Scientific journalism is a difficult task as it requires both understanding the content of the research at hand and the ability to make conclusions that are coherent with the researchers' findings that the researchers themselves did not state. Oftentimes, it is easy to exaggerate claims to produce shocking articles. This is prevalent when journalists get their hands on statistics about topics people care about such as heart disease.
For example, The New England Journal of Medicine published a study looking at the “Outcomes of Rapid Defibrillation by Security Officers after Cardiac Arrest in Casinos” (Valenzuela et al, 2000).
The purpose of this study was to see if the survival rate of people with ventricular fibrillation in casinos and hotels was significantly affected by how soon rapid defibrillation is conducted. The aim was to evaluate whether having automated external defibrillators available in public spaces actually helped save lives.
The study found that
Among subjects whose collapse was witnessed, the survival rate was 74 percent (26 of 35) for those who received their first defibrillation no later than three minutes after collapse and 49 percent (27 of 55) for those who received their first defibrillation more than three minutes after collapse (Valenzuela et al).
Therefore, the rapid defibrillation did increase the survival rate of people who had heart attacks in casinos. Furthermore, the sooner the rapid defibrillation occurs, the more likely it is that the subject survives. This leads to the conclusion that automated external defibrillators should be more accessible in public areas. Even before this study was conducted, airlines had started making defibrillators available on planes and airports (Valenzuela et al).
Although this article is very clear in its conclusion, one statistic makes it confusing. It states that the survival rate for cases of ventricular fibrillation in hospitals in large cities is less than 5% (Valenzuela et al). Furthermore, in “some mid-sized urban areas with excellent emergency medical systems have achieved survival rates of 15 to 35 percent” (Valenzuela et al). It seems like casinos are much better places to have heart attacks since the survival rates are “74% for those who received their first defibrillation no later than three minutes after collapse and 49 percent (27 of 55) for those who received their first defibrillation more than three minutes after collapse” (Valenzuela et al). Are hospitals less safe for people who get heart attacks?
Thomas Maugh II writing for the LA times thought so. In 2008, he published an article stating that a “study finds hospitals slow to defibrillate” (Maugh II, 2008) pointing to the study discussed above. He claims that the study shows that you are more likely to survive a heart attack if you collapsed in a casino compared to a hospital.
At first glance, the numbers seem to show this. The highest survival rate for cases of ventricular fibrillation in hospitals seems to be 35% while it can get as high as 74% in casinos. However, Maugh overlooks other variables. The age and health of the individuals in casinos compared to hospitals. The Journal of American Health Association found that patients over the age of 65 accounted for 85.6% of heart attack mortality in hospitals between 2001 and 2014. When looking at specific age strata, we find that people between the ages of 55-65 accounted for 15.2%, 65-75 accounted for 20.9%, 75-85 accounted for 27.0%, and over 85 accounted for 24.2% of the hospitalizations related to heart failure between 2010 and 2014 (JAHA, 2017). Furthermore, the average age of patients who died of heart attacks between 2001 and 2014 in hospitals is 77.6 (JAHA).
However, the average age of casino goers is 50-64 (Statista, 2011). Hence, casino goers are firstly less likely to be affected by heart attacks as shown by the hospitalization rates. Also, even if they get heart attacks, they are much more likely to survive due to their age. Finally, people in hospitals over the age of 65 usually have other health conditions. The Committee on the Future Health Care Workforce for Older Americans states that “older adults vary greatly in terms of health status, the majority of them have at least one chronic condition that requires care.” Hence, their likelihood of survival is lower due to their deteriorated health.
In conclusion, it is impossible to claim that hospitals are less safe for people with heart attacks compared to casinos because the people that go to casinos and hospitals are not comparable. People who go to hospitals with heart attacks are usually less likely to survive because of their older age which makes them have a higher mortality rate and more likely to have other conditions that worsen their chances of survival. On the other hand, people who go to casinos are more likely to be a bit younger and hence are more likely to survive wherever they get defibrillated. Hospitals are by design where people get the best care for their conditions. Hence, informing the public that they are less safe in hospitals does not seem logical.
By Nathnael Bekele
Sources
Akintoye, Emmanuel, et al. “National Trends in Admission and in‐Hospital Mortality of Patients with Heart Failure in the United States (2001–2014).” Journal of the American Heart Association, 29 Nov. 2017, www.ahajournals.org/doi/10.1161/JAHA.117.006955.
Institute of Medicine (US) Committee on the Future Health Care Workforce for Older Americans. Retooling for an Aging America: Building the Health Care Workforce. National Academies Press (US), 2008. doi:10.17226/12089
Maugh II, Thomas H. “Study Finds Hospitals Slow to Defibrillate.” Los Angeles Times, Los Angeles Times, 3 Jan. 2008, www.latimes.com/archives/la-xpm-2008-jan-03-sci-heart3-story.html.
Optimizing the Deployment of Automated External Defibrillators by a Data-Driven Algorithmic Approach - Scientific Figure on ResearchGate. Available from: https://www.researchgate.net/figure/Automated-External-Defibrillator-device_fig2_323336872
Published by Statista Research Department. “Age Group Distribution of U.S. Casino Visitors in 2010.” Statista, 4 May 2011, www.statista.com/statistics/188424/percentage-distribution-of-casino-visitors-in-the-us-by-age-2010/.
Valenzuela, Terence D., et al. “Outcomes of Rapid Defibrillation by Security Officers after Cardiac Arrest in Casinos: Nejm.” New England Journal of Medicine, 26 Oct. 2000, www.nejm.org/doi/full/10.1056/NEJM200010263431701.
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