Abstract 18987: Warning Symptoms Precede Sudden Cardiac Death in Majority of Men
Introduction: Despite significant enhancements in resuscitation methodology, survival after sudden cardiac arrest (SCA) remains low. Improved knowledge of warning signs and symptoms may assist the process of early intervention for SCA.
Hypothesis: We hypothesize that a sub-group of men who suffer SCA have warning symptoms prior to SCA.
Methods: In a large, ongoing, prospective, population-based study in a Northwestern US metro region (population approx. 1 million; 2002-2012), we systematically evaluated the frequency, characteristics and temporal trends of all symptomatology in the 4 weeks prior to SCA among middle aged male cases (35-65 years). We performed a detailed and comprehensive assessment of the accounts of family members/relatives, witnesses, emergency medicine personnel, as well as medical records during this time period.
Results: Of the 825 SCA cases, 258 (31%) did not have sufficient information to ascertain the presence of symptoms. Of the 567 cases with appropriate assessment [mean age 52±12 yr, initial shockable rhythm 59%, presence of witness 40%, bystander CPR 27%, presence of coronary artery disease (CAD) 84%], 300 (53%) patients presented with symptoms. These were principally chest pain in 167 patients (56%), dyspnea in 38 (13%), and dizziness/syncope/palpitations in 11 (4%). Episodes of chest pain were categorized as typical angina in 111 (67%) and suspicion of angina in 56 (33%). In an additional 29 cases (10%), typical flu symptoms were noted during the 4 weeks period. Overall, most symptoms (79%) occurred more than 1 hr before the SCD event (up to 4 weeks), whereas symptoms immediately preceding (<1 hour) were less frequent (21%). Symptoms were especially frequent with associated CAD compared to non CAD-related SCA (56% vs. 32%, P=0.0005). Among patients with previously known CAD 55% had symptoms before SCA.
Conclusions: In this community-based study, a higher than expected proportion of middle-aged men had warning symptoms prior to SCA. These findings may be explained by longer duration of evaluation, and have implications for SCA surveillance and prevention.
- © 2013 by American Heart Association, Inc.