Arab ethnicity independently predicts long-term mortality among intensive cardiac care unit admissions

Background Ethnic disparities in cardiovascular health are well recognized worldwide, including in Israel, where Jewish and Arab populations differ in cardiovascular risk profiles and life expectancy. However, data regarding outcomes among critically ill cardiac patients treated in the standardized environment of an intensive cardiac care unit (ICCU) remain limited. This study compared demographic characteristics, comorbidities, clinical presentation, and outcomes between Arab and Jewish patients admitted to a tertiary ICCU. Methods We conducted a prospective single-center cohort study including all consecutive patients admitted to the ICCU between July 2019 and December 2025. Patients were stratified by ethnicity (Jewish vs. Arab). The primary endpoint was long-term all-cause mortality. Multivariable Cox regression analysis adjusted for baseline characteristics and index diagnosis. Results The cohort included 7,026 patients: 5,615 (79.9%) Jewish and 1,411 (20.1%) Arab. Arab patients were approximately 10 years younger [59.5 (SD 14.9) vs. 69.5 (SD 15.7) years; p < 0.001], more often male (77.6% vs. 66.0%; p < 0.001), and had a higher prevalence of diabetes mellitus, smoking, dyslipidemia, prior coronary artery disease, and prior coronary artery bypass grafting (all p < 0.001). They more frequently presented with ST-elevation myocardial infarction (34.4% vs. 26.7%; p < 0.001) and stent thrombosis (1.8% vs. 0.7%; p < 0.001). Arab ethnicity was independently associated with higher long-term mortality (adjusted HR 1.31, 95% CI 1.09–1.57; p = 0.004). Conclusions Despite being younger, Arab patients had a higher burden of cardiovascular risk factors and a 31% increased risk of long-term mortality, highlighting the need for intensified primary and secondary prevention and cardiovascular risk reduction strategies.