Cardiac arrests in black neighborhoods less likely to get CPR, defibrillation

August 30, 2017

DURHAM, N.C. -- Surviving cardiac arrest often seems like a matter of luck -- whether a passerby knows CPR, or a defibrillator is close at hand or the ambulance arrives quickly.

But one surprising factor also plays a role: The racial makeup of your neighborhood.

Compared to people who live in predominantly white neighborhoods, those who live in predominantly black areas are much less likely to receive CPR or defibrillation from a bystander when their heart suddenly stops beating while they are at home or out in the community.

And that appears to translate into a worse chance of survival for people in black neighborhoods, according to a study published online Aug. 30 in JAMA Cardiology by researchers at the Duke Clinical Research Institute.

"We have known that there are differences in the rates of survival from cardiac arrest between blacks and whites, but it was surprising to see how the demographics of a neighborhood affected outcomes of residents who experience cardiac arrest," said lead author Monique Starks, M.D., a cardiologist and member of the Duke Clinical Research Institute. "This is absolutely a call to action to improve and expand CPR training and defibrillator access."

Starks and colleagues -- including senior author Graham Nichol, M.D., director of the University of Washington-Harborview Center for Prehospital Emergency Care -- analyzed cardiac arrest data from a registry that includes information from seven U.S. cities: Birmingham, Dallas-Fort Worth, Pittsburgh, Portland, Seattle, and Milwaukee. U.S. Census data were used to provide demographic information at the neighborhood level.

The researchers analyzed more than 22,000 cases in which cardiac arrest occurred in a non-hospital setting over a four-year period between 2008-11. Neighborhoods where out-of-hospital cardiac arrests occurred were classified by census tract, based on percentage of black residents, ranging from fewer than 25 percent, between 25-50 percent, between 51-75 percent, and more than 75 percent.

Compared with patients who experienced a cardiac arrest in mainly white neighborhoods, those in predominantly black neighborhoods were slightly younger, more frequently female, had lower rates of initial shockable rhythm, and less frequently experienced their heart event in a public location.

Overall, nearly 40 percent of people stricken with cardiac arrest outside of the hospital received bystander CPR. In primarily white neighborhoods, the rate was almost 47 percent, but in predominantly black neighborhoods, the rate was just 18 percent.

Use of an automated external defibrillator was similarly disproportionate by racial composition of the neighborhood. In mostly white neighborhoods, 4.5 percent of cardiac arrest victims received defibrillation from a bystander, compared to 0.9 percent in black neighborhoods.

Neighborhood make-up was also associated with survival. People with cardiac arrest in mixed- to majority- black neighborhoods had significantly lower adjusted survival rates at hospital discharge, the researchers found.

"We clearly see that treatments and outcomes for patients with cardiac arrest in black neighborhoods are worse than those in white neighborhoods. We then asked does it matter if you were black or white within those neighborhoods?" Nichol said. "Our observations were reassuring. It actually does not matter if you are black or white within the neighborhood, but the neighborhood matters."

That finding, the researchers noted, points to a lack of education about cardiac arrest and CPR in general among people living in black neighborhoods, along with a dearth of defibrillators in public spaces.

"This is something that can be addressed," Starks said. "Organizations such as the American Heart Association and the American Red Cross, along with medical centers and public health departments, have a unique opportunity to address this issue with dedicated education programs that are particularly tailored for black neighborhood. This is a relatively low-cost solution that could save lives."
-end-
In addition to Starks and Nichol, study authors include Robert H. Schmicker, Eric D. Peterson, Susanne May, Jason E. Buick, Peter J. Kudenchuk, Ian R. Drennan, Heather Herren, Jamie Jasti, Michael Sayre, Dion Stub, Gary M. Vilke, Shannon W. Stephens, Anna M. Chang and Jack Nuttall on behalf of the Resuscitation Outcomes Consortium investigators.

The study was supported by the Resuscitation Outcomes Consortium, which was funded by the National Institutes of Health and American Heart Association. Starks also receives grant support from the National Institutes of Health Common Fund to promote diversity in health-related research (3U54AT007748-02S1).

Duke University Medical Center

Related Cardiac Arrest Articles from Brightsurf:

Outcomes for out-of-hospital cardiac arrest during COVID-19 pandemic
This study used a large US registry of out-of-hospital cardiac arrests to asses the association between the COVID-19 pandemic and the outcomes of out-of-hospital cardiac arrests, including in areas with low and moderate COVID-19 disease.

Cardiac arrest is common in critically ill patients with COVID-19
Cardiac arrest is common in critically ill patients with covid-19 and is associated with poor survival, particularly among patients aged 80 or older, finds a study published by The BMJ today.

In-hospital cardiac arrest in COVID-19
Outcomes of in-hospital cardiac arrest among patients with COVID-19 are examined in this case series.

New risk tool developed for cardiac arrest patients
Experts have developed a risk score to predict cardiac arrest patient outcomes.

Intravenous sodium nitrite ineffective for out-of-hospital cardiac arrest
Among patients who had an out-of-hospital cardiac arrest, intravenous sodium nitrite given by paramedics during resuscitation did not significantly improve their chances of being admitted to or discharged from the hospital alive, according to research presented at the American College of Cardiology's Annual Scientific Session Together with World Congress of Cardiology (ACC.20/WCC).

Getting to the heart of epinephrine use in pediatric cardiac arrest patients
The effectiveness of epinephrine treatment during resuscitation of adult patients with cardiac arrest is generally promising, but little is known about its effects in pediatric patients.

Bystanders can help more cardiac arrest victims survive
Only 8% of Americans survive cardiac arrest outside a hospital, but that percentage could increase significantly if bystanders recognize cardiac arrest and perform simple lifesaving tasks, a UVA Health physician says in a New England Journal of Medicine article.

Opioid-related cardiac arrest patients differ from other cardiac arrests
People who suffer cardiac arrest due to an opioid overdose are younger, have fewer chronic medical conditions and may be more likely to be to receive bystander CPR, according to a review of emergency response records in Maine.

Selective coronary angiography following cardiac arrest
In the current issue of Cardiovascular Innovations and Applications volume 4, issue 2, pp.

Sudden cardiac arrest in athletes: Prevention and management
It's marathon season, and every so often a news report will focus on an athlete who has collapsed from sudden cardiac arrest.

Read More: Cardiac Arrest News and Cardiac Arrest Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.