Reasons for Ethnic Disparities in the Prehospital Care Pathway Following an Out-of-Hospital Cardiac Event: Protocol of a Systematic Review

Newport, Rochelle
Grey, Corina
Dicker, Bridget
Ameratunga, Shanthi
Harwood, Matire
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JMIR Publications Inc.

BACKGROUND: Substantial inequities in cardiovascular disease occur between and within countries, driving much of the current burden of global health inequities. Despite well-established treatment protocols and clinical interventions, the extent to which the prehospital care pathway for people who have experienced an out-of-hospital cardiac event (OHCE) varies by ethnicity and race is inconsistently documented. Timely access to care in this context is important for good outcomes. Therefore, identifying any barriers and enablers that influence timely prehospital care can inform equity-focused interventions.

OBJECTIVE: This systematic review aims to answer the question: Among adults who experience an OHCE, to what extent and why might the care pathways in the community and outcomes differ for minoritized ethnic populations compared to nonminoritized populations? In addition, we will investigate the barriers and enablers that could influence variations in the access to care for minoritized ethnic populations.

METHODS: This review will use Kaupapa Māori theory to underpin the process and analysis, thus prioritizing Indigenous knowledge and experiences. A comprehensive search of the CINAHL, Embase, MEDLINE (OVID), PubMed, Scopus, Google Scholar, and Cochrane Library databases will be done using Medical Subject Headings terms themed to the 3 domains of context, health condition, and setting. All identified articles will be managed using an Endnote library. To be included in the research, papers must be published in English; have adult study populations; have an acute, nontraumatic cardiac condition as the primary health condition of interest; and be in the prehospital setting. Studies must also include comparisons by ethnicity or race to be eligible. Those studies considered suitable for inclusion will be critically appraised by multiple authors using the Mixed Methods Appraisal Tool and CONSIDER (Consolidated Criteria for Strengthening the Reporting of Health Research Involving Indigenous Peoples) framework. Risk of bias will be assessed using the Graphic Appraisal Tool for Epidemiology. Disagreements on inclusion or exclusion will be settled by a discussion with all reviewers. Data extraction will be done independently by 2 authors and collated in a Microsoft Excel spreadsheet. The outcomes of interest will include (1) symptom recognition, (2) patient decision-making, (3) health care professional decision-making, (4) the provision of cardiopulmonary resuscitation, (5) access to automated external defibrillator, and (6) witnessed status. Data will be extracted and categorized under key domains. A narrative review of these domains will be conducted using Indigenous data sovereignty approaches as a guide. Findings will be reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines.

RESULTS: Our research is in progress. We anticipate the systematic review will be completed and submitted for publication in October 2023.

CONCLUSIONS: The review findings will inform researchers and health care professionals on the experience of minoritized populations when accessing the OHCE care pathway. TRIAL REGISTRATION: PROSPERO CRD42022279082; INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/40557.

cardiology , cardiovascular , emergency responders , ethnicity , health care , health equity , Indigenous peoples , out-of-hospital cardiac arrest , patient care , Indigenous peoples , cardiology , cardiovascular , emergency responders , ethnicity , health care , health equity , out-of-hospital cardiac arrest , patient care , 4203 Health Services and Systems , 4206 Public Health , 42 Health Sciences , Cardiovascular , Heart Disease , 8.1 Organisation and delivery of services , 8 Health and social care services research , Generic health relevance , 3 Good Health and Well Being , 1103 Clinical Sciences , 1117 Public Health and Health Services , 4203 Health services and systems , 4206 Public health
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©Rochelle Newport, Corina Grey, Bridget Dicker, Shanthi Ameratunga, Matire Harwood. Originally published in JMIR Research Protocols (, 12.07.2023. This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on, as well as this copyright and license information must be included.