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Reinier K, Dizon B, Chugh H, Bhanji Z, Seifer M, Sargsyan A, Uy-Evanado A, Norby FL, Nakamura K, Hadduck K, Shepherd D, Grogan T, Elashoff D, Jui J, Salvucci A, Chugh SS. Warning symptoms associated with imminent sudden cardiac arrest: a population-based case-control study with external validation. Lancet Digit Health 2023; 5:e763-e773. [PMID: 37640599 PMCID: PMC10746352 DOI: 10.1016/s2589-7500(23)00147-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 07/07/2023] [Accepted: 07/18/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Sudden cardiac arrest is a global public health problem with a mortality rate of more than 90%. Prearrest warning symptoms could be harnessed using digital technology to potentially improve survival outcomes. We aimed to estimate the strength of association between symptoms and imminent sudden cardiac arrest. METHODS We conducted a case-control study of individuals with sudden cardiac arrest and participants without sudden cardiac arrest who had similar symptoms identified from two US community-based studies of patients with sudden cardiac arrest in California state, USA (discovery population; the Ventura Prediction of Sudden Death in Multi-Ethnic Communities [PRESTO] study), and Oregon state, USA (replication population; the Oregon Sudden Unexpected Death Study [SUDS]). Participant data were obtained from emergency medical services reports for people aged 18-85 years with witnessed sudden cardiac arrest (between Feb 1, 2015, and Jan 31, 2021) and an inclusion symptom. Data were also obtained from corresponding control populations without sudden cardiac arrest who were attended by emergency medical services for similar symptoms (between Jan 1 and Dec 31, 2019). We evaluated the association of symptoms with sudden cardiac arrest in the discovery population and validated our results in the replication population by use of logistic regression models. FINDINGS We identified 1672 individuals with sudden cardiac arrest from the PRESTO study, of whom 411 patients (mean age 65·7 [SD 12·4] years; 125 women and 286 men) were included in the analysis for the discovery population. From a total of 76 734 calls to emergency medical services, 1171 patients (mean age 61·8 [SD 17·3] years; 643 women, 514 men, and 14 participants without data for sex) were included in the control group. Patients with sudden cardiac arrest were more likely to have dyspnoea (168 [41%] of 411 vs 262 [22%] of 1171; p<0·0001), chest pain (136 [33%] vs 296 [25%]; p=0·0022), diaphoresis (50 [12%] vs 90 [8%]; p=0·0059), and seizure-like activity (43 [11%] vs 77 [7%], p=0·011). Symptom frequencies and patterns differed significantly by sex. Among men, chest pain (odds ratio [OR] 2·2, 95% CI 1·6-3·0), dyspnoea (2·2, 1·6-3·0), and diaphoresis (1·7, 1·1-2·7) were significantly associated with sudden cardiac arrest, whereas among women, only dyspnoea was significantly associated with sudden cardiac arrest (2·9, 1·9-4·3). 427 patients with sudden cardiac arrest (mean age 62·2 [SD 13·5]; 122 women and 305 men) were included in the analysis for the replication population and 1238 patients (mean age 59·3 [16·5] years; 689 women, 548 men, and one participant missing data for sex) were included in the control group. Findings were mostly consistent in the replication population; however, notable differences included that, among men, diaphoresis was not associated with sudden cardiac arrest and chest pain was associated with sudden cardiac arrest only in the sex-stratified multivariable analysis. INTERPRETATION The prevalence of warning symptoms was sex-specific and differed significantly between patients with sudden cardiac arrest and controls. Warning symptoms hold promise for prediction of imminent sudden cardiac arrest but might need to be augmented with additional features to maximise predictive power. FUNDING US National Heart Lung and Blood Institute.
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Affiliation(s)
- Kyndaron Reinier
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA, USA
| | - Bernadine Dizon
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA, USA
| | - Harpriya Chugh
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA, USA
| | - Ziana Bhanji
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA, USA
| | - Madison Seifer
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA, USA
| | - Arayik Sargsyan
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA, USA
| | - Audrey Uy-Evanado
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA, USA
| | - Faye L Norby
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA, USA
| | - Kotoka Nakamura
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA, USA
| | - Katy Hadduck
- Ventura County Health Care Agency, Ventura, CA, USA
| | | | - Tristan Grogan
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - David Elashoff
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jonathan Jui
- Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, USA
| | | | - Sumeet S Chugh
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA, USA; Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Health System, Los Angeles, CA, USA.
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2
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Alm-Kruse K, Tjelmeland I, Reiner A, Kvåle R, Kramer-Johansen J. Use of healthcare services before and after out-of-hospital cardiac arrest. Resuscitation 2023; 187:109805. [PMID: 37088268 DOI: 10.1016/j.resuscitation.2023.109805] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/27/2023] [Accepted: 04/13/2023] [Indexed: 04/25/2023]
Abstract
INTRODUCTION Knowledge about the use of healthcare services in patients experiencing out-of-hospital cardiac arrest (OHCA) is limited. We aimed to describe and compare the use of healthcare by OHCA survivors two years before and one year after cardiac arrest. METHODS Adult patients with OHCA of medical cause, who survived >30 days, were identified in the Norwegian Cardiac Arrest Registry. The Norwegian Patient Registry, The Cause of Death Registry, and The Norwegian Registry for Primary Healthcare provided data on survival and the use of healthcare services. We investigated the use of primary, specialist and mental healthcare, as well as rehabilitation services. RESULTS In 2015-2018, 13,112 OHCA cases were identified; 1435 (14%) patients survived >30 days (6.8/100,000 patients/year). The proportion of patients in the cohort that used primary healthcare each month increased form 43% before to 69% after OHCAto (p<0.001). We found a doubling of monthly healthcare contacts in both specialist healthcare (from 26% to 57%, p<0.001) and mental healthcare (from 3% to 8%, p>0.001). The observed increases in primary, specialist and mental healthcare use started two weeks, six months, and eight months before OHCA, respectively. Half of the patients had contact with primary healthcare services on the same day as the cardiac arrest. Two out of five patients were registered for rehabilitation after OHCA. CONCLUSION The use of primary, specialist and mental healthcare services increased before OHCA and remained significantly higher the year after OHCA. Less than half of the patients surviving cardiac arrest were registered for rehabilitation.
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Affiliation(s)
- Kristin Alm-Kruse
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingvild Tjelmeland
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Institute for Emergency Medicine, University-Hospital Schleswig-Holstein, Kiel, Germany
| | - Andrew Reiner
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Rune Kvåle
- Department of Oncology, Haukeland University Hospital, Bergen, Norway; Department of Health Registry Research and Development, National Institute of Public Health, Bergen, Norway
| | - Jo Kramer-Johansen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
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3
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Zylyftari N, Lee CJY, Gnesin F, Møller AL, Mills EHA, Møller SG, Jensen B, Ringgren KB, Kragholm K, Christensen HC, Blomberg SNF, Tan HL, Folke F, Køber L, Gislason G, Torp-Pedersen C. Registered prodromal symptoms of out-of-hospital cardiac arrest among patients calling the medical helpline services. Int J Cardiol 2023; 374:42-50. [PMID: 36496039 DOI: 10.1016/j.ijcard.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/12/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
Background Early identification of warning symptoms among out-of-hospital cardiac arrest (OHCA) patients remains challenging. Thus, we examined the registered prodromal symptoms of patients who called medical helpline services within 30-days before OHCA. Methods Patients unwitnessed by emergency medical services (EMS) aged ≥18 years during their OHCA were identified from the Danish Cardiac Arrest Registry (2014-2018) and linked to phone records from the 24-h emergency helpline (1-1-2) and out-of-hours medical helpline (1813-Medical Helpline) in Copenhagen before the arrest. The registered symptoms were categorized into chest pain; breathing problems; central nervous system (CNS)-related/unconsciousness; abdominal/back/urinary; psychiatric/addiction; infection/fever; trauma/exposure; and unspecified (diverse from the beforementioned categories). Analyses were divided by the time-period of calls (0-7 days/8-30 days preceding OHCA) and call type (1-1-2/1813-Medical Helpline). Results Of all OHCA patients, 18% (974/5442) called helpline services (males 56%, median age 76 years[Q1-Q3:65-84]). Among these, 816 had 1145 calls with registered symptoms. The most common symptom categories (except for unspecified, 33%) were breathing problems (17%), trauma/exposure (17%), CNS/unconsciousness (15%), abdominal/back/urinary (12%), and chest pain (9%). Most patients (61%) called 1813-Medical Helpline, especially for abdominal/back/urinary (17%). Patients calling 1-1-2 had breathing problems (24%) and CNS/unconsciousness (23%). Nearly half of the patients called within 7 days before their OHCA, and CNS/unconsciousness (19%) was the most registered. The unspecified category remained the most common during both time periods (32%;33%) and call type (24%;39%). Conclusions Among patients who called medical helplines services up to 30-days before their OHCA, besides symptoms being highly varied (unspecified (33%)), breathing problems (17%) were the most registered symptom-specific category.
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Affiliation(s)
- Nertila Zylyftari
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark; Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark.
| | - Christina Ji-Young Lee
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark; Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark
| | - Filip Gnesin
- Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark
| | | | - Elisabeth Helen Anna Mills
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Sidsel G Møller
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, Denmark; Copenhagen Emergency Medical Services, Denmark
| | - Britta Jensen
- Public Health and Epidemiology, Department of Health Science and Technology, Aalborg University, Denmark
| | - Kristian Bundgaard Ringgren
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Department of Anesthesia and Intensive Care, North Denmark Regional Hospital, Denmark
| | - Kristian Kragholm
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | | | - Hanno L Tan
- Department of Clinical and Experimental Cardiology, Amsterdam University Medical Center AMC, University of Amsterdam, the Netherlands; Netherlands Heart Institute, Utrecht, the Netherlands
| | - Fredrik Folke
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark; Copenhagen Emergency Medical Services, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Lars Køber
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark; The Danish Heart Foundation, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
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A Retrospective Study: Quick Scoring of Symptoms to Estimate the Risk of Cardiac Arrest in the Emergency Department. Emerg Med Int 2022; 2022:6889237. [DOI: 10.1155/2022/6889237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 10/09/2022] [Accepted: 10/15/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose. At present, not enough is known about the symptoms before cardiac arrest. The purpose of this study is to describe the precursor symptoms of cardiac arrest, focusing on the relationship between symptoms and cardiac arrest, and to establish a quick scoring model of symptoms for predicting cardiac arrest. Patients and Methods. A retrospective case-control study was carried out on cardiac arrest patients who visited the emergency department of Peking University Third Hospital from January 2018 to June 2019. Symptoms that occurred or were obviously aggravated within the 14 days before CA were defined as warning symptoms. Results. More than half the cardiac arrest patients experienced warning symptoms within 14 days before cardiac arrest. Dyspnea (
) was found to be associated with cardiac arrest; syncope and cold sweat are other symptoms that may have particular clinical significance. Gender (
), age (
), history of heart failure (
), chronic kidney disease (
), and hyperlipidemia (
) were other factors contributing to our model. Conclusions. Warning symptoms during the 14 days prior to cardiac arrest are common for CA patients. The Quick Scoring Model for Cardiac Arrest (QSM-CA) was developed to help emergency physicians and emergency medical services (EMS) personnel quickly identify patients with a high risk of cardiac arrest.
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5
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van Dongen LH, Blom MT, de Haas SCM, van Weert HCPM, Elders P, Tan H. Higher chances of survival to hospital admission after out-of-hospital cardiac arrest in patients with previously diagnosed heart disease. Open Heart 2021; 8:openhrt-2021-001805. [PMID: 34933962 PMCID: PMC8693164 DOI: 10.1136/openhrt-2021-001805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 11/19/2021] [Indexed: 12/05/2022] Open
Abstract
Aim This study aimed to determine whether patients suffering from out-of-hospital cardiac arrest (OHCA) with a pre-OHCA diagnosis of heart disease have higher survival chances than patients without such a diagnosis and to explore possible underlying mechanisms. Methods A retrospective cohort study in 3760 OHCA patients from the Netherlands (2010–2016) was performed. Information from emergency medical services, treating hospitals, general practitioner, resuscitation ECGs and civil registry was used to assess medical histories and the presence of pre-OHCA diagnosis of heart disease. We used multivariable regression analysis to calculate associations with survival to hospital admission or discharge, immediate causes of OHCA (acute myocardial infarction (AMI) vs non-AMI) and initial recorded rhythm. Results Overall, 48.1% of OHCA patients had pre-OHCA heart disease. These patients had higher odds to survive to hospital admission than patients without pre-OHCA heart disease (OR 1.25 (95%CI 1.05 to 1.47)), despite being older and more often having cardiovascular risk factors and some non-cardiac comorbidities. These patients also had higher odds of shockable initial rhythm (SIR) (OR 1.60 (1. 36 to 1.89)) and a lower odds of AMI as immediate cause of OHCA (OR 0.33 (0.25 to 0.42)). Their chances of survival to hospital discharge were not significantly larger (OR 1.16 (0.95 to 1.42)). Conclusion Having pre-OHCA diagnosed heart disease is associated with better odds to survive to hospital admission, but not to hospital discharge. This is associated with higher odds of a SIR and in a subgroup with available diagnosis a lower proportion of AMI as immediate cause of OHCA.
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Affiliation(s)
- Laura Helena van Dongen
- Department of Cardiology, Heart Center, Amsterdam UMC Location AMC, Amsterdam, North Holland, The Netherlands
| | - Marieke T Blom
- Department of Cardiology, Heart Center, Amsterdam UMC Location AMC, Amsterdam, North Holland, The Netherlands
| | - Sandra C M de Haas
- Department of Cardiology, Heart Center, Amsterdam UMC Location AMC, Amsterdam, North Holland, The Netherlands
| | - Henk C P M van Weert
- Department of General Practice, Amsterdam Public Health, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Petra Elders
- General Practice Medicine, Amsterdam UMC Locatie VUmc, Amsterdam, Noord-Holland, The Netherlands
| | - Hanno Tan
- Department of Cardiology, Heart Center, Amsterdam UMC Location AMC, Amsterdam, North Holland, The Netherlands .,Netherlands Heart Institute, Utrecht, The Netherlands
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6
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Zylyftari N, Møller SG, Wissenberg M, Folke F, Barcella CA, Møller AL, Gnesin F, Mills EHA, Jensen B, Lee CJY, Tan HL, Køber L, Lippert F, Gislason GH, Torp-Pedersen C. Contacts With the Health Care System Before Out-of-Hospital Cardiac Arrest. J Am Heart Assoc 2021; 10:e021827. [PMID: 34854313 PMCID: PMC9075404 DOI: 10.1161/jaha.121.021827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background It remains challenging to identify patients at risk of out-of-hospital cardiac arrest (OHCA). We aimed to examine health care contacts in patients before OHCA compared with the general population that did not experience an OHCA. Methods and Results Patients with OHCA with a presumed cardiac cause were identified from the Danish Cardiac Arrest Registry (2001-2014) and their health care contacts (general practitioner [GP]/hospital) were examined up to 1 year before OHCA. In a case-control study (1:9), OHCA contacts were compared with an age- and sex-matched background population. Separately, patients with OHCA were examined by the contact type (GP/hospital/both/no contact) within 2 weeks before OHCA. We included 28 955 patients with OHCA. The weekly percentages of patient contacts with GP the year before OHCA were constant (25%) until 1 week before OHCA when they markedly increased (42%). Weekly percentages of patient contacts with hospitals the year before OHCA gradually increased during the last 6 months (3.5%-6.6%), peaking at the second week (6.8%) before OHCA; mostly attributable to cardiovascular diseases (21%). In comparison, there were fewer weekly contacts among controls with 13% for GP and 2% for hospital contacts (P<0.001). Within 2 weeks before OHCA, 57.8% of patients with OHCA had a health care contact, and these patients had more contacts with GP (odds ratio [OR], 3.17; 95% CI, 3.09-3.26) and hospital (OR, 2.32; 95% CI, 2.21-2.43) compared with controls. Conclusions The health care contacts of patients with OHCA nearly doubled leading up to the OHCA event, with more than half of patients having health care contacts within 2 weeks before arrest. This could have implications for future preventive strategies.
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Affiliation(s)
- Nertila Zylyftari
- Department of Cardiology Copenhagen University Hospital Herlev and Gentofte Hellerup Denmark.,Department of Cardiology Nordsjaellands Hospital Hillerød Denmark
| | - Sidsel G Møller
- Department of Cardiology Copenhagen University Hospital Herlev and Gentofte Hellerup Denmark
| | - Mads Wissenberg
- Department of Cardiology Copenhagen University Hospital Herlev and Gentofte Hellerup Denmark.,Copenhagen Emergency Medical Services and University of Copenhagen Copenhagen Denmark
| | - Frederik Folke
- Department of Cardiology Copenhagen University Hospital Herlev and Gentofte Hellerup Denmark.,Copenhagen Emergency Medical Services and University of Copenhagen Copenhagen Denmark
| | - Carlo A Barcella
- Department of Cardiology Copenhagen University Hospital Herlev and Gentofte Hellerup Denmark
| | | | - Filip Gnesin
- Department of Cardiology Nordsjaellands Hospital Hillerød Denmark
| | | | - Britta Jensen
- Department of Health Science and Technology Aalborg University Aalborg Denmark
| | - Christina Ji-Young Lee
- Department of Cardiology Copenhagen University Hospital Herlev and Gentofte Hellerup Denmark.,Department of Cardiology Nordsjaellands Hospital Hillerød Denmark
| | - Hanno L Tan
- Department of Cardiology Academic Medical Center University of Amsterdam The Netherlands.,Netherlands Heart Institute Utrecht The Netherlands
| | - Lars Køber
- The Heart Centre Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Freddy Lippert
- Copenhagen Emergency Medical Services and University of Copenhagen Copenhagen Denmark
| | - Gunnar H Gislason
- Department of Cardiology Copenhagen University Hospital Herlev and Gentofte Hellerup Denmark.,The Danish Heart Foundation Copenhagen Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology Nordsjaellands Hospital Hillerød Denmark.,Department of Cardiology Aalborg University Hospital Aalborg Denmark
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7
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van Rensburg LC, Richmond L, Mgidi S, Claassen J, Wylie C, Stassen W. The lay descriptors of out-of-hospital cardiac arrest in the Western Cape province, South Africa. Resusc Plus 2021; 7:100146. [PMID: 34553180 PMCID: PMC8441464 DOI: 10.1016/j.resplu.2021.100146] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/02/2021] [Accepted: 06/08/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction Out-of-Hospital Cardiac Arrest (OHCA) is a time-sensitive emergency requiring prompt identification and emergency care to reduce morbidity and mortality. The first step in managing OHCA is rapid identification by the emergency dispatch centre. Identification of these patients remains challenging in South Africa due to multiple languages and widely differing levels of education. This study aimed to identify the key descriptors (words and phrases) of OHCA used by callers in the Western Cape when contacting the provincial Emergency Medical Services' emergency call centre. Methodology Computer-aided dispatch data with a corresponding “patient unresponsive” incident type were drawn for a 12-month period (January–December 2018). Corresponding patient care records were extracted to verify OHCA. The original voice recordings between the caller and emergency call taker at the time of the emergency were extracted and transcribed verbatim. Transcriptions were subjected to inductive, qualitative content analysis to the manifest level. Descriptors of OHCA in isiXhosa, English and Afrikaans calls were coded, categorised, and quantified. Results A total of 729 confirmed OHCA cases were identified, of which 38 (5.2%) Afrikaans, 24 (3.3%) isiXhosa and a random sample of 50 (6.8%) English calls were transcribed. Following content analysis, five distinct categories were identified. The most prevalent categories were descriptors related to ill health (medical history and suspected diagnosis; 35.5%), level of consciousness (unresponsive; 18.6%) and cardiac activity (pulselessness and suspected death; 17.2%). Conclusion The vast majority of callers within the Western Cape province of South Africa use consistent descriptors across languages when requesting an ambulance for OHCA. Future studies should focus on the development and validation of OHCA recognition algorithms, based on these findings.
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Affiliation(s)
| | - Lliam Richmond
- Division of Emergency Medicine, University of Cape Town, South Africa
| | - Sinethemba Mgidi
- Division of Emergency Medicine, University of Cape Town, South Africa
| | - Joel Claassen
- School of Languages and Literatures, University of Cape Town, South Africa
| | - Craig Wylie
- Division of Emergency Medicine, Stellenbosch University, South Africa
| | - Willem Stassen
- Division of Emergency Medicine, University of Cape Town, South Africa
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Ramaka S, Nazir NT, Murthy VS, Hoek TV, Prabhakar BS, Chodavarapu R, Peri S, Uppuleti A, Jatoth R, Murthy SV, Mohammed AS, Weine SM. Epidemiology of out-of-Hospital Cardiac Arrests, knowledge of cardiovascular disease and risk factors in a regional setting in India: The Warangal Area out-of-hospital Cardiac Arrest Registry (WACAR). Indian Heart J 2020; 72:517-523. [PMID: 33357639 PMCID: PMC7772591 DOI: 10.1016/j.ihj.2020.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/17/2020] [Accepted: 10/14/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Out-of-Hospital Cardiac Arrest (OHCA) is a global public health problem. There is inadequate data on OHCA in India. The Warangal Area out-of-hospital Cardiac Arrest Registry (WACAR) was planned to understand OHCA in a regional setting in India. METHODS WACAR is a prospective one-year observational cohort study of OHCA in the Warangal area, Telangana, India. The study included 814 subjects of OHCA of presumed cardiac etiology brought to the Mahatma Gandhi Memorial Hospital during January 1, 2018, and December 31, 2018. The data collected included; standard Utstein variables with additional data on clinical characteristics (modified Utstein template). RESULTS The majority of OHCA subjects were male with a median age of 60 years, and mostly occurring in residential locations within 1 h of onset of symptoms. Individuals with knowledge of CVD risk factors were more likely to report symptoms before OHCA. Data on resuscitation characteristics were inadequate. CONCLUSIONS The WACAR study provides baseline data regarding OHCA in a regional setting in India. The study demonstrated barriers involving data collection, patient knowledge of CVD risk factors and disease, and access to healthcare, which; impacted the data registry.
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Affiliation(s)
- Srinivas Ramaka
- Principal Investigator WACAR Study, Srinivasa Heart Centre, Warangal, Telangana, India.
| | - Noreen T Nazir
- Department of Internal Medicine, Division of Cardiology, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Vemuri S Murthy
- Coinvestigator WACAR Study,Department of Emergency Medicine, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Terry Vanden Hoek
- Department of Emergency Medicine, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Bellur S Prabhakar
- Department of Microbiology and Immunology, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Ravikumar Chodavarapu
- Department of Pediatrics, Pinnamaneni Institute of Medical Sciences and Research, Vijayawada, Andhra Pradesh, India
| | - Sundaresh Peri
- Dept of Social and Preventive Medicine, Kakatiya Medical College, Warangal, Telangana, India
| | | | - Rakesh Jatoth
- Kakatiya Medical College, Warangal, Telangana, India
| | - Sindgi Vasudeva Murthy
- Department of Pharmacology, Jayamukhi College of Pharmacy, Narsampet, Warangal, Telangana, India
| | | | - Stevan M Weine
- Departments of Global Health & Psychiatry, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
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9
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Prognostic value of first-recorded breathlessness for future chronic respiratory and heart disease: a cohort study using a UK national primary care database. Br J Gen Pract 2020; 70:e264-e273. [PMID: 32041768 DOI: 10.3399/bjgp20x708221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 06/21/2019] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Breathlessness is a common presentation in primary care. AIM To assess the long-term risk of diagnosed chronic obstructive pulmonary disease (COPD), asthma, ischaemic heart disease (IHD), and early mortality in patients with undiagnosed breathlessness. DESIGN AND SETTING Matched cohort study using data from the UK Clinical Practice Research Datalink. METHOD Adults with first-recorded breathlessness between 1997 and 2010 and no prior diagnostic or prescription record for IHD or a respiratory disease ('exposed' cohort) were matched to individuals with no record of breathlessness ('unexposed' cohort). Analyses were adjusted for sociodemographic and comorbidity characteristics. RESULTS In total, 75 698 patients (the exposed cohort) were followed for a median of 6.1 years, and more than one-third subsequently received a diagnosis of COPD, asthma, or IHD. In those who remained undiagnosed after 6 months, there were increased long-term risks of all three diagnoses compared with those in the unexposed cohort. Adjusted hazard ratios for COPD ranged from 8.6 (95% confidence interval [CI] = 6.8 to 11.0) for >6-12 months after the index date to 2.8 (95% CI = 2.6 to 3.0) for >36 months after the index date; asthma, 11.7 (CI = 9.4 to 14.6) to 4.3 (CI = 3.9 to 4.6); and IHD, 3.0 (CI = 2.7 to 3.4) to 1.6 (CI = 1.5 to 1.7). Risk of a longer time to diagnosis remained higher in members of the exposed cohort who had no relevant prescription in the first 6 months; approximately half of all future diagnoses were made for such patients. Risk of early mortality (all cause and disease specific) was higher in members of the exposed cohort. CONCLUSION Breathlessness can be an indicator of developing COPD, asthma, and IHD, and is associated with early mortality. With careful assessment, appropriate intervention, and proactive follow-up and monitoring, there is the potential to improve identification at first presentation in primary care in those at high risk of future disease who present with this symptom.
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Andersson PO, Lawesson SS, Karlsson JE, Nilsson S, Thylén I. Characteristics of patients with acute myocardial infarction contacting primary healthcare before hospitalisation: a cross-sectional study. BMC FAMILY PRACTICE 2018; 19:167. [PMID: 30305077 PMCID: PMC6180517 DOI: 10.1186/s12875-018-0849-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 09/17/2018] [Indexed: 12/02/2022]
Abstract
Background The characteristics of patients with on-going myocardial infarction (MI) contacting the primary healthcare (PHC) centre before hospitalisation are not well known. Prompt diagnosis is crucial in patients with MI, but many patients delay seeking medical care. The aims of this study was to 1) describe background characteristics, symptoms, actions and delay times in patients contacting the PHC before hospitalisation when falling ill with an acute MI, 2) compare those patients with acute MI patients not contacting the PHC, and 3) explore factors associated with a PHC contact in acute MI patients. Methods This was a cross-sectional multicentre study, enrolling consecutive patients with MI within 24 hours of admission to hospital from Nov 2012 until Feb 2014. Results A total of 688 patients with MI, 519 men and 169 women, were included; the mean age was 66±11 years. One in five people contacted PHC instead of the recommended emergency medical services (EMS), and 94% of these patients experienced cardinal symptoms of an acute MI; i.e., chest pain, and/or radiating pain in the arms, and/or cold sweat. Median delay time from symptom-onset-to-decision-to-seek-care was 2:15 hours in PHC patients and 0:40 hours in non-PHC patients (p<0.01). The probability of utilising the PHC before hospitalisation was associated with fluctuating symptoms (OR 1.74), pain intensity (OR 0.90) symptoms during off-hours (OR 0.42), study hospital (OR 3.49 and 2.52, respectively, for two of the county hospitals) and a final STEMI diagnosis (OR 0.58). Conclusions Ambulance services are still underutilized in acute MI patients. A substantial part of the patients contacts their primary healthcare centre before they are diagnosed with MI, although experiencing cardinal symptoms such as chest pain. There is need for better knowledge in the population about symptoms of MI and adequate pathways to qualified care. Knowledge and awareness amongst primary healthcare professionals on the occurrence of MI patients is imperative.
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Affiliation(s)
- Per O Andersson
- Primary Health Care and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden. .,Ljungsbro Health Care Centre, Evastigen 9, 590 71 Ljungsbro, Ljungsbro, Sweden.
| | - Sofia Sederholm Lawesson
- Department of Cardiology and department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Jan-Erik Karlsson
- Department of Internal Medicine, Region Jönköping County, Jönköping, and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Staffan Nilsson
- Primary Health Care and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Ingela Thylén
- Department of Cardiology and department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Hamilton A, Steinmetz J, Wissenberg M, Torp-Pedersen C, Lippert FK, Hove L, Lohse N. Association between prehospital physician involvement and survival after out-of-hospital cardiac arrest: A Danish nationwide observational study. Resuscitation 2016; 108:95-101. [DOI: 10.1016/j.resuscitation.2016.08.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 07/18/2016] [Accepted: 08/02/2016] [Indexed: 10/21/2022]
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Tirkkonen J, Hellevuo H, Olkkola KT, Hoppu S. Aetiology of in-hospital cardiac arrest on general wards. Resuscitation 2016; 107:19-24. [PMID: 27492850 DOI: 10.1016/j.resuscitation.2016.07.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 06/11/2016] [Accepted: 07/14/2016] [Indexed: 11/26/2022]
Abstract
AIM Aetiology of in-hospital cardiac arrests (IHCAs) on general wards has not been studied. We aimed to determine the underlying causes for IHCAs by the means of autopsy records and clinical judgement of the treating consultants. Furthermore, we investigated whether aetiology and preceding vital dysfunctions are associated with long-term survival. DESIGN AND SETTING Prospective observational study between 2009-2011 including 279 adult IHCA patients attended by medical emergency team in a Finnish university hospital's general wards. RESULTS The median age of the patients was 72 (64, 80) years, 185 (66%) were male, 178 (64%) of events were monitored/witnessed, first rhythm was shockable in 42 (15%) cases and 53 (19%) patients survived six months. Aetiology was determined as cardiac in 141 events, 73 of which were due to acute myocardial infarction. There were 138 non-cardiac IHCAs; most common causes were pneumonia (39) and exsanguination (16). No statistical difference was observed in the incidence of objective vital dysfunctions preceding the event between the cardiac and non-cardiac groups (40% vs. 44%, p=0.448). Subjective antecedents were more common in the cardiac cohort (47% vs. 32%, p=0.022), chest pain being an example (11% vs. 0.7%, p<0.001). Reviewing all 279 IHCAs, only shockable primary rhythm, monitored/witnessed event and low comorbidity score were independently associated with 180-day survival. CONCLUSIONS Cardiac aetiology underlies half of the IHCAs on general wards. Both objective and subjective antecedents are common. However, neither the cardiac aetiology nor the absence of preceding deterioration of vital signs were factors independently associated with a favourable outcome.
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Affiliation(s)
- Joonas Tirkkonen
- Tampere University Hospital, Department of Intensive Care Medicine, P.O. Box 2000, FI-33521 Tampere, Finland; Department of Anaesthesiology and Intensive Care Medicine, Seinäjoki Central Hospital, Finland.
| | - Heidi Hellevuo
- Department of Emergency Medicine, Tampere University Hospital, P.O. Box 2000, FI-33521 Tampere, Finland.
| | - Klaus T Olkkola
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, P.O. Box 340, FI-00029 HUS Helsinki, Finland.
| | - Sanna Hoppu
- Tampere University Hospital, Department of Intensive Care Medicine, P.O. Box 2000, FI-33521 Tampere, Finland.
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