Neurological outcomes after patients suffer cardiac arrest at home are similar between low- and high-income areas in Vienna

Vienna, Austria: People who have a cardiac arrest in their own homes have similar neurological outcomes regardless of socioeconomic background, according to research presented at the European Emergency Medicine Congress today (Wednesday) [1].

However, the study of 676 patients who received treatment in the Department of Emergency Medicine at the Medical University of Vienna suggested that those who lived in lower-income areas may be less likely to receive cardiopulmonary resuscitation (CPR) from bystanders compared to people suffering a cardiac arrest (when the heart stops pumping blood around the body) in higher-income areas – a finding that the researchers say requires further studies to see whether it is a real effect.

The study was carried out by researchers led by Drs Jürgen Grafeneder and Christoph Schriefl at the Medical University of Vienna. They looked at outcomes for patients who experienced an out-of-hospital cardiac arrest (OHCA) and were treated in their emergency department between January 2020 and December 2022. They took data from the department’s CPR records, and looked at patients’ addresses, which they linked to electoral districts. These districts were then matched with the average household income for each area using data from Austria’s National Statistical System.

The researchers assessed neurological outcomes, such as brain damage and thinking ability, one, six and twelve months after the OHCA. They also investigated the association between these outcomes and household incomes, taking into account factors specific to each patient’s condition and any interventions or other treatments before they arrived at the hospital.

Ms Hannah Voith, a medical student at the Medical University of Vienna, presented the findings to the Congress. She said: “We found no significant association between patients’ income and neurological outcomes after an out-of-hospital cardiac arrest. For cases that happened at the patient’s home address, we divided patients’ incomes into quartiles and examined basic life support rates from bystanders across the four groups. We observed a trend towards lower rates for patients in the bottom quartile with the lowest incomes  – 64% – compared to 78% for patients from the top quartile with the highest incomes, but this trend was not statistically significant.

“Even though this trend is not significant, it does suggest disparities in pre-hospital care in lower income areas, and underscores the importance of targeted public health interventions, such as expanding first aid training, to reduce inequities and improve survival after out-of-hospital cardiac arrest. Our analysis emphasises the complex relationship between social factors and emergency care outcomes, highlighting the importance of further research in this field.

“Multiple studies have established that early bystander-performed cardiopulmonary resuscitation significantly enhances both survival rates and favourable neurologic outcomes following out-of-hospital cardiac arrest.

“In addition, it is important to note that the group of patients we studied was pre-selected, as we only included patients who were admitted to the hospital. There is a high likelihood that patients who never received bystander basic life support did not enter our registry, because they died before reaching the hospital. Therefore, much of the effect of basic life support, or lack of it, would be ‘filtered out’ before our population was assembled and would not notably impact the neurologic outcomes we report.

“The results suggest that further research is needed to investigate bystander basic life support rates between varying income levels. This could help to promote basic life support training and awareness. Public health strategies that boost bystander readiness across all societal groups may help reduce disparities and improve outcomes. For policymakers, this involves investing in accessible, low-threshold education and training programmes.

She concluded: “To our knowledge, this is the first Austrian study to systematically examine the link between patients’ income and neurological outcomes after out-of-hospital cardiac arrest. It is also unique in combining detailed registry data with geosocial analysis, providing new insights into regional variations in emergency response.”

While recognising that Vienna’s infrastructure and professional preclinical emergency care network are unique, the researchers say it would be helpful to see what happens in other large cities in Austria, such as Graz. In addition, they plan to evaluate bystander basic life support rates across Vienna, investigate long-term outcomes for patients, and for patients who have received extracorporeal cardiopulmonary resuscitation – a procedure that passes a patient’s blood supply through a machine to oxygenate the blood.

Strengths of the study include its use of a large, validated registry of OHCAs in Vienna, detailed socioeconomic information, and the focus on a clinically meaningful outcome: neurological survival. Limitations include the fact that the study was observational, socioeconomic data were based on geographic area rather than on information for individual patients, and infrastructural factors, such as proximity to specialised care centres such as Vienna General Hospital, may have influenced outcomes but were not fully accounted for in the analysis.

Dr Felix Lorang is a member of the EUSEM abstract selection committee. He is head of the emergency department at SRH Zentralklinikum Suhl, Thuringia, Germany, and was not involved with the research. He said: “These findings suggest that if someone survives an out-of-hospital cardiac arrest and can be discharged from hospital, then their neurological outcomes are not affected by their socioeconomic background. We already know that the most important intervention on the way to a favourable neurological outcome is bystander CPR. However, the trend the researchers observed towards lower CPR rates in lower-income areas of Vienna definitely deserves further investigation. More education and training of people everywhere, not just in Vienna, is needed to try to improve the numbers who can offer CPR in an emergency.”

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[1] Abstract no: OA023, “The impact of socioeconomic factors on the outcome in adult out-of-hospital cardiac arrest patients – a retrospective data analysis”, by Hannah Voith. Cardio-respiratory session, Wednesday 1 October, 09:00-10:30 hrs CEST, Schubert 4 room: https://eusem.floq.live/kiosk/eusem-2025/dailyprogramme?objectClass=timeslot&objectId=68871e9e626af251d24be445&type=detail