A high-profile Canadian study is raising questions about whether high-rise living is linked to a greater risk of death from cardiac arrest.
In the study, published on Monday in the Canadian Medical Association Journal, researchers found that people who live on the third floor or above were less likely to live after suffering cardiac arrest. The overall survival rate among those living below the third floor was 4.2 per cent compared with 2.6 per cent on the third floor and higher.
The researchers say a number of factors, including a longer paramedic response time due to issues such as elevator delays, could help explain the findings. Simple fixes, such as co-ordinating with building staff so that elevators are on the ground floor waiting when paramedics arrive and giving paramedics access to universal elevator keys, the system currently used by firefighters, could help reduce delays.
"There's definitely some avoidable delays that occur in high-rise buildings or apartment buildings that I think can be decreased at least a little bit," said Ian Drennan, lead author of the study, an advanced care paramedic with York Region Paramedic Services and a PhD candidate with the Li Ka Shing Institute at St. Michael's Hospital in Toronto.
Before you put your 15th-floor condominium up for sale or give your landlord notice, there are a few points to keep in mind.
Cause and effect
The design of the study is retrospective, meaning that researchers looked back at data collected from nearly 8,000 cases of cardiac arrest that occurred in Southern Ontario.
The study itself doesn't prove living on high floors actually causes a lower cardiac arrest survival rate. What it does show is it takes paramedics nearly two minutes longer to reach patients living on the third floor or higher than those below. It's a hugely important number. Most studies track how long it takes from the time a 911 call is placed to the time of arrival at the patient's residence. But in an apartment or condo, there is the added time that it takes to climb stairs or ride an elevator.
People who lived on the lower floors were also more likely to have an initial shockable heart rhythm when paramedics arrived compared with those on upper floors – 19 per cent versus 13 per cent.
It seems obvious to conclude the delayed response time is responsible for the lower survival rates on upper floors. But it's also possible other factors could play a role. For instance, it's well known that people are more likely to survive a cardiac arrest if someone is with them at the time. In the CMAJ paper, there were slightly fewer witnesses to the cardiac arrests that took place on upper floors compared with those on lower floors (39.7 per cent compared with 42.1 per cent). It's also possible that overall health differences between cardiac arrest victims who live in a home versus those living in a high-rise can explain the differing survival rates.
Overall survival rate is dismal
Of the nearly 8,000 cases of cardiac arrest tracked by the study, the overall survival rate was poor: Only 300, or 3.8 per cent, of patients survived to be discharged from the hospital.
"We're really not doing good with these patients altogether," said Michel Le May, an interventional cardiologist at the University of Ottawa Heart Institute.
The differences between outcomes for patients in high-rise buildings and ground-floor residences needs to be looked at more closely to figure out how to close the gaps. But improving survival rates also depends on making people more aware of what to do in an emergency.
Le May said there are too many people who attempt to drive their loved ones to a hospital when they are having chest pains, only to have them suffer a cardiac arrest on the way. Also, the study found that automated external defibrillators (AEDs) were used in less than 1 per cent of cases of cardiac arrest included in the study. And only about one-third of bystanders tried to perform cardiopulmonary resuscitation before paramedics arrived.
There is much more that needs to be done to boost survival rates. Calling 911, performing CPR and having AEDs readily accessible are just part of the answer.