TY - JOUR
T1 - Warning symptoms are associated with survival from sudden cardiac arrest
AU - Marijon, Eloi
AU - Uy-Evanado, Audrey
AU - Dumas, Florence
AU - Karam, Nicole
AU - Reinier, Kyndaron
AU - Teodorescu, Carmen
AU - Narayanan, Kumar
AU - Gunson, Karen
AU - Jui, Jonathan
AU - Jouven, Xavier
AU - Chugh, Sumeet S.
N1 - Funding Information:
The authors thank all EMS personnel (American Medical Response and Portland and Gresham fire departments), the Oregon State Medical Examiner''s Office, and hospitals in the Portland metropolitan area for their assistance; and Dr. Wulfran Bougouin (Paris Sudden Death Expertise Center, Paris, France) and Prof. David S. Celermajer (Sydney Medical School, Sydney, Australia) for their critical review of the manuscript. In part by the National Heart, Lung, and Blood Institute (grants R01HL105170 and R01HL122492; Dr. Chugh). Dr. Marijon was a visiting faculty scientist at the Cedars-Sinai Heart Institute funded by research grant support from the Philip Foundation, Bettencourt Schueller Foundation, French Society of Cardiology, Foundation for Medical Research, and French National Institute of Health and Medical Research.
Publisher Copyright:
Copyright © 2016 American College of Physicians.
PY - 2016/1/5
Y1 - 2016/1/5
N2 - Background: Survival after sudden cardiac arrest (SCA) remains low, and tools for improved prediction of patients at long-term risk for SCA are lacking. Alternative short-term approaches aimed at preemptive risk stratification and prevention are needed. Objective: To assess characteristics of symptoms in the 4 weeks before SCA and whether response to these symptoms is associated with better outcomes. Design: Ongoing prospective population-based study. Setting: Northwestern United States (2002 to 2012). Patients: Residents aged 35 to 65 years with SCA. Measurement: Assessment of symptoms in the 4 weeks preceding SCA and association with survival to hospital discharge. Results: Of 839 patients with SCA and comprehensive assessment of symptoms (mean age, 52.6 years [SD, 8]; 75% men), 430 (51%) had warning symptoms (50% of men vs. 53% of women; P = 0.59), mainly chest pain and dyspnea. In most symptomatic patients (93%), symptoms recurred within the 24 hours preceding SCA. Only 81 patients (19%) called emergency medical services (911) to report symptoms before SCA; these persons were more likely to be patients with a history of heart disease (P < 0.001) or continuous chest pain (P < 0.001). Survival when 911 was called in response to symptoms was 32.1% (95% CI, 21.8% to 42.4%) compared with 6.0% (CI, 3.5% to 8.5%) in those who did not call (P < 0.001). Limitation: Potential for recall and response bias, symptom assessment not available in 24% of patients, and missing data for some patients and SCA characteristics. Conclusion: Warning symptoms frequently occur before SCA, but most are ignored. Emergent medical care was associated with survival in patients with symptoms, so new approaches are needed for short-term prevention of SCA. Primary Funding Source: National Heart, Lung, and Blood Institute.
AB - Background: Survival after sudden cardiac arrest (SCA) remains low, and tools for improved prediction of patients at long-term risk for SCA are lacking. Alternative short-term approaches aimed at preemptive risk stratification and prevention are needed. Objective: To assess characteristics of symptoms in the 4 weeks before SCA and whether response to these symptoms is associated with better outcomes. Design: Ongoing prospective population-based study. Setting: Northwestern United States (2002 to 2012). Patients: Residents aged 35 to 65 years with SCA. Measurement: Assessment of symptoms in the 4 weeks preceding SCA and association with survival to hospital discharge. Results: Of 839 patients with SCA and comprehensive assessment of symptoms (mean age, 52.6 years [SD, 8]; 75% men), 430 (51%) had warning symptoms (50% of men vs. 53% of women; P = 0.59), mainly chest pain and dyspnea. In most symptomatic patients (93%), symptoms recurred within the 24 hours preceding SCA. Only 81 patients (19%) called emergency medical services (911) to report symptoms before SCA; these persons were more likely to be patients with a history of heart disease (P < 0.001) or continuous chest pain (P < 0.001). Survival when 911 was called in response to symptoms was 32.1% (95% CI, 21.8% to 42.4%) compared with 6.0% (CI, 3.5% to 8.5%) in those who did not call (P < 0.001). Limitation: Potential for recall and response bias, symptom assessment not available in 24% of patients, and missing data for some patients and SCA characteristics. Conclusion: Warning symptoms frequently occur before SCA, but most are ignored. Emergent medical care was associated with survival in patients with symptoms, so new approaches are needed for short-term prevention of SCA. Primary Funding Source: National Heart, Lung, and Blood Institute.
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U2 - 10.7326/M14-2342
DO - 10.7326/M14-2342
M3 - Article
C2 - 26720493
AN - SCOPUS:84953339564
VL - 164
SP - 23
EP - 29
JO - Annals of Internal Medicine
JF - Annals of Internal Medicine
SN - 0003-4819
IS - 1
ER -