Cardiac arrests happen most often at home. Researchers knew that. What they didn’t know, until now, is this: If your home is a highrise, the higher your floor, the lower your chance of survival.

A new study published on Monday in the Canadian Medical Association Journal examined five years of health data from the City of Toronto and Peel Regions — areas selected because of high population density. Specifically, researchers wanted to see how “vertical delay” affects matters of life and death.

Researchers at Toronto’s St. Michael’s Hospital examined nearly 8,000 cases of cardiac arrest between 2006 and 2011 that occurred in private residences, including highrises, houses and townhomes. Those who lived on the ground or second floor fared best in the study. The data showed 4.2 per cent of them survived to hospital discharge. Survival dipped to 2.6 per cent for patients on or above the third floor. Above the 16th floor, the survival rate was “negligible” — less than one per cent. The statistics are most grim, though, for the 30 patients who went into cardiac arrest on or above the 25th floor.

“They all died,” said Dr. Laurie Morrison, a scientist at St. Michael’s Hospital and one of the study’s authors. “It’s like the higher you go the more isolated you become.”

It’s a stark finding in a city that has seen a 13-per-cent increase in highrise living recently. More than 40 per cent of homeowners over the age of 65 live in multi-story condos or apartment buildings.

“As more highrise buildings are built, in response to the demand for affordable condominium and rental properties,” the study noted, “the negative impact on community survival may increase.”

Researchers ruled out the presence of “toxic neighbourhoods” as a factor that might have impacted results. No single geographic or socioeconomic area captured in the study stood out.

“It doesn’t matter whether you’re poor, middle class or high class, it’s just the vertical that makes a difference,” said Morrison, who is also director of Rescu — a group that studies out-of-hospital emergency health care. Rescu is part of the Rescue Outcomes Consortium, or ROC, a multinational research collaboration of 10 sites across the United States and Canada, studying how promising new tools and treatments can improve survival rates among people who suffer cardiac arrest or life-threatening traumatic injury.

The study’s lead author Ian Drennan, a paramedic with York Region Paramedic Services, is familiar with barriers to life-saving care at condos and apartments.

“Building access issues, elevator delays and extended distance from the emergency vehicle to the patient can all contribute to longer times for 911-initiated first responders to reach the patient and start time-sensitive, potentially life-saving resuscitation,” he said.

Survival rates decrease 7 to 10 per cent with every one-minute delay to defibrillation, the study notes.

“Time is life,” Morrison said.

Improving outcomes

The study’s authors suggest a few interventions that may increase survival rates in highrise buildings.

Apartment and condo residents should lobby for their building to have at least one automated external defibrillator device on site, registered with EMS, and make sure security staff or even residents are trained in using it. Use of AEDs across Toronto and Peel was “pathetically low,” Morrison said. The device was used just seven times during the study’s five-year period. The Chase McEachern Act, established in 2007, protects anyone who attempts to use the device to save a life from civil liability

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Highrise residents, particularly the elderly, should think about forming community check-in groups “so they provide an immediate community that saves itself,” Morrison said. More than three-quarters of patients who survived cardiac arrests at home had a loved one or neighbour or building staff watch them go down. Seniors might also consider investing in a medical lifeline service where they can call for help at the push of a button.