Funding for cardiac arrest (CA) research lags far behind other leading causes of death in the United States, according to research published in the Journal of the American Heart Association.

Per annual death, National Institutes of Health (NIH) funding for CA research is approximately $91—roughly 20 times less than the amount for heart disease ($2,100) or stroke ($2,200). More than 450,000 Americans die each year of CA, the researchers wrote, making it the third leading cause of death in the U.S.

Lead author Ryan A. Coute, of the department of emergency medicine at the University of Michigan in Ann Arbor, and colleagues studied annual NIH funding statistics from 2007 to 2016. They searched the NIH Research Portfolio Online Reporting Tools Expenditures and Results (NIH RePORTER) database using a search term string designed to encompass all CA research. Grants were then individually reviewed to determine whether they met the criteria for inclusion in the study.

When adjusted for inflation, total CA research funding was $35.4 million in 2007, crested at $76.7 million in 2010 and decreased to $28.5 million in 2016.

“This analysis demonstrates that the annual NIH investment in CA research is low relative to other leading causes of death in the United States and has declined over the past decade,” Coute et al. wrote. “Although these results do not elucidate the cause of this apparent funding disparity, they should inform the debate regarding optimal funding for CA research in the United States.”

In an editorial response, Clifton W. Callaway, from the department of emergency medicine at the University of Pittsburgh, attempted to highlight causes for and solutions to the lack of funding for CA research.

For starters, Callaway believes the general public and policy makers underestimate the prevalence of CA.

“In public discussion and media, sudden death is often referred to as a ‘massive heart attack,’ confusing the syndrome with other heart disease,” Callaway wrote. “For surviving families, sudden death may be perceived as ‘dying naturally.’ Perhaps sudden death is so common in our society that the public assumes it is natural. Out of compassion, medical professionals are loath to correct this perception or to suggest that an individual death might have been preventable.”

Also, Callaway pointed out research of other conditions could fall under a CA-related umbrella. For example, studies resulting in survival improvements for drug overdose and respiratory failure could, in turn, reduce or delay incidence of CA among those populations.

Callaway also cautioned against the assumption that more money, or a greater volume of studies, equals more impactful research.

All those qualifications aside, he agreed more CA analysis is desirable—even while acknowledging it’s a difficult syndrome to research.

“A shortage of qualified or sufficiently motivated investigators partly explains why there are not more applications and more grants at NIH for cardiac arrest research,” Callaway wrote. “Cardiac arrest–specific requests for applications, fostering of research networks, and investment in training of early career investigators are key. We also might encourage all project applications to more explicitly identify their relevance and impact on the leading causes of death.”