Survival of cardiac arrest tied to neighborhood racial demographics

Cardiac arrest suffered in predominately black neighborhoods is associated with worse rates of survival and bystander treatment, despite quicker emergency medical services (EMS) response times, according to a new study in JAMA Cardiology.

Researchers examined 22,816 patients, with an average age of 64, with out-of-hospital cardiac arrest (OHCA) between 2008 and 2011. The address where each OHCA occurred was assigned to one of 2,543 census tracts, which included neighborhood-level demographic information from the 2000 U.S. Census.

Specifically, the researchers classified each neighborhood based on its percentage of black residents: less than 25 percent, 25 to 50 percent, 50 to 75 percent and more than 75 percent.

Compared to predominately white neighborhoods, OHCA sufferers had a stepwise reduction in survival rates as the percentage of black residents increased. The survival rates of black and white patients within each neighborhood didn’t differ.

“Those with OHCA in predominantly black neighborhoods had the lowest rates of bystander cardiopulmonary resuscitation and automatic external defibrillation use and significantly lower likelihood for survival compared with predominantly white neighborhoods,” wrote lead author Monique Anderson Starks, MD, with Duke University Medical Center in Durham, North Carolina, and colleagues. “Improving bystander treatments in these neighborhoods may improve cardiac arrest survival.”

In predominately white communities, OHCA patients were five times more likely to receive bystander AED assistance than in neighborhoods with more than 75 percent black residents. Those same groups also showed significant difference in bystander CPR rates, from 43 percent to 18 percent, respectively. For both methods of assistance, there was an incremental decrease in bystander intervention as the percentage of black residents increased.

In a JAMA Cardiology interview, Starks offered some suggestions to combat the disparity.

“It is important to direct resources to these communities to improve both treatments and survival,” she said. “These should include telephone-assisted CPR, mandated high school CPR training, culturally tailored and inexpensive mass-community training as well as general AED availability and education on where they are located.”

In an accompanying editorial, Raina M. Merchant, MD, and Peter W. Groeneveld, MD, both with the University of Pennsylvania, said digital strategies could help eliminate the barriers to care some communities face.

They offered three possible approaches: cell phone positioning systems to alert trained laypersons in the area when OHCA occurs, plus provide them the location of nearby AEDs; social networking apps to engage potential OHCA responders; and using drone technology to deliver AEDs and provide CPR instructions and feedback from 911 centers.

“Advancing the field of resuscitation science requires that research move beyond describing disparities for vulnerable populations and instead focus on implementing practices that reduce and/or eliminate disparities,” Merchant and Groeneveld wrote. “Given the lack of progress in the past 20 years, creative efforts and novel interventions are imperative.”