Abstract 19646: Gender Disparities in End-of-Life Care Decisions for Cardiac Arrest Patients
Background: Gender disparities exist in the treatment of many diseases. We sought to discover whether disparities exist in the timing of end-of-life care for cardiac arrest (CA) patients who are eventually transitioned to comfort measures only (CMO). We hypothesized that males would have less time between the index CA event and the CMO decision.
Methods: This work was conducted under an existing IRB protocol. We reviewed medical records for all treated CAs in one Pittsburgh healthcare system from January 2010 to June 2013 who were eventually designated CMO in the hospital. Data included the date and location of the index CA, CMO decision, and death, first CA rhythm, coma status, patient age and gender, and positive cancer diagnosis. We also recorded whether organ donation occurred and the gender of the physician who oversaw the CMO decision. We used t-tests and multiple regression where appropriate with an alpha level of 0.05.
Results: We reviewed 250 medical records, of which 152 were male (58.0%). The mean (SD) age was 60.3 (17.2) years for males and 62 (15.2) years for females, and 71.3% of all index CA events occurred outside the hospital. The median (IQR) time from index CA to CMO decision was 3 (1-5) days for men and 3 (1-4) days for women; the median (IQR) time from CMO decision to death was 0 (0-0) days for both men and women; the median (IQR) time from index CA to death was 3 (1-5) days for men and 3 (1.25-4) days for women. None of these times were significantly different between genders. Age, cancer diagnosis, organ donation, shockable first rhythm, and gender of the overseeing physician did not significantly affect the time from index CA to CMO time. Coma upon arrival was not associated with decreased time from CA to CMO decision. In-hospital CA patients were on average given more time before the CMO decision was made than out-of-hospital CA patients when accounting for common demographic data (IHCA: mean (SD) 4.4 (5.7) days, OHCA: 3.3 (3.1) days, p = 0.005).
Conclusions: We found no gender bias in the time between index CA and CMO decision or from CMO decision to time of death. Age, cancer, physician gender, first CA rhythm, and organ donation were not associated with CMO timing. Out-of-hospital location of CA was associated with earlier transition to CMO.
Author Disclosures: A.C. Koller: None. J.C. Rittenberger: Honoraria; Modest; CR Bard for presenting at 3rd Asia TTM Master Class 2015. C.W. Callaway: None.
- © 2016 by American Heart Association, Inc.