Boston does well in heart death comparison

Sudden cardiac arrest outside a hospital is often lethal, but chances for survival can depend on where you live.

A study of 10 North American locations in the Journal of the American Medical Association found that only 4.6 percent of the people whose hearts stopped beating for reasons not related to trauma or terminal illness were revived and kept alive long enough to leave the hospital. Resuscitation isn't always attempted because it's too late or it's against the patient's or family's wishes, but in those cases where resuscitation was attempted, 7.9 percent survived until discharge from the hospital.

The researchers, led by a team from the University of Washington, found a five-fold variation in survival rates among patients who are treated, from 3 percent in Alabama to 16.3 percent in Seattle.

Boston was not included in the study, but Boston EMS tracks the survival of heart patients it treats, and its rate of 13.7 percent places it at the upper end of the range in the study.

"We're probably in the top handful of cities," Dr. Peter Moyer, medical director for the Boston Fire Department, Police Department, and Boston EMS said in an interview.

He credits a 4-minute response time by emergency personnel and widespread use of the American Heart Association's "Chain of Survival" principles, which start with calling 911, followed by recognizing cardiac arrest and starting to do CPR, both according to instructions given over the phone while waiting for rescue personnel to arrive.

Moyer said Boston's survival rate could improve.

"The reason why we're not the best is we have a very poor citizen CPR rate," he said.

In Boston's 336 cardiac arrest cases last year, only 12 percent involved citizen CPR, Moyer said. In contrast, 60 percent of sudden cardiac arrest cases in Seattle had citizen bystanders who tried cardiopulmonary resuscitation, according to the JAMA article.

A program in the Boston Public Schools taught CPR to 3,000 freshmen last year, and the goal this year is to teach 5,000, Moyer said.

In the study, the overall survival rate for people who had ventricular fibrillation, a common heart rhythm disorder, was 21 percent. It also varied across the sites the JAMA authors studied, ranging from 7.7 percent in Alabama to 39.9 percent in Seattle. In Boston, EMS reported the rate was 25 percent.

The JAMA authors say some of the differences in survival may stem from differences in the populations' risk for cardiac arrest as well as in how emergency services respond. Cardiovascular disease is the leading cause of gaps between rich and poor people's premature death, they write, citing previous studies. But the variations in survival show that cardiac arrest is treatable, they say.

"Only 31.4 percent of treated cardiac arrests ... received bystander CPR," they write. "Ongoing efforts are necessary to encourage the public to be ready, willing, and able to provide CPR when necessary."

In an editorial, Dr. Arthur B. Sanders and Dr. Karl. B. Kern of the University of Arizona call for more attention to sudden cardiac arrest and survival rates.

"It is time to recognize the importance of EMS systems to the health of a community," they write. "It is time to work to overcome barriers in each community, devote appropriate resources, and optimize survival of all patients so that location by city becomes a minor factor in survival of cardiac arrest."