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Racial and Ethnic Differences in Bystander CPR for Cardiac Arrest
Quick Takes
- The relative likelihood of receiving bystander CPR at home was 26% lower for Black and Hispanic persons than for White persons, and the likelihood of bystander CPR for arrests in public locations was 37% lower for Black and Hispanic persons.
- Multifaceted public health interventions that go beyond CPR training such as low-cost or no-cost CPR training in Black and Hispanic communities, use of linguistically appropriate and culturally sensitive CPR training, funding for dispatcher-assisted CPR in majority Black and Hispanic neighborhoods, and engagement of community leaders are indicated to reduce racial and ethnic differences in bystander CPR.
Study Questions:
What are the racial and ethnic differences in lay person–initiated bystander cardiopulmonary resuscitation (CPR) for witnessed out-of-hospital cardiac arrests at home and in public locations?
Methods:
The investigators identified 110,054 witnessed out-of-hospital cardiac arrests during the period from 2013 through 2019 within a large US registry (CARES [Cardiac Arrest Registry to Enhance Survival]). They used a hierarchical logistic regression model to analyze the incidence of bystander CPR in Black or Hispanic persons as compared with White persons with witnessed cardiac arrests at home and in public locations. The authors analyzed the overall incidence as well as the incidence according to neighborhood racial or ethnic makeup and income strata. Neighborhoods were classified as predominantly White (>80% of residents), majority Black or Hispanic (>50% of residents), or integrated, and as high income (an annual median household income of >$80,000), middle income ($40,000–$80,000), or low income (<$40,000).
Results:
Overall, 35,469 of the witnessed out-of-hospital cardiac arrests (32.2%) occurred in Black or Hispanic persons. Black and Hispanic persons were less likely to receive bystander CPR at home (38.5%) than White persons (47.4%) (adjusted odds ratio [aOR], 0.74; 95% confidence interval [CI], 0.72-0.76) and less likely to receive bystander CPR in public locations than White persons (45.6% vs. 60.0%) (aOR, 0.63; 95% CI, 0.60-0.66). The incidence of bystander CPR among Black and Hispanic persons was less than that among White persons not only in predominantly White neighborhoods at home (aOR, 0.82; 95% CI, 0.74-0.90) and in public locations (aOR, 0.68; 95% CI, 0.60-0.75) but also in majority Black or Hispanic neighborhoods at home (aOR, 0.79; 95% CI, 0.75-0.83) and in public locations (aOR, 0.63; 95% CI, 0.59-0.68) and in integrated neighborhoods at home (aOR, 0.78; 95% CI, 0.74-0.81) and in public locations (aOR, 0.73; 95% CI, 0.68-0.77). Similarly, across all neighborhood income strata, the frequency of bystander CPR at home and in public locations was lower among Black and Hispanic persons with out-of-hospital cardiac arrest than among White persons.
Conclusions:
The authors concluded that in witnessed out-of-hospital cardiac arrest, Black and Hispanic persons were less likely than White persons to receive potentially lifesaving bystander CPR at home and in public locations.
Perspective:
This study reports large racial and ethnic differences in the incidence of bystander CPR for witnessed out-of-hospital cardiac arrest. Of note, the relative likelihood of receiving bystander CPR at home was 26% lower for Black and Hispanic persons than for White persons, and the likelihood of bystander CPR for arrests in public locations was 37% lower for Black and Hispanic persons. These findings suggest that multifaceted public health interventions that go beyond CPR training, such as low-cost or no-cost CPR training in Black and Hispanic communities, use of linguistically appropriate and culturally sensitive CPR training, funding for dispatcher-assisted CPR in majority Black and Hispanic neighborhoods, and engagement of community leaders are indicated to reduce racial and ethnic differences in bystander CPR.
Clinical Topics: Acute Coronary Syndromes, Arrhythmias and Clinical EP, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias
Keywords: Acute Coronary Syndrome, African Americans, Arrhythmias, Cardiac, Cardiopulmonary Resuscitation, Healthcare Disparities, Heart Arrest, Hispanic Americans, Myocardial Ischemia, Out-of-Hospital Cardiac Arrest, Public Health, Secondary Prevention
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