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Training in CPR and defibrillation should be reserved for those most likely to encounter out-of-hospital cardiac arrest victims

Most of the 360,000 out-of-hospital cardiac arrests that occur in the United States each year strike elderly men and women in their homes. Certain individuals, such as casino security guards or flight attendants, are more likely than others to encounter victims of out-of-hospital cardiac arrest, and training them in cardiopulmonary resuscitation (CPR) and defibrillation makes sense. However, training unselected individuals who are unlikely to encounter out-of-hospital cardiac arrest victims is not cost effective, concludes a study supported by the Agency for Healthcare Research and Quality (AHRQ T32 HS00028).

Peter W. Groeneveld, M.D., M.S., of the University of Pennsylvania, and Douglas K. Owens, M.D., M.S., of Stanford University, compared the costs and health benefits of three alternative resuscitation training strategies for adults without professional first-responder duties who were at average risk of encountering cases of out-of-hospital cardiac arrest. The three strategies were: CPR/defibrillation training alone, training combined with a home defibrillator purchase, and no training. CPR/defibrillation training cost $202,400 per quality-adjusted life-year (QALY) gained. Training plus defibrillator purchase cost $2,489,700 per QALY. In contrast, training cost less than $75,000 per QALY if trainees lived with individuals who had cardiac disease or were older than 75 years (6 percent of U.S. households) or if total training costs were less than $10 per person.

The researchers conclude that training unselected individuals in CPR/defibrillation is costly compared with other public health initiatives. Conversely, training men and women selected by occupation, low training costs, or having high-risk household companions is substantially more efficient.

More details are in "Cost-effectiveness of training unselected laypersons in cardiopulmonary resuscitation and defibrillation," by Drs. Groeneveld and Owens, in the January 2005 American Journal of Medicine 118, pp. 58-67.

Editor's Note: Another AHRQ-supported study on a related topic found that rates of cardioverter-defibrillator implants became more equal among whites and blacks during the 1990s, although persistent disparity remained at the decade's end. For more details, see Groeneveld, P.W., Heidenreich, P.A., and Garber, A.M. (2005). "Trends in implantable cardioverter-defibrillator racial disparity." (AHRQ grant T32 HS00028). Journal of the American College of Cardiology 45(1), pp. 72-78.

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