Warning Symptoms Are Associated With Survival From Sudden Cardiac Arrest
Publication: Annals of Internal Medicine
Volume 164, Number 1
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Abstract
Background:
Survival after sudden cardiac arrest (SCA) remains low, and tools for improved prediction of patients at long-term risk for SCA are lacking. Alternative short-term approaches aimed at preemptive risk stratification and prevention are needed.
Objective:
To assess characteristics of symptoms in the 4 weeks before SCA and whether response to these symptoms is associated with better outcomes.
Design:
Ongoing prospective population-based study.
Setting:
Northwestern United States (2002 to 2012).
Patients:
Residents aged 35 to 65 years with SCA.
Measurement:
Assessment of symptoms in the 4 weeks preceding SCA and association with survival to hospital discharge.
Results:
Of 839 patients with SCA and comprehensive assessment of symptoms (mean age, 52.6 years [SD, 8]; 75% men), 430 (51%) had warning symptoms (50% of men vs. 53% of women; P = 0.59), mainly chest pain and dyspnea. In most symptomatic patients (93%), symptoms recurred within the 24 hours preceding SCA. Only 81 patients (19%) called emergency medical services (911) to report symptoms before SCA; these persons were more likely to be patients with a history of heart disease (P < 0.001) or continuous chest pain (P < 0.001). Survival when 911 was called in response to symptoms was 32.1% (95% CI, 21.8% to 42.4%) compared with 6.0% (CI, 3.5% to 8.5%) in those who did not call (P < 0.001).
Limitation:
Potential for recall and response bias, symptom assessment not available in 24% of patients, and missing data for some patients and SCA characteristics.
Conclusion:
Warning symptoms frequently occur before SCA, but most are ignored. Emergent medical care was associated with survival in patients with symptoms, so new approaches are needed for short-term prevention of SCA.
Primary Funding Source:
National Heart, Lung, and Blood Institute.
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References
1.
Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, et al; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2014 update: a report from the American Heart Association. Circulation. 2014;129:e28-e292. [PMID: 24352519]
2.
Adabag AS, Luepker RV, Roger VL, Gersh BJ. Sudden cardiac death: epidemiology and risk factors. Nat Rev Cardiol. 2010;7:216-25. [PMID: 20142817]
3.
Sasson C, Rogers MA, Dahl J, Kellermann AL. Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes. 2010;3:63-81. [PMID: 20123673]
4.
Pauker SG, Estes NA, Salem DN. Preventing sudden cardiac death: can we afford the benefit? [Editorial]. Ann Intern Med. 2005;142:664-6. [PMID: 15838073]
5.
Achtelik M. Preventing sudden cardiac death [Letter]. Ann Intern Med. 2005;143:756. [PMID: 16287802]
6.
Steinhubl SR, Muse ED, Topol EJ. Can mobile health technologies transform health care? JAMA. 2013;310:2395-6. [PMID: 24158428]
7.
Topol EJ. Transforming medicine via digital innovation. Sci Transl Med. 2010;2:16cm4. [PMID: 20371472]
8.
Noheria A, Teodorescu C, Uy-Evanado A, Reinier K, Mariani R, Gunson K, et al. Distinctive profile of sudden cardiac arrest in middle-aged vs. older adults: a community-based study. Int J Cardiol. 2013;168:3495-9. [PMID: 23684602]
9.
Chugh SS, Jui J, Gunson K, Stecker EC, John BT, Thompson B, et al. Current burden of sudden cardiac death: multiple source surveillance versus retrospective death certificate-based review in a large U.S. community. J Am Coll Cardiol. 2004;44:1268-75. [PMID: 15364331]
10.
Narayanan K, Reinier K, Uy-Evanado A, Teodorescu C, Chugh H, Marijon E, et al. Frequency and determinants of implantable cardioverter defibrillator deployment among primary prevention candidates with subsequent sudden cardiac arrest in the community. Circulation. 2013;128:1733-8. [PMID: 24048201]
11.
Teodorescu C, Reinier K, Uy-Evanado A, Ayala J, Mariani R, Wittwer L, et al. Survival advantage from ventricular fibrillation and pulseless electrical activity in women compared to men: the Oregon Sudden Unexpected Death Study. J Interv Card Electrophysiol. 2012;34:219-25. [PMID: 22406930]
12.
Jacobs I, Nadkarni V, Bahr J, Berg RA, Billi JE, Bossaert L, et al; International Liason Committee on Resusitation. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries. A statement for healthcare professionals from a task force of the international liaison committee on resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa). Resuscitation. 2004;63:233-49. [PMID: 15582757]
13.
Vandenbroucke JP, von Elm E, Altman DG, Gøtzsche PC, Mulrow CD, Pocock SJ, et al; STROBE initiative. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Ann Intern Med. 2007;147:W163-94. [PMID: 17938389]
14.
Vandenbroucke JP. The making of STROBE. Epidemiology. 2007;18:797-9. [PMID: 18049193]
15.
White IR, Royston P, Wood AM. Multiple imputation using chained equations: Issues and guidance for practice. Stat Med. 2011;30:377-99. [PMID: 21225900]
16.
Sterne JA, White IR, Carlin JB, Spratt M, Royston P, Kenward MG, et al. Multiple imputation for missing data in epidemiological and clinical research: potential and pitfalls. BMJ. 2009;338:b2393. [PMID: 19564179]
17.
Nishiyama C, Iwami T, Kawamura T, Kitamura T, Tanigawa K, Sakai T, et al. Prodromal symptoms of out-of-hospital cardiac arrests: a report from a large-scale population-based cohort study. Resuscitation. 2013;84:558-63. [PMID: 23069588]
18.
Müller D, Agrawal R, Arntz HR. How sudden is sudden cardiac death? Circulation. 2006;114:1146-50. [PMID: 16952983]
19.
Meischke H, Dulberg EM, Schaeffer SS, Henwood DK, Larsen MP, Eisenberg MS. 'Call fast, Call 911': a direct mail campaign to reduce patient delay in acute myocardial infarction. Am J Public Health. 1997;87:1705-9. [PMID: 9357360]
20.
Kannel WB, Wilson PW, D'Agostino RB, Cobb J. Sudden coronary death in women. Am Heart J. 1998;136:205-12. [PMID: 9704680]
21.
Albert CM, Chae CU, Grodstein F, Rose LM, Rexrode KM, Ruskin JN, et al. Prospective study of sudden cardiac death among women in the United States. Circulation. 2003;107:2096-101. [PMID: 12695299]
22.
Graham MM, Westerhout CM, Kaul P, Norris CM, Armstrong PW. Sex differences in patients seeking medical attention for prodromal symptoms before an acute coronary event. Am Heart J. 2008;156:1210-1216. [PMID: 19033022]
23.
Moriel M, Gavrielov-Yusim N, Gottlieb S. Cardiac symptoms in women and men [Letter]. JAMA Intern Med. 2013;173:1929. [PMID: 24217383]
24.
Khan NA, Daskalopoulou SS, Karp I, Eisenberg MJ, Pelletier R, Tsadok MA, et al; GENESIS PRAXY Team. Sex differences in acute coronary syndrome symptom presentation in young patients. JAMA Intern Med. 2013;173:1863-71. [PMID: 24043208]
25.
Alonzo AA, Simon AB, Feinleib M. Prodromata of myocardial infarction and sudden death. Circulation. 1975;52:1056-62. [PMID: 1182949]
26.
Teodorescu C, Reinier K, Dervan C, Uy-Evanado A, Samara M, Mariani R, et al. Factors associated with pulseless electric activity versus ventricular fibrillation: the Oregon sudden unexpected death study. Circulation. 2010;122:2116-22. [PMID: 21060069]
27.
Cobb LA, Weaver WD, Fahrenbruch CE, Hallstrom AP, Copass MK. Community-based interventions for sudden cardiac death. Impact, limitations, and changes. Circulation. 1992;85:I98-102. [PMID: 1728511]
28.
Bougouin W, Marijon E, Puymirat E, Defaye P, Celermajer DS, LeHeuzey JY, et al; FAST-MI Registry Investigators. Incidence of sudden cardiac death after ventricular fibrillation complicating acute myocardial infarction: a 5-year cause-of-death analysis of the FAST-MI 2005 registry. Eur Heart J. 2014;35:116-22. [PMID: 24258072] doi: 10.1093/eurheartj/eht453
Information & Authors
Information
Published In
Annals of Internal Medicine
Volume 164 • Number 1 • 5 January 2016
Pages: 23 - 29
History
Published in issue: 5 January 2016
Published online: 22 December 2016
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Copyright
© 2016 American College of Physicians.
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Warning Symptoms Are Associated With Survival From Sudden Cardiac Arrest. Ann Intern Med.2016;164:23-29. doi:10.7326/M14-2342
Warning Symptoms Are Associated With Survival From Sudden Cardiac Arrest. Ann Intern Med.2016;164:23-29. doi:10.7326/M14-2342
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