Browsing by Author "Nallamothu, Brahmajee K."

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    Racial and Ethnic Differences in Bystander CPR for Witnessed Cardiac Arrest
    (Massachusetts Medical Society, 2022) Garcia, R. Angel; Spertus, John A.; Girotra, Saket; Nallamothu, Brahmajee K.; Kennedy, Kevin F.; McNally, Bryan F.; Breathett, Khadijah; Del Rios, Marina; Sasson, Comilla; Chan, Paul S.; Medicine, School of Medicine
    Background: Differences in the incidence of cardiopulmonary resuscitation (CPR) provided by bystanders contribute to survival disparities among persons with out-of-hospital cardiac arrest. It is critical to understand whether the incidence of bystander CPR in witnessed out-of-hospital cardiac arrests at home and in public settings differs according to the race or ethnic group of the person with cardiac arrest in order to inform interventions. Methods: Within a large U.S. registry, we identified 110,054 witnessed out-of-hospital cardiac arrests during the period from 2013 through 2019. We used a hierarchical logistic regression model to analyze the incidence of bystander CPR in Black or Hispanic persons as compared with White persons with witnessed cardiac arrests at home and in public locations. We analyzed the overall incidence as well as the incidence according to neighborhood racial or ethnic makeup and income strata. Neighborhoods were classified as predominantly White (>80% of residents), majority Black or Hispanic (>50% of residents), or integrated, and as high income (an annual median household income of >$80,000), middle income ($40,000-$80,000), or low income (<$40,000). Results: Overall, 35,469 of the witnessed out-of-hospital cardiac arrests (32.2%) occurred in Black or Hispanic persons. Black and Hispanic persons were less likely to receive bystander CPR at home (38.5%) than White persons (47.4%) (adjusted odds ratio, 0.74; 95% confidence interval [CI], 0.72 to 0.76) and less likely to receive bystander CPR in public locations than White persons (45.6% vs. 60.0%) (adjusted odds ratio, 0.63; 95% CI, 0.60 to 0.66). The incidence of bystander CPR among Black and Hispanic persons was less than that among White persons not only in predominantly White neighborhoods at home (adjusted odds ratio, 0.82; 95% CI, 0.74 to 0.90) and in public locations (adjusted odds ratio, 0.68; 95% CI, 0.60 to 0.75) but also in majority Black or Hispanic neighborhoods at home (adjusted odds ratio, 0.79; 95% CI, 0.75 to 0.83) and in public locations (adjusted odds ratio, 0.63; 95% CI, 0.59 to 0.68) and in integrated neighborhoods at home (adjusted odds ratio, 0.78; 95% CI, 0.74 to 0.81) and in public locations (adjusted odds ratio, 0.73; 95% CI, 0.68 to 0.77). Similarly, across all neighborhood income strata, the frequency of bystander CPR at home and in public locations was lower among Black and Hispanic persons with out-of-hospital cardiac arrest than among White persons. Conclusions: In witnessed out-of-hospital cardiac arrest, Black and Hispanic persons were less likely than White persons to receive potentially lifesaving bystander CPR at home and in public locations, regardless of the racial or ethnic makeup or income level of the neighborhood where the cardiac arrest occurred.
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    Reporting of race and ethnicity in medical and scientific journals
    (American Medical Association, 2021) Breathett, Khadijah; Spatz, Erica S.; Nallamothu, Brahmajee K.; Medicine, School of Medicine
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    Strategies to Reduce Low-Value Cardiovascular Care: A Scientific Statement From the American Heart Association
    (American Heart Association, 2022) Kini, Vinay; Breathett, Khadijah; Groeneveld, Peter W.; Ho, P. Michael; Nallamothu, Brahmajee K.; Peterson, Pamela N.; Rush, Pam; Wang, Tracy Y.; Zeitler, Emily P.; Borden, William B.; American Heart Association Council on Quality of Care and Outcomes Research; Medicine, School of Medicine
    Low-value health care services that provide little or no benefit to patients are common, potentially harmful, and costly. Nearly half of the patients in the United States will receive at least 1 low-value test or procedure annually, creating risk of avoidable complications from subsequent cascades of care and excess costs to patients and society. Reducing low-value care is of particular importance to cardiovascular health given the high prevalence and costs of cardiovascular disease in the United States. This scientific statement describes the current scope and impact of low-value cardiovascular care; reviews existing literature on patient-, clinician-, health system-, payer-, and policy-level interventions to reduce low-value care; proposes solutions to achieve meaningful and equitable reductions in low-value care; and suggests areas for future research priorities.
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    The Groundwater of Racial and Ethnic Disparities Research. A Statement from Circulation: Cardiovascular Quality & Outcomes
    (American Heart Association, 2021) Breathett, Khadijah; Spatz, Erica S.; Kramer, Daniel B.; Essien, Utibe R.; Wadhera, Rishi K.; Peterson, Pamela N.; Ho, P. Michael; Nallamothu, Brahmajee K.; Medicine, School of Medicine
    The Fish. The Pond. The Groundwater. Imagine that you have a personal pond filled with fish. When viewing your pond, you notice that one fish has died, floating belly-up. You decide that the fish must have been ill and think nothing more of it. The next day, you notice that half of the fish in your pond are now dead. You are alarmed and decide to contact the neighborhood management services to investigate your pond. Something must be wrong with the local system. The following day, however, you discover that all of your neighbors with ponds have noticed the same thing. In fact, half of the fish are dead throughout all waterways in the entire state. At this point, it is clear something deeper must be wrong. This is when you need to analyze the groundwater feeding these ponds. The fish are not at fault, and not even the local systems. Rather the underlying structures through which the fish seek life has failed. Imagine that instead of fish, we are discussing patients. —Paraphrase of Groundwater Approach Metaphor by Love and Hayes-Greene of The Racial Equity Institute.
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    Within-Hospital Racial Disparities in Operative Mortality Following Coronary Artery Bypass Grafting
    (Sage, 2022) Murali, Sitara; Shay, Addison; Lai, Lillian Y.; Breathett, Khadijah; Nallamothu, Brahmajee K.; Hollingsworth, John M.; Medicine, School of Medicine