People who suffer heart attacks outside a hospital are more likely to die today than five years ago, and this has sparked calls for the urgent installation of defibrillators across the state.
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A study of call-outs for cardiac arrests in NSW has found only one in 10 people survived, down 17 per cent between 2005 and 2010.
Experts say more defibrillator machines and people trained in CPR would stop the needless deaths, and bring NSW in line with "the rest of the civilised world".
Study co-author and Australian Resuscitation Council NSW chairman Paul Middleton said NSW was well behind in those areas.
"If I stand outside my house tomorrow and my heart stops, I have got three to four minutes until irreversible brain damage, and that means somebody has got to start doing CPR on me to make sure my blood starts flowing," he said. "The fastest ambulance service in the world will not get there in time."
He said his research, published in the Critical Care and Resuscitation journal, showed at least 40 more people had died in one year in the Sydney metropolitan area alone.
Overall, 12.3 per cent of people with ambulances called for out-of hospital cardiac arrest survived in 2005, compared with 10.2 per cent in 2010.
During a heart attack, the supply of blood to the heart is blocked, in some cases causing cardiac arrest, where the heart stops beating.
Associate Professor Middleton, from the University of Sydney, said the study did find a smaller proportion of people were experiencing so-called "shockable" arrests, which could explain some of the decrease in survival, but this had been seen in many other places without similar decreases.
Heart Foundation national chief executive Lyn Roberts said the research was gravely worrying.
"We need to have defibrillators available in all of the key places you would expect lots of people to be, places like train stations, casinos and sporting events," she said. "We also need community training to make sure people are confident using them … and performing CPR."
She said the country urgently needed a national register of cardiac arrests, which would help identify if some states had poorer survival rates than others.
"If we don't have that data collected nationally, it is very difficult to see if there are differences between the states," she said.
The study also found that the rate of out-of-hospital cardiac arrests was decreasing, which Dr Roberts said was one small piece of good news.
Correction: This article has been changed to say 12.3 per cent (2005) and 10.2 per cent (2010) of people survived out-of-hospital cardiac arrest.
