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Advances in health and medicine.
Marjorie Bekaert Thomas
Advances in health and medicine.
Cardiovascular Health Channel
Reported June 1, 2010

Chance of Surviving Cardiac Arrest Depends On Your Neighborhood

(Ivanhoe Newswire) -- The old real estate adage "Location, location, location" has never been more critically important. Your odds of surviving cardiac arrest may hinge on which part of town you call home and whether anyone in your neighborhood comes to your aid with cardiopulmonary resuscitation (CPR).

Certain neighborhoods in Fulton County, Ga., which includes Atlanta, historically had two to three times as many cardiac arrests as other parts of the county. Year after year, residents of these neighborhoods were at the highest risk for cardiac arrest and had the lowest rates of bystander CPR in Fulton County. The neighborhoods tended to have lower median household incomes, more black residents, and lower education levels.

"These findings have national public health indications. They show that it is time to change our thinking on how and where we conduct CPR training if we are ever going to change the dismal rate of survival from cardiac arrest," lead author Comilla Sasson, M.D., M.S., who conducted the study as a Robert Wood Johnson Foundation Clinical Scholar at the University of Michigan, was quoted as saying. "Nine out of 10 people die from a cardiac arrest event. This number can and must change."

CPR training often targets young, healthy volunteers who are least likely to encounter an individual in cardiac arrest. However, using Dr. Sasson's method, a public health surveillance registry based on that of the CDC can be used to design targeted interventions in the neighborhoods that need CPR training the most. Boosting bystander CPR rates in the United States from the current average of 27 percent to 56 percent could save an additional 1,500 lives per year.

Each year, in the United States, nearly 300,000 patients experience cardiac arrest -- the sudden, abrupt loss of heart function -- while outside of the hospital. Heart disease is the most common cause of cardiac arrest, but other factors such as drowning, choking, electrocution and trauma also can cause cardiac arrest.

The nation's survival rate for out-of-hospital cardiac arrest has stalled at 7.6 percent for nearly 30 years. Because cardiac arrest occurs outside a hospital and is often witnessed by bystanders, efforts to improve survival should focus on the prompt delivery of medical interventions such as CPR.

"To improve cardiac survival rates that have been stagnant for 30 years, CPR training should be more basic and available to the people who are most likely to witness someone experiencing cardiac arrest," Dr. Sasson said. "Health care resources are extremely limited. To make improvements, we need to understand where and how best to make change."

Researchers analyzed emergency medical services (EMS) and 911 call data from the Cardiac Arrest Registry to Enhance Survival Rates (CARES), which identified areas with higher incidences of cardiac arrest and low rates of bystander CPR. Census information was used to approximate neighborhoods.

Dr. Sasson is preparing to take her message on the road to improve cardiac survival with education and outreach efforts in the 30 U.S. cities that constitute the CARES Study Group. The cities are spread across the U.S. and include Anchorage, Austin, Boston, Columbus, Ohio, Denver, Honolulu, Houston, San Diego, Sioux Falls, Idaho, and Wake County, N.C.

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SOURCE: Annals of Internal Medicine, June, 2010

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