Abstract 17123: Warning Symptoms Prior to Sudden Cardiac Arrest: Spotlight on Sub-Acute Prevention
Introduction: Survival after sudden cardiac arrest (SCA) remains low despite significant developments in the field of resuscitation. While long-term strategies for primary prevention continue to evolve, the spotlight must shift to short-term primary prevention strategies. Sentinel events preceding SCA may be of special interest in this regard, especially in light of recent advances in communication and remote transmission technologies.
Hypothesis: We hypothesized that “warning events” in the hours, days and weeks prior to SCA may identify a subgroup of SCA cases that will benefit from a timely 911 call for resuscitation.
Methods and Results: From an ongoing prospective study of out-of-hospital SCA in an urban population of one million in the Northwestern US (2002-2012), we evaluated symptoms in the four weeks preceding SCA among middle-aged residents (35-65 years), using multiple sources. If symptoms were present and emergent health care sought, association with survival from SCA was assessed. Of 839 SCA cases with comprehensive assessment of symptoms (51±12 years, 75% males), 430 (51%) had symptoms, mainly chest pain and dyspnea. Symptoms recurred during the 24 hours preceding SCA in the majority (93%). Only 81 subjects (19%) called EMS (911) to report symptoms prior to SCA; these were more likely to be subjects with a history of heart disease (P=0.0001) and/or continuous chest pain (P<0.0001). Survival when 911 was called prior to SCA was 32.1% (95% confidence interval 21.7-42.4), compared to 6.0% (95% confidence interval 3.5-8.5) in those who did not call (P<0.0001).
Conclusions: Warning symptoms are frequent prior to SCA but the vast majority of these are not acted upon. Survival from SCA was significantly higher (five-fold) when symptoms prompted a 911 call, indicating the significant potential to enhance SCA survival by closely coupling warning symptoms to emergent care.
- Sudden death
- Symptom management
- Emergency medical services (EMS)
- Cardiopulmonary resuscitation
- Ventricular arrhythmia
Author Disclosures: E. Marijon: None. A. Uy-Evanado: None. K. Reinier: None. C. Teodorescu: None. K. Narayanan: None. K. Gunson: None. J. Jui: None. S.S. Chugh: Research Grant; Significant; NIH.
- © 2014 by American Heart Association, Inc.