1
|
Abbott EE, Oh W, Dai Y, Feuer C, Chan L, Carr BG, Nadkarni GN. Joint Modeling of Social Determinants and Clinical Factors to Define Subphenotypes in Out-of-Hospital Cardiac Arrest Survival: Cluster Analysis. JMIR Aging 2023; 6:e51844. [PMID: 38059569 PMCID: PMC10721134 DOI: 10.2196/51844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/28/2023] [Accepted: 10/29/2023] [Indexed: 12/08/2023] Open
Abstract
Background Machine learning clustering offers an unbiased approach to better understand the interactions of complex social and clinical variables via integrative subphenotypes, an approach not studied in out-of-hospital cardiac arrest (OHCA). Objective We conducted a cluster analysis for a cohort of OHCA survivors to examine the association of clinical and social factors for mortality at 1 year. Methods We used a retrospective observational OHCA cohort identified from Medicare claims data, including area-level social determinants of health (SDOH) features and hospital-level data sets. We applied k-means clustering algorithms to identify subphenotypes of beneficiaries who had survived an OHCA and examined associations of outcomes by subphenotype. Results We identified 27,028 unique beneficiaries who survived to discharge after OHCA. We derived 4 distinct subphenotypes. Subphenotype 1 included a distribution of more urban, female, and Black beneficiaries with the least robust area-level SDOH measures and the highest 1-year mortality (2375/4417, 53.8%). Subphenotype 2 was characterized by a greater distribution of male, White beneficiaries and had the strongest zip code-level SDOH measures, with 1-year mortality at 49.9% (4577/9165). Subphenotype 3 had the highest rates of cardiac catheterization at 34.7% (1342/3866) and the greatest distribution with a driving distance to the index OHCA hospital from their primary residence >16.1 km at 85.4% (8179/9580); more were also discharged to a skilled nursing facility after index hospitalization. Subphenotype 4 had moderate median household income at US $51,659.50 (IQR US $41,295 to $67,081) and moderate to high median unemployment at 5.5% (IQR 4.2%-7.1%), with the lowest 1-year mortality (1207/3866, 31.2%). Joint modeling of these features demonstrated an increased hazard of death for subphenotypes 1 to 3 but not for subphenotype 4 when compared to reference. Conclusions We identified 4 distinct subphenotypes with differences in outcomes by clinical and area-level SDOH features for OHCA. Further work is needed to determine if individual or other SDOH domains are specifically tied to long-term survival after OHCA.
Collapse
Affiliation(s)
- Ethan E Abbott
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New YorkNY, United States
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New YorkNY, United States
- Division of Data-Driven and Digital Medicine, Icahn School of Medicine at Mount Sinai, New YorkNY, United States
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New YorkNY, United States
| | - Wonsuk Oh
- Division of Data-Driven and Digital Medicine, Icahn School of Medicine at Mount Sinai, New YorkNY, United States
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New YorkNY, United States
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New YorkNY, United States
| | - Yang Dai
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New YorkNY, United States
| | - Cole Feuer
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New YorkNY, United States
| | - Lili Chan
- Division of Data-Driven and Digital Medicine, Icahn School of Medicine at Mount Sinai, New YorkNY, United States
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New YorkNY, United States
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New YorkNY, United States
| | - Brendan G Carr
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New YorkNY, United States
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New YorkNY, United States
| | - Girish N Nadkarni
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New YorkNY, United States
- Division of Data-Driven and Digital Medicine, Icahn School of Medicine at Mount Sinai, New YorkNY, United States
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New YorkNY, United States
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New YorkNY, United States
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New YorkNY, United States
| |
Collapse
|
2
|
Gamberini L, Del Giudice D, Saltalamacchia S, Taylor B, Sala I, Allegri D, Pastori A, Coniglio C, Gordini G, Semeraro F. Factors associated with the arrival of smartphone-activated first responders before the emergency medical services in Out-of-Hospital cardiac arrest dispatch. Resuscitation 2023; 185:109746. [PMID: 36822460 DOI: 10.1016/j.resuscitation.2023.109746] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/10/2023] [Accepted: 02/14/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND First responder programs were developed to speed up access to cardiopulmonary resuscitation and defibrillation for out-of-hospital cardiac arrest (OHCA) victims. Little is known about the factors influencing the efficiency of the first responders arriving before the EMS and, therefore, effectively contributing to the chain of survival. OBJECTIVES The primary objective of this retrospective observational study was to identify the factors associated with first responders' arrival before EMS in the context of a regional first responder program arranged to deliver automated external defibrillators on suspected OHCA scenes. METHODS Eight hundred ninety-six dispatches where FRs intervened were collected from 2018 to 2022. A robust Poisson regression was performed to estimate the role of the time of day, the immediate availability of a defibrillator, the type of first responder, distances between the responder, the event and the dispatched vehicle, and the nearest available defibrillator on the probability of responder arriving before EMS. Moreover, a geospatial logistic regression model was built. RESULTS Responders arrived before EMS in 13.4% of dispatches and delivered a shock in 0.9%. The immediate availability of a defibrillator for the responder (OR = 3.24) and special categories such as taxi drivers and police (OR = 1.74) were factors significantly associated with the responder arriving before EMS. Moreover, a geospatial effect suggested that first responder programs may have a greater impact in rural areas. CONCLUSIONS When dispatched to OHCA scenes, responders already carrying defibrillators could more probably reach the scene before EMS. Special first responder categories are more competitive and should be further investigated.
Collapse
Affiliation(s)
- Lorenzo Gamberini
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | | | - Stefano Saltalamacchia
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | - Benjamin Taylor
- University College Cork, Department School of Mathematical Sciences, Ireland
| | - Isabella Sala
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy; Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Davide Allegri
- Department of Clinical Governance and Quality, Bologna Local Healthcare Authority, Bologna, Italy
| | - Antonio Pastori
- Settore Assistenza Ospedaliera, Direzione Generale Cura della Persona, Salute e Welfare, Assessorato Politiche per la Salute, Regione Emilia, Bologna, Italy
| | - Carlo Coniglio
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy.
| | - Giovanni Gordini
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | - Federico Semeraro
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | | |
Collapse
|