Abstract 17523: Improved Rates of Bystander Cardiopulmonary Resuscitation and Survival Consistent Across Socioeconomic Spectrum: Results From the North Carolina HeartRescue Project

Abstract

Introduction: Data have shown that out of hospital cardiac arrest (OHCA) patients in lower socioeconomic status (SES) groups have lower rates of bystander intervention and survival. Following the North Carolina HeartRescue project, we explored whether improved rates of statewide bystander cardiopulmonary resuscitation (CPR) and survival are consistent across SES. Hypothesis: Statewide efforts have improved both bystander CPR and survival following OHCA irrespective of SES. Methods: Using the CARES registry, we identified and geocoded OHCAs from counties with complete case capture from 2010-14 in North Carolina (population 3 million). We divided patients (n=7,220) into tertiles of census-determined neighborhood SES by % with high school degree and median household income. Results: Rates of bystander CPR improved significantly irrespective of neighborhood SES level as determined by % with a high school degree or median household income, but remained highest for those with highest SES (Figure). The increase in survival rates significantly differed between SES groups (interaction p<0.05), and the greatest increase was in the lowest tertile: 144% increase for lowest % of high school degree and 66% increase for lowest median household income. The absolute difference in survival between the highest and the lowest tertile decreased from 3.3% in 2010 to 1.8% in 2014 according to % with a high school degree, p for trend 0.001; and from 2.1% to 0.9% according to median household income, p=0.002. Conclusion: Following 4 years of the HeartRescue quality improvement program, there were substantial improvements in bystander CPR and survival, which was consistent across socioeconomic status. The greatest increase in survival appeared to be among lower SES. The absolute differences in rates of bystander CPR and survival between the highest and lowest tertiles for neighborhood level of high school degree and median household income appear to have narrowed during this period.