London Ambulance. Pic: Bailey Beverly
Patients are ten times less likely to survive a cardiac arrest in Hackney than they are in parts of central and greater London, a report has suggested.
The London Ambulance Service’s 2014 Cardiac Arrest Report listed City and Hackney’s Ambulance Complex survival rate as just 4.8 per cent. This figure is more than 50 percentage points lower than Chase Farm in Greater London, which has the highest level of survival in London.
Croydon also lags behind other ambulance complexes with a survival rate of 23.3 per cent, whilst in Tower Hamlets 54.5 per cent of cardiac arrest patients pulled through.
Response times and patient outcomes per Complex.Pic:LAS report
Heart attacks occur when the heart muscle is starved of oxygen-rich blood, while the heart stops pumping blood around the body altogether during a cardiac arrest.
The figures above are based on “Utstein survival rates”, which is the “internationally recognised criteria for [cardiac] outcomes”, according to the report.
The Utstein calculation works by dividing the number of patients discharged alive, after suffering a cardiac arrest, by the number of patients who had resuscitation attempted. All arrests studied were bystander witnessed.
Data was sourced from the LAS cardiac arrest registry, which takes information from sources including patient report forms, 999 call logs and defibrillator data. National databases and individual hospital records were also used to collect “survival to discharge [from hospital]” data.
Despite being dubbed a “postcard lottery” by some reports, a spokesperson from the London Ambulance Service said the low figures “did not necessarily indicate failures of care.”
Referencing central London’s younger population as an example, the spokesperson admitted that the data does not fully acknowledge factors other than location, such as age and ethnicity.
Hackney and City also fared badly when survival rates were compared by Clinical Commissioning Group. Just 3.7 per cent of patients in this CCG area survived to be eventually discharged from hospital.
All Eastlondonlines boroughs, apart from Tower Hamlets at 12.1 per cent, had a rate lower than 10 per cent for this indicator.
The report also reveals major inequalities in the survival rates of cardiac arrest patients between hospitals.
Only 6.1 per cent of patients sustained to hospital by the LAS survived to be discharged from Croydon Hospital. This figure represents a fall from 25 per cent since 2011.
Homerton University Hospital also has a low survival rate of 10 per cent, with Lewisham Hospital and Royal London in Tower Hamlets slightly higher at 20.8 per cent and 20 per cent respectively.
These figures contrast with the 51.1 per cent of patients who survived cardiac arrests at Kings College Hospital in Lambeth.
Survival per hospital. Pic: LAS report
A spokesperson for Croydon Health Services NHS Trust suggested that the low rates were due to the increasing profile of specialist heart attack centres.
Heart attack centres are “setting the pace for reform” meaning that only the most serious emergencies are directed to Croydon Hospital, he explained.
St George’s, which has a survival to discharge rate of 42.6 per cent, is the closest specialist centre to the general Croydon Hospital.
The spokesperson said: “Centralised heart attack centres have been a huge success in London and are saving lives every year. Ambulance crews are trained to quickly spot the signs of a heart attack, treat patients on the scene and take them to the heart attack centres for treatment.”
He added: “Not all cardiac arrests are heart attacks. Many of the cardiac arrests we see are where the heart has stopped because a patient is in the final stages of a terminal illness or has another serious underlying health condition. Sadly, many of these serious conditions often have a much lower chance of long-term survival than heart attacks, which is explained and reflected in the LAS report.”
He also highlighted the improvements to cardiac care which have been made from within the facility: “We have reduced ward-based cardiac arrests by more than 70 per cent through electronic monitoring of our patients, which can be utilised 24/7.”
A spokesperson from Homerton hospital echoed Croydon Hospital’s statements. He said: “The referral to the heart attack centre in east London [Royal London] is already well established, with the majority of patients being referred there. This means that our hospital only receives a small number of patients every year. These are patients brought to Homerton who are thought, by ambulance personnel, to be too sick to survive a journey to the heart attack centre.”
Despite the decline of survival rates in individual boroughs, the study reports that survival levels as a whole have seen an increase across London.
It states: “The fact that this year represents our highest survival rates to date constitutes a great achievement for the LAS. Our efforts in the pre-hospital environment are reflected in our enhanced rate of ‘return of spontaneous circulation’ sustained to hospital, of which our staff should be proud.”
