Warning symptoms, notably chest pain and dyspnea, occur during the 4 weeks preceding sudden cardiac arrest (SCA) in at least half of cases involving middle-aged adults, suggests a new study. The warnings are usually ignored, observe researchers, with few patients phoning 911 in response to what is almost always a fatal event.
The analysis is based on the Oregon Sudden Unexpected Death (SUD) cohort which was published online December 22, 2015 in the Annals of Internal Medicine.
It suggests that sudden death may not be as sudden as we have been thinking till now. There were people who had their symptoms not only in the 24 hours that preceded the arrest, but also in the 4 weeks that preceded their event.
The Oregon SUD study is a large, prospective, community-based study of deceased and surviving patients who had an SCA in the Portland, Oregon metropolitan area. The analysis included 839 patients between 35 and 65 years of age with SCA whose prodromal symptoms could be comprehensively assessed.
Of the 839 patients, 430 patients or 51% of the cohort experienced at least one symptom within the 4 weeks preceding their arrest. Men and women experienced prodromal symptoms with equal frequency at 50% vs 53%, respectively.
Symptoms also started more than an hour before SCA onset in 80% of patients; but in 147 of these patients, symptom onset occurred more than 24 hours before their arrest. Among this subgroup of patients, 93% had recurrent new episodes of symptoms during the 24 hours preceding their arrest.
“The main symptom was chest pain, documented in 199 patients,” or 46%, Marijon observed. Of those, 76% had “intermittent typical angina,” he said.
Another 18% of patients had dyspnea as their apparent prodromal symptom; about one-third of this group had established congestive heart failure or a pulmonary condition.
What Can Be Done
An early call to 911 was associated with better survival odds in the current study suggesting that there is a potential to enhance short-term prevention of SCA by targeting public awareness of SCA.