Abstract 29: Does Neighborhood Really Matter? How Where One Lives Influences Their Outcome Following Out-of-Hospital Cardiac Arrest

Abstract

Introduction: Traditional Utstein factors for an out of hospital cardiac arrest (OHCA) have been extensively investigated, with numerous studies evaluating economic status for association with survival. Few studies have evaluated neighbourhood factors collectively as determinants of cardiac arrest outcomes. This will be the first multifactorial Canadian to investigate neighbourhood factors as determinants of OHCA outcomes. Hypothesis: We hypothesized that within 140 neighbourhoods in Toronto, Canada, there are neighbourhood level factors associated with survival to hospital discharge after an OHCA. Methods: A retrospective, observational study of all OHCA treated by Toronto EMS between April 2006 and March 2010. Using Geographic Information System (GIS) analysis, OHCA patients were assigned to a neighbourhood based on their residential address. Neighbourhood survival rates were calculated. Results: A total of 4408 OHCA were eligible for enrollment and contained the necessary information for GIS mapping. The mean (SD) age was 69.7 (16.4) y; 64% were male. The response time was 6.3 (3.6) min, 41.9% received bystander CPR, 16.8% occurred in a public location, 20.7% presented in a shockable rhythm, 27.7% had a ROSC and 5.3% survived to hospital discharge. Survival rates varied across all neighbourhoods: 25% of neighbourhoods had a 0% survival rate, while some had rates as high as 25% (See Figure). Conclusions: In conclusion, differences in survival following OHCA vary by neighbourhood, suggesting that a patient's home neighbourhood plays a role in outcomes. Further analyses are underway to investigate which neighbourhood factors are associated with improved survival.