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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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Andersen LS, Lorentzen V, Beedholm K. From Suspicion to Recognition-Being a Bystander to a Relative Affected by Acute Coronary Syndrome. QUALITATIVE HEALTH RESEARCH 2022; 32:307-316. [PMID: 34866472 DOI: 10.1177/10497323211050911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Within cardiac research, an overwhelming number of studies have explored factors related to pre-hospital delay. However, there is a knowledge gap in studies that explore the bystander's experiences or significance when an individual is affected by acute coronary syndrome (ACS). We conducted an interview study with 17 individuals affected by ACS and the bystander(s) involved and performed a qualitative thematic analysis. In the pre-hospital phase, the bystander moved from suspicion of illness to recognition of illness while trying to convince the individual affected by ACS (p-ACS) to respond to bodily sensations. This led to conflicts and dilemmas which affected the bystander both before and after the p-ACS was hospitalized. Bystanders may influence pre-hospital delay in both positive and negative direction depending on their own knowledge, convictions, and the nature of their interaction with the p-ACSs. The bystander's influence during the pre-hospital delay is more extensive than previously recognized.
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Affiliation(s)
| | - Vibeke Lorentzen
- Centre for Research in Clinical Nursing, Viborg, Denmark
- Deakin University, Melbourne, Australia
- Aarhus University, Aarhus, Denmark
| | - Kirsten Beedholm
- Department of for Public Health, Aarhus University, Aarhus, Denmark
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Keen SK, Masoudi EA, Williams JG, Thota-Kammili S, Mirzaei M, Lin FC, Simpson RJ. Symptoms prior to sudden death. Resusc Plus 2021; 5:100078. [PMID: 34223344 PMCID: PMC8244516 DOI: 10.1016/j.resplu.2021.100078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 01/08/2021] [Accepted: 01/08/2021] [Indexed: 11/30/2022] Open
Abstract
Background Sudden death accounts for up to 15% of all deaths among working age adults. A better understanding of victims’ medical care and symptoms reported at their last medical encounter may identify opportunities for interventions to prevent sudden deaths. Methods From 2013−15, all out-of-hospital deaths, ages 18–64 reported by Emergency Medical Services (EMS) in Wake County, North Carolina were screened and adjudicated to identify 399 victims of sudden death, 264 of whom had available medical records. Demographic and clinical characteristics and prescribed medications were compared between victims with versus without a medical encounter within one month preceding death with chi-square tests and t-tests, as appropriate. Symptoms reported in medical encounters within one month preceding death were analyzed. Results Among the 264 victims with available medical records, 73 (27.7%) had at least one encounter within a month preceding death. These victims were older and more likely to have multiple chronic illnesses, yet most were not prescribed evidence-based medicines. Of these 73 victims, 30 (41.1%) reported cardiac symptoms including dyspnea, edema, and chest pain. Conclusions Many victims seek medical care and report cardiac symptoms in the month prior to sudden death. However, medications that might prevent sudden death are under prescribed. These findings suggest that there are opportunities for intervention to prevent sudden death.
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Affiliation(s)
- Susan K Keen
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Elham A Masoudi
- Department of Internal Medicine, Cone Health, Greensboro, NC, United States
| | - Jefferson G Williams
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Sanjana Thota-Kammili
- Department of Internal Medicine, Appalachian Regional Hospital, Whitesburg, KY, United States
| | - Mojtaba Mirzaei
- Department of Internal Medicine, Yale-New Haven Medical Center, Waterbury, CT, United States
| | - Feng-Chang Lin
- Department of Biostatistics and NC TraCS Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Ross J Simpson
- Department of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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