US survival rates of out-of-hospital cardiac arrest lower among Asian vs. white adults
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Key takeaways:
- Asian adults in the U.S. may have worse survival of out-of-hospital cardiac arrest vs. white adults.
- The difference occurred despite similar rates of bystander CPR, so the driver of the disparity is unclear.
Asian individuals experience poorer outcomes after out-of-hospital cardiac arrest in the U.S. compared with white individuals, despite similar rates of bystander CPR, researchers reported.
Researchers utilized the Cardiac Arrest Registry to Enhance Survival (CARES) to better understand the impact of out-of-hospital cardiac arrest among Asian adults compared with white adults.
The results were published in the Journal of the American Heart Association.
“We were surprised that rates of bystander CPR in Asian adults were the same as white adults, as we have previously found that Black and Hispanic persons with out-of-hospital cardiac arrest have much lower rates of bystander CPR than white persons,” Paul S. Chan, MD, professor of medicine at Saint Luke’s Mid America Heart Institute and the University of Missouri-Kansas City, said in a press release. “The Asian community in the U.S. is economically and culturally diverse and not monolithic, and skin color of Asian persons also varies widely. Because of this, we had expected to see lower rates of bystander CPR in Asian vs. white adults.
“Subsequently, since Asian individuals had similar rates of bystander CPR as white individuals, we didn’t expect them to have lower survival rates,” Chan said. “Receiving bystander CPR is usually a very strong predictor of survival after out-of-hospital cardiac arrest, therefore, it is not entirely clear what may be driving the lower survival rate among Asian adults.”
Cardiac arrest outcomes
Using CARES, Chang and colleagues identified 278,989 Asian and white individuals who experienced an out-of-hospital cardiac arrest from 2013 to 2021. With this data, the researchers compared rates of bystander CPR, survival to discharge and favorable neurological outcomes between the two groups.
Asian individuals represented 5.3% out-of-hospital cardiac arrests from 2013 and 2021, and were more often older (mean age, 67 vs. 62.8 years), less likely to have cardiac arrest attributed to drug overdose (1.3% vs. 6.6%) and less likely to have a shockable rhythm (19.2% vs. 22.4%) than white individuals, according to the study.
The rate of bystander CPR was similar among Asian and white individuals experiencing out-of-hospital cardiac arrest (Asian, 42.6%; white, 42.1%; adjusted RR for Asian individuals = 0.99; 95% CI, 0.97-1.02; P = .69).
Despite similar bystander CPR, the rate of survival to discharge was lower among Asian individuals (8.2% vs. 10.3%; aRR = 0.92; 95% CI, 0.86-0.98; P = .006) as well as the rate of favorable neurological survival (6.5% vs. 8.7%; aRR = 0.85; 95% CI, 0.79-0.91; P < .001), compared with white individuals.
CPR findings ‘encouraging’
“It is quite encouraging that bystander CPR rates for Asian adults were comparable to white adults; however, the overall analysis indicates additional research is needed to better understand the gap in CPR survival and neurological outcomes among Asian adults after out-of-hospital cardiac arrest,” Joseph C. Wu, MD, PhD, FAHA, director of the Stanford Cardiovascular Institute, the Simon H. Stertzer Professor of Medicine and Radiology at Stanford School of Medicine and president of the American Heart Association, said in the release. “The results here call for us to investigate the biological and physiological factors, as well as socioeconomic determinants of health and outcomes, and how they may impact people in various Asian subgroups.”
Reference:
- Asian adults in U.S. less likely to survive cardiac arrest despite bystander CPR equal to white adults. https://newsroom.heart.org/news/asian-adults-in-u-s-less-likely-to-survive-cardiac-arrest-despite-bystander-cpr-equal-to-white-adults. Published July 26, 2023. Accessed July 26, 2023.
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