The Cost of Cardiac Arrest in the Workplace

In our studies, a death costs the employer 175 percent of that worker's annual salary, just for replacement.

CARDIAC arrest, the equal opportunity killer, took 1,261 Americans' lives yesterday, most of them before they reached the hospital. Many of the deaths happened at work. Each death yesterday will cost employers, employees, and their families today and for the foreseeable near future.

Many people don't know the difference between "cardiac arrest" and a "heart attack." We hear about heart attacks every day in the media, partly because medical technology has improved for heart attack prevention. A heart attack is when the heart muscle dies because of a lack of blood supply. A heart attack can be a slow progression of events that produces warning signs and symptoms. The dead area of the heart causes pain that typically radiates to the left arm and jaw. There are many other symptoms: shortness of breath, sweating, nausea, and angina. Because the heart attack victim experiences symptoms, treatment is possible, and many survive.

Cardiac arrest is a fatal malfunction of the heart's electrical system. Cardiac arrest has no warning signs; the event of death is the first and only symptom. When a person has a cardiac arrest, the heart rhythm converts, most of the time, to a rapid fluttering of the heart called ventricular tachycardia and then quickly turns into the chaotic, unproductive ventricular fibrillation (VF). VF moves no blood around the body; the victim loses consciousness, loses pulse and breathing, and then passes out. All of these happen within just a brief moment of time.

How the Problem Affects You
According the American Heart Association, 400,000 to 460,000 die each year of cardiac arrest, and 13 percent of these deaths are in the workplace.

As a respectful comparison, more people die of cardiac arrest every three days than died on 9/11. But unlike 9/11, these deaths are not happening together in one swift action. Rather, they are spread out among the people across this great land--1,261 are dying every day from cardiac arrest, silently, one at time, all over the country. So the impact can never be experienced in the same fashion as with a single major event.

Should each victim continue to tolerate this burden alone, or is it time to mobilize as a nation and fight cardiac arrest?

Since 1975 women diagnosed with cardiac issues have been outpacing men, and since 1991 their rate of diagnosis continues to grow at a rapid rate as men are leveling off. So women are at a greater risk. Other risk factors such as age, cholesterol, blood pressure, inactivity, and ethnicity play small roles. Essentially, cardiac arrest is an equal opportunity killer; one in every 2.6 of us will die from cardiac problems.

Cardiac arrest costs Americans $2.2 billion in direct hospital costs; the indirect costs to the family and employer are multiples of this. These deaths cost the workplace in insurance premiums, lost productivity, and actual and indirect costs. In our studies, a death costs the employer 175 percent of that worker's annual salary, just for replacement.

Insurance premiums, a direct cost, will rise when claims increase; this affects the insurance rates a minimum of one year after the insurance claims have been reduced. All employees' premiums increase for one renewal period, which is one year after the increased claim usage. The inverse of this is also true: Health insurance premiums can be reduced with reduced claims. Life insurance premiums are reduced as death rates are reduced. Worker's compensation premiums also may decline as claims decrease, but the rates stay elevated for three years after the increased claim activity and compare against the rest of your industry.

Productivity, another direct cost, is affected, just as a pebble affects a still lake. After the death of a co-worker, there are many workplace problems and issues that can reduce productivity: stress, resentments, fear, trauma, personal crisis, job performance dysfunctions, negative attitudes, divisiveness, miscommunication, grievances, rumors, and gossip. These problems can cause low morale, poor customer service, and unhappy workers. Each of these issues can hurt your company's productivity. The death of a co-worker can reduce productivity with all sorts of health ailments, as well: migraine headaches, back pain, allergies, and depression. Depression is among the most costly because depressed people still show up for work, but their performance may be substantially reduced while at work.

A new study published in the Journal of the American Medical Association estimates the impact of depression in the workplace at $44 billion. "If companies do effective intervention, education, screenings, and things like that, for every dollar they spend, they're going to save somewhere between $2.50 and $5 in treatment costs per person," according to this source. Not only that, but productivity tends to go up as a result.

The Solution
There is a solution to this costly epidemic. A new technology has been developed and heavily tested that determines your risk of having a cardiac arrest in the near future. The non-invasive test identifies your risk of a life-threatening heart rhythm disturbance that leads to cardiac arrest. The test is quick, inexpensive, and completely painless. It looks for beat-to-beat variations in a portion of your electrocardiogram, or ECG. When visible on the ECG, these variations have long been associated with increased likelihood of a life-threatening heart rhythm. (Unfortunately, most of the time the variations are not visible to the naked eye during routine ECG testing.) The test is designed for measurement of the ECG at the microvolt level (one millionth of a volt), allowing this condition to be identified before it becomes life-threatening.

Because sudden cardiac death is the first and only symptom of cardiac arrest, Americans have had to rely on reactive measures such as CPR and AEDs to attempt to save a life. But with this test offered proactively, we can reduce the need for these reactive measures and actually cost your company less with much higher survival rates.

The test can help your company avoid the cost and impact of the problem by detecting the cardiac arrest before it happens. When detected early, cardiac arrest can be reduced and possibly avoided through common medical solutions. This proactive solution has been made available only recently.

The Los Angeles International Airport Study
The Citizen Safety Institute contracted a local mobile testing company to use the test on all employees of the Los Angeles International Airport. In Phase One, the 2,500 employees LAX were sent an e-mail and an announcement attached to their paycheck by project coordinator Jackie Adams informing them the test would be available to all employees with 12 days for the testing. Testing would be first come, first served. Employees called to schedule the appointments personally and confidentially. Testing was scheduled by appointment every 20 minutes during the contracted hours of testing.

Space was not available in the airport buildings, so a mobile testing unit was used. This also maintained consistent study conditions. Each employee was prepped to ensure the best quality of electrode contact, and 14 electrodes were connected on the chest and back. Manufacturers' protocols were used, collecting data for five minutes. Data were analyzed immediately after testing and reviewed with each employee. Only one copy of the test results was printed; it was immediately given to the employee, maintaining strict confidentiality.

In Phase One, 409 employees were tested and more than 100 were placed on the waiting list who wanted to be tested but were unable to fit into the scheduled times. This represents 16.4 percent of the employees at LAX. The results of the testing were that 15 percent of the men (37 total) and 25.9 percent of the women (42 total) tested "positive," which means they have a significant risk of having a cardiac arrest within the next two years.4 A total of 19 percent of the entire LAX staff tested positive. After learning of the risk, each employee is encouraged to seek out treatment solutions with his or her medical provider.

We calculated this testing saved LAX $4,175,382 in total cost savings and avoidance, producing a 25,522 percent return on investment.

As documented in this study, 19 percent were found to have a significant risk of having a cardiac arrest. The impressive ROI calls out to other organizations that cardiac arrest testing is a good use of funds. But more important, yet more difficult to define, is the human impact. Cost savings aside, this form of testing may be able to offer a greater solution than the reactive measures employed to date. If we can reduce cardiac arrest proactively and save considerable amounts of money in the meantime, is there any reason not to try?


1. Heart Disease & Stroke Statistics--2004 Update, American Heart Association



4. Cambridge Heart, Inc.

5. Journal of the American Medical Association, Walter F. Stewart, Ph.D., MPH, with Geisinger Health Systems in Danville, Pa.

This article originally appeared in the September 2004 issue of Occupational Health & Safety.

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