Possibilities for, and obstacles to, CPR training among cardiac care patients and their co-habitants

Abstract

Aim

: To investigate the level of cardiopulmonary resuscitation (CPR) training among cardiac patients and their co-habitants and to describe the possibilities for, and obstacles to, CPR training among this group.

Methods

: All patients admitted to a coronary care unit during a four-month period were considered for participation in an interview study. Out of 401 patients, 268 were co-habiting. This study deals with these subjects.

Results

: According to the answers given by the patients, 46% of the patients and 33% of the co-habitants had attended a CPR course at some time. Among those who had not previously attended a course, 58% were willing to attend, and 60% of the patients whose co-habitant had not received CPR education, wanted him or her to attend a course. The major obstacle to CPR training was the patient's own medical status. The major obstacle to the co-habitant's participation was the patient's doubts concerning their partner's physical ability or willingness to participate. Younger persons were more often willing to undergo training than older persons (p < 0.0001).

Of those patients who had previously attended a course or who were willing to undergo training, 72% were prepared to do so together with their co-habitant. A course specially designed for cardiac patients and their relatives was a possible alternative for 75% of those willing to participate together with their co-habitant.

Conclusions

: Two-thirds of the patients did not believe that their co-habitant had taken part in CPR training. More than half of these would like their co-habitant to attend such a course. Seventy-two percent were willing to participate in CPR instruction together with their co-habitant. Major obstacles to CPR training were doubts concerning the co-habitant's willingness or physical ability and their own medical status.

Introduction

Most cases of hospital cardiac arrest (CA) occur in the victims home [1], [2], [3], while the major proportion of rescue efforts take place on the street or in public places [1], [2], [4], [5]. The location of the cardiac arrest, whether or not it occurs outside the victim's home, has been reported as an independent factor for survival [1], [5], [6]. Despite the efforts made to increase the proportion of trained lay rescuers the incidence of bystander cardiopulmonary resuscitation (CPR) still remains low [1], [2], [3], [7]. Figures from the Swedish Cardiac Arrest Registry (SCAR) show that 36% of patients who suffered a CA received bystander CPR. However, only 23% received CPR when the CA occurred at home compared to 42 and 55% if the CA occurred in public places or other places, respectively [2]. One prerequisite for being prepared to intervene in a cardiac arrest is previous CPR instruction and training. Another prerequisite is for the rescuer to be in a suitable physical or psychological state that permits such an action. Swor et al. [3] found that patients who suffered a cardiac arrest at home and the bystanders involved were older compared to those who had a cardiac arrest in public places. The bystander was also less likely to be trained in CPR or to have attended a course during the last five years and less likely to perform CPR, even if trained.

Ever since the first CPR training programme, families of cardiac patients have been a target group for CPR training [8], [9]. In Sweden, the National Board of Health and Welfare recommended that hospitals and county councils should offer CPR education both to health care professionals, to patients with a high risk of a heart attack and their relatives [10]. However, there still is a discrepancy between those trained and those most likely to witness a cardiac arrest [11], [12], [13], [14], [15]. According to the result of a survey of 1012 persons recently trained in CPR, 16% of those aged 59 and over stated that their own cardiac disease or that of a relative or a friend was a reason for taking the CPR course. Nevertheless, those over 59 years old constituted only 3% of the respondents [15]. This result resembles that obtained by Brennan and Braslow [11], where only about 7% of CPR training participants were aged 50 or older and a minority (19%) lived together with someone at a high risk of a heart attack. Moreover, in one study in Wales, where basic life support mass training was advertised by a local newspaper campaign, 67% of the participants were related to someone with a heart problem [16]. The readership profile of the newspaper used in that study comprised of 62% non-manual workers and 47% aged 45 years or over. The strategy was to reach volunteers that matched the risk groups better.

In a study of the preparedness and willingness of cardiac patients family members to perform CPR, Platz et al. [17] found that 49% had received some CPR training (although only 14% within the previous year), most of whom were medical professionals. In addition, most had undergone training because of job or school requirements and only a few as a result of living with a person at high risk of CA.

Many authors stress the importance of identifying ways of increasing the number of family members of cardiac patients who are trained in CPR [3], [6], [11], [12], [17], [18], [19], [20], [21]. However, there are few studies, focusing on disincentives to bystander intervention or obstacles to CPR training among this group [12], [17], [20]. The present study, which focuses on patients living with a family member or other person, is part of a larger investigation, in which cardiac patients’ attitudes towards CPR and CPR instruction were examined.

This study aimed to investigate the level of CPR training among cardiac patients and their co-habitants and to describe the possibilities for, and obstacles to, CPR training among this group.