Introduction
Out-of-hospital cardiac arrest affects 180,000–400,000 Americans annually (1). Survival often depends on early bystander cardiopulmonary resuscitation (CPR) 2, 3, 4. The odds of survival from sudden cardiac arrest increase 3.7 times if early bystander CPR is performed (3). Survival is three times greater when effective CPR is given vs. ineffective CPR (4). The proportion of cases of out-of-hospital arrest that receive bystander CPR is 27.4%, and most of those giving CPR are 45 years of age or older 5, 6. Therefore, one strategy for improving survival rates is to increase the proportion of the population trained in CPR, particularly those aged over 45 years.
The Physician CPR Prescription Program is recommended by the American Heart Association (AHA). This initiative asks doctors to “prescribe” CPR to their patients (7). Although the AHA program is admirable, evidence that this prescriptive advice could motivate individuals to learn CPR is lacking. Our primary study aim was to see if physician-prescribed advice to purchase a CPR Anytime™ kit (American Heart Association, Dallas, TX) was more effective than advice to take a CPR class. We set out to determine if providing either a CPR Anytime™ kit or a CPR class “prescription” (Rx) to patients with heart disease or at risk for coronary artery disease (CAD) could motivate them to learn CPR. Because both the kit and class are accepted by the AHA as effective training methods, the measured outcome for this hypothesis was self-reported positive response to purchasing and completing the kit (or taking a class) at telephone follow-up (7).
Secondarily, as part of a “multiplier effect,” an additional 1.5 family members or friends per participant in the kit group were projected to be trained in CPR. Family and friend participation was measured at telephone follow-up by research subject report. Finally, patients and their families might experience a “teachable moment” when their loved one was in the Emergency Department (ED). In comparison to an office setting, this was felt to potentially increase the likelihood that the patient would fill the prescription for CPR Anytime™. The strength of the power of the advice was to be assessed by comparatively measuring subject participation rates in the ED setting to other sites.