Experts were “surprised” after finding, this is a major problem for the Asian community living in Today’s America, according to a new study.

American Heart Association’s latest study shows that U.S. Asian adults display lower survival rates following cardiac arrest even though bystander CPR efforts match those extended to white adults.

A recent study in the Journal of the American Heart Association has uncovered a disparity in survival rates following out-of-hospital cardiac arrest between Asian American and white adults in the U.S., despite similar rates of bystander-initiated CPR.

How effective is bystander CPR for Asian adults?

The study, regarded as the first of its kind to compare the impact of bystander CPR on survival rates between these two groups, analyzed almost 279,000 out-of-hospital cardiac arrest cases.

Both Asian and white adults who suffered a cardiac arrest at home or in a public setting (excluding hospitals) received bystander CPR at similar rates (around 42%). Yet, following adjustments for factors like age, sex, and the cause of the cardiac arrest, Asian adults were 8% less likely to survive until hospital discharge and 15% less likely to exhibit favorable neurological outcomes than white adults.

“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,” explains Paul Chan, M.D., the study’s lead author and a professor of medicine at Saint Luke’s Mid America Heart Institute and the University of Missouri-Kansas City.

What factors contribute to lower survival rates after cardiac arrest for Asian adults?

The lead author further points out that “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 versus 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. 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.”

Ethnic differences in cardiac outcomes

The heart can suddenly stop beating, causing cardiac arrest. A 2023 Scientific Statement, co-penned by the American Heart Association, has flagged out-of-hospital cardiac arrest as a global leading cause of death, with the rate of bystander CPR varying across countries and averaging about 20% globally. Global survival rates among all adults are between 2% to 20%, and particularly low if immediate bystander intervention is absent.

The study employed data from 2013-2021 from the Cardiac Arrest Registry to Enhance Survival (CARES), a nationwide registry for out-of-hospital cardiac arrests in the U.S., established by the U.S. Centers for Disease Control and Emory University in Atlanta.

“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,” added Joseph C. Wu, M.D., Ph.D., FAHA, the volunteer president of the American Heart Association, the director of the Stanford Cardiovascular Institute, and the Simon H. Stertzer Professor of Medicine and Radiology at Stanford School of Medicine. “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.”

One limitation of the study: the CARES registry did not differentiate among Asian subgroups such as South Asians, East Asians, and Southeast Asians, hence the findings apply generally to Asian adults.

Furthermore, the results may not apply to individuals in rural U.S. regions as these communities are underrepresented in the CARES registry, and information about other health conditions besides cardiac arrest was not available.

Source: 10.1161/JAHA.123.030087 

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