival from out-of-hospital cardiac arrest (OHCA) in New Zealand. This study investigates how receiving-hospital impacts on outcomes, comparing hospitals with, or without, percutaneous coronary intervention (PCI) capability. Method: A retrospective observational study using St John New Zealand OHCA registry data for adult patients treated for OHCA of presumed cardiac aetiology between 1 October 2013 and 31 October 2018. Demographic characteristics were investigated using Chi-Squared analysis. Binary logistic regression modelling was used to investigate outcome differences in survival at thirty-days post-event, according to receiving-hospital PCI-capability. Results: Following an OHCA, 1750 patients were transported to hospital with sustained return-of-spontaneous-circulation (ROSC). Pacific Peoples (86.2%) had the highest proportion of transport to PCI-capable hospitals, followed by European (55.6%) then Māori (32.9%) (p < 0.001). Overall, a lower proportion of patients >65 years (49.9%) were conveyed to PCI-capable hospitals compared to younger age groups, 15–44 years (52.1%) and 45–64 years (59.7%) (p < 0.001). A lower proportion of patients located rurally (34.7%) were transported to PCI-capable hospitals compared to patients in urban locations (59.1%) (p < 0.001). Thirty-day survival was higher in patients transported to hospitals with PCI-capability (Adjusted OR 1.285, 95%CI (1.01 to 1.63), p = 0.04). Median ambulance transport time from OHCA scene to PCI-capable hospitals (13 minutes) was longer compared to non-PCI-capable hospitals (10 minutes) (p < 0.001). Conclusions: Inequities in healthcare may exist related to ethnicity, age, and rurality, associated with receiving-hospital capability. These warrant further investigation. Survival was significantly increased in patients conveyed to hospitals with PCI-capability compared to those who were not.