Hot Tip: Have Your Heart Attack In Seattle

A new study finds dramatic regional differences in cardiac-arrest survival rates. Why some places are better than others when it comes to saving lives.

By Anne Underwood | Newsweek Web Exclusive

Sep 23, 2008 | Updated: 3:49 p.m. ET Sep 23, 2008

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What are your chances of surviving cardiac arrest outside a hospital setting? In a word, remote. But some doctors are turning that around, boosting survival rates to previously unthinkable levels. That's great news, right? Now for the bad news: your likelihood of being in that lucky group of survivors depends a great deal on where you live. "It's like real estate—location, location, location," says Dr. Arthur Sanders, a professor of emergency medicine at the University of Arizona's Sarver Heart Center.

That is the upshot of a study appearing this week in the Journal of the American Medical Association. Dr. Graham Nichol, director of the University of Washington's Center for Prehospital Emergency Care, surveyed the outcomes of cardiac arrest in 10 North American cities and states. Though outcomes for most medical procedures vary with factors like socioeconomic status, the differences in this study were even more pronounced than usual. Survival from site to site varied as much as fivefold. Patients in Seattle who were treated by emergency medical technicians (EMTs) pulled through in 16 percent of cases. In Alabama, they survived just 3 percent of the time.

And Alabamans are probably better off than people in many other states. That's because, like the other localities represented in the JAMA study, Alabama participates in a government-funded research network dedicated to improving outcomes after cardiac arrest. Cities outside that network—even places like New York City, with all its high-powered medical centers—appear to have lower survival rates, judging by studies from the 1990s. "Older studies from New York, Chicago, Detroit and Los Angeles found overall survival rates of just 1-2 percent," says Sanders, who wrote an editorial in JAMA to accompany Nichol's paper.

What's Seattle doing that other cities aren't? The JAMA study didn't analyze public-health policies. But Nichol, who happens to live and work in Seattle, says one crucial difference lies in the simple fact that the city tracks outcomes of cardiac-arrest cases. Most cities do not—and therefore have no basis on which to judge their performance or measure improvements.
Second, it has an exceptionally well-organized EMS system. Emergency-medical technicians and paramedics are not only experienced and well trained, but also monitored by physicians on a daily basis to make sure they're doing everything in the best way possible. This daily oversight is not common in other cities, and the organization and efficiency of EMS systems can vary widely. Some are run by hospitals—others, by fire departments. In some towns, they're staffed by volunteers rather than paid professionals.

Finally, the public in Seattle is well informed about what to do in the case of such an emergency, thanks to a public-service campaign from the Seattle Fire Department that focuses on training the public to recognize and respond to cardiac arrest.

Wherever you are, the most crucial factor is rapid treatment. "Survival depends on how quickly you recognize the problem and respond—how quickly you start CPR, how quickly you provide a defibrillator and how quickly you cool the patient to protect the brain," Nichol says. Chances of survival can decrease by as much as 10 percent a minute, so there's no time to waste. Well-organized EMS systems are crucial. So are readily accessible defibrillators and bystanders who will perform CPR.

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Posted By: aint2sure @ 10/18/2008 12:28:50 AM

I walked into the ER of the Baptist Hosptial in Prattville, Alabama a few years ago and told the gal behind the counter I was having an heart attack. She told me to fill out some forms, take a number, and they'd call me when it was my turn. Alabama's better....oh yeah...go on believing that!
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Posted By: daniRN @ 09/26/2008 5:49:48 PM

cedar-sweetie: Its great that you survived your ordeals, but the situation you describe is one of the considerations of living in a rural area. Emergency medical services are not always immediately on-hand in the rural setting; that should be as much a consideration as your property taxes, education and school resources, employment opportunities, and cost of living. Rural areas and small towns often do not have the resources to staff full-time EMS; often they are staffed by basic EMT professionals or first responders only who work on a part-time or even volunteer basis and have to cover a large area within their particular rural setting. As for your other comments: often it is too late. In the medical field, this is termed futility. If a patient has had an unwitnessed arrest, no pulse, no respirations, and no heart rhythm, it is absolutely futile in almost all cases to attempt resuscitation of any kind. Even with a witnessed arrest, the odds are small that the patient can be resuscitated to prior neurological functioning. I cannot speak for you, but I do not want to be resuscitated to live in a persistently vegetative or severely neurologically impaire state; nor would I allow that for my husband, my mother, my father, or even my own children.
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Posted By: cedar_sweetie @ 09/26/2008 12:09:25 AM

Sept. of 2004, I had open heart surgery, to repair a damaged heart. They did all kinds of things, including a new mechanical valve.Two weeks later, I had a heart attack.We live in a very small town, and at the local clinic we were told to wait for the ambulance, but after finding out it would take about half an hour to get there, my husband said I'm not waiting.He drove me to a town about 22 miles away, and on the way, we picked up the local police, and met the ambulance about 1/2 way there.We didn't stop, and had a caravan to the ER, and I think had we waited, it would have been too late.Once there, I got the proper care, and survived.Agreed that an EMT staff can be the turning point, but sometimes it just doesn't work out that way.Had we had our ambulance and EMT's there, it would have been better, and care could have been given sooner, but sometimes you just have to do it yourself.
On the other side, sometimes the first responder to a situation can be a virtual lifesaver.I did CPR and breathing for a gent that was down, and no one would do anything for him.He had no pulse, no breath,and had already voided his bladder.He was revived, and some years after, his wife still kept in touch.So I disagree with the premise of it's too late.It's never too late to try.We are both survivors, and thank God for the folks that helped!