1. Section Editor(s): Pfeifer, Gail MA, RN

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Black patients with in-hospital cardiac arrest are less likely to survive to discharge than white patients, according to a study in the November 9, 2009, issue of JAMA. Data were obtained for 1,883 black patients and 8,128 white patients from 274 hospitals participating in the National Registry of Cardiopulmonary Resuscitation, a large prospective, multisite registry of in-hospital cardiac arrest. Researchers found that rates of survival to discharge were 25.2% among black cardiac patients and 37.4% among white patients. The investigators found that white cardiac patients were older, more likely to be male, and more likely to be admitted with a cardiac diagnosis. In contrast, in black patients, ventricular fibrillation was more likely to be the first rhythm identified; black patients were also sicker at the time of cardiac arrest. They were also more likely to be admitted to the hospital unit without cardiac monitoring in place, to a hospital in the southeastern United States, to a hospital with more than 500 beds, and to hospitals with lower rates of survival in general. The authors conclude that racial disparities in survival were related not to disparities in care within the hospitals but to disparities between the hospitals themselves; blacks were more likely to be treated at hospitals that have worse cardiac care, and these disparities in outcomes aren't likely to improve until the quality of care at those hospitals improves.