Cardiac Arrest Survival Linked to Neighborhood Racial Makeup

Residents of predominantly black neighborhoods are less likely to receive cardiopulmonary resuscitation (CPR) or defibrillation from a bystander when they experience cardiac arrest while at home or in their community.

As a result, people living in these communities have a lower chance of survival, according to a study published online in August 2017 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,” says lead author Monique Starks, MD, 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, MD, director of the University of Washington-Harborview Center for Prehospital Emergency Care—analyzed cardiac arrest data from a registry that includes information from 7 US cities: Birmingham, DallasFort Worth, Pittsburgh, Portland, Seattle, and Milwaukee. US 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 4-year period between 2008 and 2011. Neighborhoods where out-of-hospital cardiac arrests occurred were classified by census tract, based on percentage of black residents, ranging from fewer than 25%, between 25% and 50%, between 51% and 75%, and more than 75%.

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

Overall, nearly 40% of those who went into cardiac arrest outside of the hospital received bystander CPR; in primarily white neighborhoods, the rate was almost 47%, but in predominantly black neighborhoods, the rate was just 18%.

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

Neighborhood racial make-up was also associated with survival. Individuals who experienced cardiac arrest in mixed or majority-black neighborhoods had significantly lower adjusted survival rates at hospital discharge. That finding, the researchers say, suggests that there may be a lack of education about cardiac arrest and CPR in general among people living in black neighborhoods, as well as a dearth of defibrillators in public spaces.

“This is something that can be addressed,” Starks says.