A new study by the Sudden Cardiac Arrest Foundation, in collaboration with StrataVerve Market Research, reveals that although sudden cardiac arrest is the third leading cause of death in the U.S., it is not on the radar screen for most consumers. Researchers call for development of a clear, uniform, consumer-friendly definition of sudden cardiac arrest emphasizing its urgency and differentiating it from heart attack, and messaging that stresses the fact that SCA can happen to anyone, anywhere, at any time.
PITTSBURGH, PA--The Sudden Cardiac Arrest Foundation, in collaboration with StrataVerve Market Research, has conducted a national baseline study to determine the extent to which the public is aware of sudden cardiac arrest (SCA), CPR, and automated external defibrillators (AEDs). The research team included Mary Newman, MS, of the Sudden Cardiac Arrest Foundation; Jennifer Chap, Youssou Ba, Karen Ba, and Rick Chap of StrataVerve; and Kelly Sawyer, MD, of William Beaumont School of Medicine. Newman and J. Chap presented study results at the Citizen CPR Foundation’s Emergency Cardiovascular Care Update in San Diego in December.
Background and Methodology
Researchers first reviewed public awareness studies conducted since 1999 and then applied consumer research thinking to design an innovative study that blended quantitative and qualitative methods. It was fielded in November 2015.
The quantitative component of the study was an online survey of a random representative sample of 1,000 people in the U.S., plus a benchmark sample of 200 people in King County (KC) Washington, an area that has been widely recognized for its high cardiac arrest survival rates. Samples matching U.S. Census data were provided by Survey Sampling International.
The qualitative component of the study consisted of one-on-one 15-20 minute interviews conducted at the research facilities of StrataVerve partner Strategic Artifex in Orlando, Florida. Ten people, ages 19-63, from six states, participated in the in-depth interviews.
The objectives of the study were to:
Determine where SCA fits in the minds of consumers, compared with other health conditions
Understand knowledge gaps that could improve community involvement
Identify key factors that could motivate people to learn CPR and how to use an AED
Explore opportunities for improvement.
Research results indicate that although sudden cardiac arrest is the third leading cause of death in the U.S., it is not on the radar screen for most consumers. When respondents were asked an open-ended, unaided question, “Considering your own health or the health of your loved ones, please list the conditions you are most concerned about,” cancer, heart disease, and diabetes topped the list, but not a single respondent mentioned sudden cardiac arrest.
When a list of 13 health conditions was provided to respondents, familiarity with sudden cardiac arrest was still low—even among those who have dealt with heart attacks, which increase the risk of SCA.
Survey participants were also asked about their familiarity with key health education campaigns. While half of those sampled were familiar with the ALS (Amyotrophic Lateral Sclerosis) Ice Bucket Challengeand the National Football League’s wear pink campaign to raise awareness about breast cancer, and a third were familiar with the American Heart Association (AHA) Go Red for Women campaign for heart attack awareness, less than one in 10 respondents was familiar with the AHA hands-only CPR awareness campaign.
About one-third of both the national sample and the KC sample agreed completely with factual statements about SCA, such as the following:
To survive SCA, victims usually need immediate CPR and treatment with a defibrillator
People who suffer heart attacks are at risk for SCA.
However, respondents in the national sample were significantly more likely than those in the KC sample to “agree completely” with these inaccurate statements:
AEDs are medical devices that only trained medical personnel are allowed to use
SCA affects only adults.
Respondents were also asked whether they had taken a CPR or AED course in the past 10 years. More than a third of respondents in both the national and KC samples reported they had taken a CPR course. While fewer respondents oveA rall reported having undergone AED instruction, significantly more people from King County said they had done so, compared with the national sample.
Based on responses from the national sample, the top four barriers to learning CPR are:
Concern about hurting the victim
Lack of confidence/competence to help
Concern about liability risks
Belief that someone else would be more competent.
When study respondents were presented with a definition of SCA, however, interest in learning CPR and how to use an AED increased dramatically. After reading the Sudden Cardiac Arrest Foundation definition of SCA, the perceived importance of learning CPR increased from 61 to 80 percent, and the perceived importance of learning how to use an AED increased from 33 to 54 percent in the national sample.
Having seen the definition of SCA, the key motivators for learning CPR became:
Someone I love could be a victim of sudden cardiac arrest
Bystander CPR provided immediately after SCA can double or triple a victim’s chances of survival
CPR training is offered free of charge in my community.
Conclusions and Implications
The key conclusions from this study are summarized below.
SCA is not on consumers’ radar. But when consumers have a clear definition of SCA, their motivation to learn CPR and how to use an AED increases. Implication: Creating a uniform definition of SCA in consumer-friendly language and using it consistently across organizations, the medical community, and the media is urgent and mandatory.
The blurring of heart attack and SCA may be contributing to unintentional consumer apathy with deadly consequences. Implication: An integrated strategic marketing, communications, and outreach plan at a national level is of utmost importance. It is critical to think bigger to grab consumer mindshare and save lives.
The SCA awareness and understanding gap extends even to those who have received CPR training, who report they are uncertain about how to use it and why. Implication: It is important that clear definitions be included with instructor training materials to prevent the perpetuation of knowledge gaps.
Key motivational drivers are the realization that SCA can happen to anyone, anywhere, anytime; that immediate CPR can double or triple the chances of survival; and that free training and convenient practice options are available nearby. Implication: Leverage this information in communications.
Connecting the dots between SCA, CPR, and AEDs is essential for consumer awareness and understanding. Implication: What may be obvious to the medical community may not be so clear to average consumers.
"It was enlightening to see that once people understood the definition of sudden cardiac arrest, they were highly motivated to learn CPR and how to use an AED," said Jennifer Chap, of StrataVerve Research. Chap has a personal connection to the cause: She helped save her husband Rick's life when he suffered cardiac arrest at their home in 2012. "When this happened to Rick, I wondered, how could I not know about sudden cardiac arrest? How many people like me are out there?" Chap saved her husband's life by calling 9-1-1 and giving him CPR. "This research validates the fact that I am not alone--that a majority of consumers have no idea what sudden cardiac arrest is. And so we are determined to help educate the public about sudden cardiac arrest and the simple lifesaving skills that everyone should possess."
Phase Two of this study will include overlay research in Pittsburgh and Orlando to establish baseline levels of public awareness in these communities, plus development of a kit designed to help other communities determine their baseline levels. Researchers plan to repeat this study every two years to monitor trends.
Related Survivor/Family Member/Friend Survey
In addition, follow-up research will be conducted among members of the Sudden Cardiac Arrest Foundation online community, which includes survivors, family members and friends. A pilot study conducted previously by Sawyer, Newman and others revealed the following common experiences among survivors: memory loss, anxiety, depression, guilt, re-establishing a routine, getting back to school/work, trouble sleeping, trouble visiting the place where SCA occurred, fear of ICD shocks, fear ICD will not shock, and fear associated with not having an ICD.
Common experiences among family and friends included: lack of information at discharge, importance of recognizing memory loss, concern the patient may experience another cardiac arrest, and need to recognize that life post SCA survival affects the whole family.
This information and related recommendations were provided by the Sudden Cardiac Arrest Foundation to the Institute of Medicine in an invited presentation in June 2014 and were reflected in the IOM report on cardiac arrest published in June 2015.
The online survey for Sudden Cardiac Arrest Foundation members will be fine-tuned, based on the public awareness survey results, and conducted in the spring of 2016. To participate, join the community atwww.sca-aware.org/sca-network.
Acknowledgments: StrataVerve Market Research, Strategic Artifex, Just Do Something…Anything, and Verocity provided their services to the Sudden Cardiac Arrest Foundation on a pro-bono basis. Survey Sampling International provided discounted pricing.
 IOM (Institute of Medicine). 2015. Strategies to improve cardiac arrest survival: A time to act. Washington, DC: The National Academies Press.
 The Sudden Cardiac Arrest Foundation provided the following definition of sudden cardiac arrest for the research study: “Sudden cardiac arrest is a medical condition that occurs when the heart suddenly and unexpectedly stops beating. As a result, blood is no longer pumped throughout the body. The victim suddenly loses consciousness, is non-responsive, and appears lifeless. Some victims also experience abnormal gasping and seizure-like activity. Sudden Cardiac Arrest is usually caused by an abnormality in the heart’s electrical system. Death occurs within minutes if the victim does not receive immediate treatment. To survive, the Sudden Cardiac Arrest victim requires immediate CPR (Cardiopulmonary Resuscitation) and treatment with an AED (Automated External Defibrillator). Sudden Cardiac Arrest is different from a heart attack. While the heart attack victim is awake and the heart is beating, the Sudden Cardiac Arrest victim is not awake and the heart is not beating.”