Abstract Body: Background: Safety net hospitals (SNH) are a vital part of the US health care system, providing care to many of the most vulnerable patients who may have limited access to care. There is a paucity of research examining the association of SNH status and clinical outcomes among in-hospital cardiac arrest (IHCA) patients. We sought to examine differences in survival to discharge and survival with good neurological outcomes by safety hospital status.

Methods: We utilized the American Heart Association (AHA) Get with The Guidelines (GWTG) Resuscitation dataset from 2000-2024 and included adult patients who suffered an IHCA. To classify SNH hospital status, we applied the disproportionate share hospital (DSH) index and stratified hospitals into quintiles. Covariates included patient demographics, event year, witnessed IHCA, comorbidities, shockable initial rhythm, weekend indicator, hospital size, teaching status, and ownership. Measured outcomes were survival to discharge and survival with good neurological status (Cerebral Performance Category 1 or 2). We utilized a multivariable logistic regression model to compare patient level outcomes at top quintile SNH vs. lower quintile hospitals.

Results: We identified 491,980 patients with IHCA during the study period at a hospital with DSH index data. Mean age was 65 years old (SD 16.8), with 4.8% (n = 23775) Hispanic patients, 62.5% (n = 307732) Non-Hispanic White patients, 24.3% (n= 119626) Non-Hispanic Black patients, and 42% (n =206383) female patients. Among 1046 total hospitals, 627 were linked to DSH classified as SNH and among those 167 were in the top quintile. Top quintile DSH hospitals accounted for 27% (134,754/491,980) of reported adult IHCA. Survival to hospital discharge was lower among patients treated at top quintile DSH hospitals (19.2% vs 23.3%, p >0.001). In multivariable logistic regression models, we found a decreased odds of survival to discharge (aOR 0.74, 95% CI 0.65-0.84) and survival with good neuro (0.62, 95% CI 0.49-0.79) as compared to hospitals not in the top quintile of SNH status.

Conclusion: Patients experiencing IHCA at SNH, particularly those in the highest DSH index quintile, demonstrated significantly lower odds of survival to discharge and favorable neurological outcomes compared to other hospitals. These findings highlight disparities in IHCA outcomes and suggest the need for targeted interventions and resource allocation to improve resuscitation care at SNH.