Half of Sudden Cardiac Arrest Patients Have Warning Symptoms, But Most Ignore Them

Warning signs like chest pain and dyspnea often occur before sudden cardiac arrest, but patients in an observational study often did not report them in time for life-saving medical care to intervene. There could be a window of opportunity for the medical community to invent new approaches for short-term prevention, the authors say.

Researchers led by Sumeet S. Chugh, MD, of Cedars-Sinai Medical Center (Los Angeles, CA), looked at a cohort of 839 patients—most of them middle-aged men—who had out-of-hospital sudden cardiac arrest and were admitted to 1 of 16 hospitals in Oregon between 2002 and 2012. Outcomes were reviewed according to any symptoms reported during the 4 weeks prior to their event.

Slightly more than half (n = 430) reported warning symptoms like chest pain (46%), dyspnea (18%), or palpitations or syncope (5%) before their sudden cardiac arrest, with most (93%) occurring within 24 hours. However, patients, relatives, or witnesses attempted to contact emergency medical services (EMS) regarding these warning symptoms in only 19% of cases. Those with a history of heart disease (P < .001) or continuous chest pain (P < .001), or older patients (P = .021) were more likely call 911 (or have calls made on their behalf). Also, chest pain symptoms were more likely to provoke a call than all other symptoms (69% vs 15%; P < .001).

When EMS was contacted, survival for patients with sudden cardiac arrest was more than 5 times higher than in those who did not call (32.1% vs 6.0%; P < .001). Even after adjustment for resuscitation variables, a 911 call was much more likely to lead to survival (OR 4.82; 95% CI 2.23-10.43). This did not change among hospitals or years.

While the frequency of overall symptoms did not differ between men and women (P = .59), men reported more chest pain and women reported more dyspnea (P < .001). Even when the analysis was restricted to cases with documented CAD, women still reported less chest pain than men (32% vs 58%; P = .001).

Short-term Prevention Strategy Needed

This dataset not only shows a “relatively high frequency of warning signs” in middle-aged patients who experience sudden cardiac arrest, Dr. Chugh and colleagues write, but it also suggests that “these symptoms seem to be frequently ignored or minimized.”

Also, because most symptoms that were reported in the days and weeks before the event recurred in the hours immediately before, the authors say, “These findings suggest the potential to enhance short-term prevention of [sudden cardiac arrest] in the future.”

Increased education efforts should also be attempted for the greater public to have a better understanding of warning signs and symptoms, they say, adding that mobile technologies may “potentially [afford] a unique opportunity for early intervention.”

Source: 
Marijon E, Uy-Evanado A, Dumas F, et al. Warning symptoms are associated with survival from sudden cardiac arrest. Ann Intern Med. 2015;Epub ahead of print.

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