Sudden Death Not So Sudden? Half Contacted GP in Days Prior

Marlene Busko

September 09, 2020

People who experience "sudden" out-of-hospital cardiac arrest (OHCA) may feel malaise days earlier, new research from Denmark suggests.

The new analysis shows that 2 weeks before a cardiac arrest, 54% of people had had phone, email, or in-person contact with their general practitioner, and 6.8% had gone to a hospital emergency department or outpatient clinic or had been hospitalized.

In contrast, roughly 25% and 3%, respectively, had had contact with their general practitioner or a hospital each week in the year preceding the cardiac arrest.

Dr Nertila Zylyftari

Nertila Zylyftari, MD, Copenhagen University Herlev and Gentofte Hospital, Hellerup, Denmark, presented these study results in a poster at the European Society of Cardiology (ESC) Congress 2020.

The findings show that clinicians and patients need to be aware that people may feel unwell before a "sudden" cardiac arrest, and they highlight the importance of applying cardiovascular disease risk scores in daily clinical practice, Zylyftari told | Medscape Cardiology.

This is an "interesting," "important" study "that adds to the growing evidence that OHCA patients experience symptoms in the weeks leading up to their arrest," Karen Smith, PhD, director of the Center for Research and Evaluation at Ambulance Victoria, Australia, told | Medscape Cardiology in an email.

Smith wrote an editorial about similar evidence ― a related study that involved more than 38,000 patients with OHCA in Ontario, Canada. Those researchers reported "in contrast to conventional wisdom," which regards OHCA as occurring without prior contact with the healthcare system. Findings from that study indicate that more than 1 in 4 patients with OHCA had visited the emergency department in the previous 90 days (Shuvy M: Resuscitation. 2019;141:158-185).

Although the researchers in the current study lacked information about why the patients contacted their general practitioner or went to the emergency department, some may have experienced shortness of breath, chest discomfort, and palpitations, Zylyftari speculated.

Other patients may have had vague symptoms that would make it difficult for them to be identified as being at high risk, she noted. Still others may have made their first contact with the healthcare system when they had the OHCA.

"There is a lot more work to be done to prevent OHCA and have an algorithm that could help identify at-risk patients," Zylyftari said.

In the meantime, Smith said, this study shows that "the percentage contacting a GP is high and highlights that if rapid screening clinics were available for patients to be referred to, many cardiac arrests could potentially be averted."

This work "adds evidence to the fact that campaigns about warning signs of heart attacks may actually avert cardiac arrests also if patients seek care earlier," she added.

Their research group conducted a study that showed that a comprehensive mass media campaign in Melbourne, Australia, to improve awareness of heart attack symptoms was associated with a substantial reduction in the incidence of OHCA and associated deaths (Nehme Z: Eur Heart J. 2017;38:1666–1673).

Need to Identify High-Risk Individuals

OHCA is the third leading cause of death worldwide; on average, fewer than 10% of patients survive, a fact that "emphasizes the need to identify those at risk," said Zylyftari.

The researchers identified 28,955 people in the Danish Cardiac Arrest Registry who had an OHCA during the period 2001 – 2014; the median age of the patients was 72 years, and 67% were men.

The researchers matched each patient with nine people in the general population on the basis of age, sex, and date of the cardiac arrest.

In the general population, only about 13% and 2%, respectively, had had contact with their general practitioner or a hospital in any week.

Of the 54% of patients who had contacted their general practitioner 2 weeks before their OHCA, 72% had phone or email interactions (these interactions were followed by an in-office visit in 11% of cases); 51% had an in-office visit, and 29% had a home visit.

Of the patients who had had any contact with the healthcare system 2 weeks before the cardiac arrest, 25% had a diagnosis of cardiovascular disease, including heart disease (8%) and heart failure (4.5%); 11% had respiratory disease, including chronic obstructive lung disease (4.3%); and others had experienced trauma/poisoning or had a digestive disease.

Fewer individuals from the general population had a diagnosis of cardiovascular disease (almost 9%).

"More data and research are needed on the reasons for these interactions ― for example, symptoms ― to identify warning signs of those at imminent danger so that future cardiac arrests can be prevented," said Zylyftari.

The study was funded the European Union's Horizon 2020 research and innovation program ESCAPE-NET. The researchers have disclosed no relevant financial relationships.

European Society of Cardiology (ESC) Congress 2020: Presented August 28, 2020.

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