Warning Symptoms Are Associated With Survival From Sudden Cardiac Arrest

Abstract

Background Survival after sudden cardiac arrest (SCA) remains low and tools for improved prediction of individuals at long-term risk for SCA are still awaited. Alternative short-term approaches aimed at pre-emptive risk stratification and prevention are needed. Objective To assess characteristics of symptoms in the four weeks prior to SCA, and whether the response to these symptoms may be associated with a better outcome. Design Ongoing prospective population-based study. Setting Population of approximately one million in the Northwestern US (2002–2012). Patients Middle-aged residents (35–65 years) suffering from SCA. Measurement Multiple sources assessment of symptoms in the four weeks preceding SCA and association with survival to hospital discharge. Results Of 839 SCA patients with comprehensive assessment of symptoms (51±12 years, 75% male), 430 patients (51%; 50% male vs. 53% female, P=0.59) experienced warning symptoms, mainly chest pain and dyspnea. In the majority of symptomatic patients (93%), symptoms recurred during the 24 hours preceding SCA. Only 81 patients (19%) called emergency medical services (911) to report symptoms prior to SCA; these were more likely to be patients with a history of heart disease (P<0.001) and/or continuous chest pain (P<0.001). Survival when 911 was called in response to symptoms was 32.1% (95%CI 21.8–42.4), compared to 6.0% (95%CI 3.5–8.5) in those who did not call (P<0.001). This association remained after considering potential confounders. Limitations Potential for recall and response bias; symptom assessment not available in 24% patients; missing data for some patients and SCA characteristics. Conclusions Warning symptoms are frequent prior to SCA but the vast majority of these are not acted upon. Emergent medical care was associated with survival in patients with symptoms, emphasizing a potential role for future approaches that enable short-term prevention of SCA. Primary Funding Source NHLBI.

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