Cardiac Arrest Care on United States Golf Courses-Up to Par Yet?

Bret Gustafson; Brett Todd; Peter Prescott; Yuying Xing; Bryan McNally; Man Qi; Rabab Al-Araji; Robert Swor; CARES Surveillance Group

doi:10.1016/j.acepjo.2025.100278

Cardiac Arrest Care on United States Golf Courses-Up to Par Yet?

J Am Coll Emerg Physicians Open. 2025 Nov 25;7(1):100278. doi: 10.1016/j.acepjo.2025.100278. eCollection 2026 Feb.

Authors

Bret Gustafson¹, Brett Todd^{1

2}, Peter Prescott², Yuying Xing³, Bryan McNally^{4

5}, Man Qi⁴, Rabab Al-Araji⁴, Robert Swor^{1

2}; CARES Surveillance Group

Affiliations

¹ Department of Emergency Medicine, Corewell Health East William Beaumont University Hospital, Royal Oak, Michigan, USA.
² Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA.
³ Division of Biostatistics, Corewell Health Research Institute, Grand Rapids, Michigan, USA.
⁴ Emory University School of Medicine, Atlanta, Georgia, USA.
⁵ Rollins School of Public Health, Atlanta, Georgia, USA.

Abstract

Out-of-hospital cardiac arrest (OHCA) is a significant public health issue with a <10% survival rate. Although exercise is beneficial for cardiovascular health, it is also associated with increased risk of OHCA during and immediately after exertion. Golf courses present the fifth most frequent location for OHCA in public settings. Bystander interventions, such as cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use, are crucial for improving survival rates. Despite recommendations from organizations like the Professional Golfers' Association of America recommending AEDs at golfing facilities, AED availability and utilization on golf courses prior to Emergency Medical Services arrival remain unknown.

Objectives: This investigation aimed to determine the incidence of OHCA on golf courses and to examine patient demographics, event and golf course characteristics, and their association with bystander CPR provision, AED use, and survival outcomes.

Methods: This retrospective study utilized data from the Cardiac Arrest Registry to Enhance Survival from 2020 to 2023. Addresses of cardiac arrests in recreational facilities were spatially linked to a comprehensive list of golf course addresses using ArcGIS. Cases identified as occurring in a recreational location, within 400 m of both the incident address and a nearby golf course, were included in the analysis. The primary outcome was the frequency of bystander interventions for either CPR or AED use. Secondary outcomes included survival to hospital admission and discharge, and a favorable neurologic outcome (cerebral performance category 1 or 2). Descriptive statistics and univariate analyses were employed to examine patient demographics, golf course characteristics, bystander interventions, and patient outcomes. Multivariable regression analysis was also used to assess these associations.

Results: A total of 476 OHCA cases were identified on golf courses during the study period. The patients were predominantly male (91.4%, n = 435) and White (85.1%, n = 330), with a mean age of 64.6 (SD 15.5). Most patients (61.8%) had an initial shockable rhythm.Distribution of cases was not different by course geographic region, course size, or public vs private course. Overall survival to discharge was 30.5% (n = 145), with almost all survivors (97.2%, n = 141) having a good neurologic outcome. For patients with Utstein characteristics (witnessed, shockable rhythm) and who had an AED placed, survival to discharge was 63.8%.AED use was associated with significantly increased survival to hospital discharge (37.9% vs 18.7% OR_adj 1.9 (95% CI, 1.1, 3.3, P <.05), with AEDs being used more frequently on private courses (32.1% vs 19.7%, P = .003).

Conclusion: Patients experiencing OHCA on golf courses frequently receive bystander interventions, including both CPR and AED use. OHCA patients on golf courses had high survival rates and excellent neurologic outcomes. This study underscores the benefit of, and critical need for, initiatives promoting CPR and AED resources, as well as comprehensive CPR training and rapid response protocols at golf courses.

Keywords: automated external defibrillation; bystander CPR; cardiac arrest; recreational facilities.