by Amy Norton
Thursday, Oct. 27, 2022 (HealthDay News) — When someone collapses in front of witnesses, the chances of receiving potentially life-saving CPR may depend in part on the color of their skin, according to a new study.
Researchers found that when Hispanic and black Americans suffer cardiac arrest, they are 37% less likely to receive CPR than white people in public and at home.
The causes of this disparity are uncertain, but there are possible explanations, said lead researcher Dr. Paul Chan of St. Luke’s Central American Heart Institute in Kansas City, Missouri.
CPR training is less available in black and Latino communities, he said, and there are other barriers, such as cost, which may help account for variances in responses to cardiac arrests at home.
But getting into the study, the researchers predicted that the disparities would be reduced when cardiac arrests occurred in public. With more people, the chances of bystanders training in CPR are greater.
Instead, the disparities were greater: Among cardiac arrests that occurred at home, black and Hispanic individuals were 26% less likely than white people to receive CPR. In public, this gap has grown to 37%.
“It was amazing,” Chan said. “It was not what we expected to see.” “And that raises a lot of questions about why.”
Unfortunately, Chan and other experts said, bias — whether conscious or not — can play a role. Bystanders may be less likely to “make assumptions” about a white person breaking down, Chan said, versus a black or Hispanic person.
He pointed out that the differences were not limited to heart attacks that struck the white neighborhoods.
Across neighborhoods of all incomes, and even in those that were predominantly black or Hispanic, albino cardiac arrest victims were more likely to receive CPR.
Cardiac arrest occurs when the heart suddenly stops beating normally, due to a problem with its electrical system. Usually, the person collapses into unconsciousness and stops breathing normally. It is rapidly fatal without emergency medical treatment.
If bystanders immediately begin chest compressions with CPR, this can keep blood and oxygen flowing in the victim’s body until paramedics arrive. But in fact, only about 45% of Americans who experience cardiac arrest outside the hospital receive CPR, according to the American Heart Association.
The new findings, published October 27 in New England Journal of Medicine, It aligns with that statistic.
Chan’s team used a large US registry to find more than 110,000 cardiac arrests where witnesses were present. Despite this, most victims did not receive CPR, with rates particularly low for Hispanics and blacks.
When they had cardiac arrest at home, 39% of them received CPR, versus 47% of whites. And when the arrest occurred in public, fewer than 46% of black and Latino victims received CPR, compared to 60% of their white counterparts.
Such disparities were seen whether the surrounding neighborhood was predominantly white, racially diverse, predominantly black or Hispanic, and whether it was high or low income.
It’s heartbreaking, it’s heartbreaking,” said Dr.
However, she also said that she was not surprised. Berlacher said that although more people are available to respond to cardiac arrest in a public setting, these people can have bias, whether they are conscious or not. She noted that these biases can influence how quickly they approach a person who has collapsed, call 911 or try to find someone who knows CPR.
Dr. Anzi Ozendo worked with the Heart Association to develop a “toolkit” to reduce disparities in cardiac arrest care and survival. He is also a cardiac arrest survivor, thanks in part to the actions of bystanders who performed CPR after he collapsed, at age 25, while playing basketball in his gym.
“It can happen to anyone,” said Ozendo, who is a cardiologist at St Luke’s Hospital but was not involved in the study.
Uzendu beat the odds, as the survival rate for cardiac arrest is low, at about 12%, according to the Heart Association. Studies show that survival is lower for Hispanics and blacks, compared to whites.
CPR can double or triple the chances of survival, and it is believed that better access to CPR training can bridge the racial divide in survival from cardiac arrest.
But the new findings suggest CPR training isn’t the only answer, Ozendo said.
“Some of this disparity may be due to a lack of training,” he said. “Some of it may be due to structural racism. Some of it may be due to implicit or explicit biases.”
However, all three clinicians agreed that increased access to CPR training could make a big difference – especially since an estimated 70% of cardiac arrests occur at home, where bias is assumed not to be the problem.
One way to do this, Chan said, is to offer free or low-cost training courses at convenient locations such as churches or community centers in underserved neighborhoods.
The exercises should also include people of color — from the coaches to the actors in the course videos, Berlacher said.
As for survival from cardiac arrest, Chan’s team found what previous studies have found: Blacks and Hispanics often die. Of those who experienced cardiac arrest in public, just under 23% survived, compared to about 32% of white people.
“CPR can make a huge difference to survival,” Chan said.
The American Heart Association has more on learning CPR.
SOURCES: Paul S. Chan, MD, professor of medicine, cardiologist, University of Missouri-Kansas City School of Medicine, Saint Luke’s Mid America Heart Institute, Kansas City, Mo.; Kathryn Berlacher, MD, MSc, assistant professor, medicine, medical director, Maggie’s Women’s Heart Program, University of Pittsburgh Medical Center, and member of the Task Force on Health Equality, American College of Cardiology, Washington, DC; Anezi Uzendu, MD, Interventional Cardiologist, St. Luke’s Central American Heart Institute; New England Journal of Medicine, October 27 2022