August 25, 2020
Patient Contacts With Health Services Before Sudden Cardiac Arrest Evaluated in Study From Denmark
August 25, 2020—The European Society of Cardiology (ESC) announced the presentation of studies at the ESC Congress 2020—The Digital Experience, which is being held virtually August 20 to September 1.
In an early study at ESC, investigators reported that 58% of sudden cardiac arrest patients sought medical help during the 2 weeks before the event. ESC noted that out-of-hospital cardiac arrest is the third leading cause of death worldwide and it is estimated that, on average, < 10% of victims survive.
Study investigator Nertila Zylyftari, MD, commented, “The high mortality from cardiac arrest in the community emphasizes the need to identify those at risk. This is very challenging since these are considered sudden and unexpected events. But our study indicates that patients felt unwell in the days leading up to the cardiac arrest.” Dr. Zylyftari is from Copenhagen University Hospital Herlev and Gentofte in Hellerup, Denmark.
According to ESC, previous studies have reported that some patients had symptoms such as shortness of breath, chest discomfort, and palpitations in advance of a cardiac arrest and contacted the health care system. But there is little information on when and where these contacts occurred.
This study investigated contacts with general practitioners (GPs) and hospitals in the year before a cardiac arrest. To determine whether there was any variation throughout the year, the study investigators examined each week separately. They found the proportion of patients who contacted a GP or hospital at 52 weeks before the event, 51 weeks before, 50 weeks before, and so on, to up to 1 week before.
The Danish Cardiac Arrest Registry was used to identify all residents who experienced a cardiac arrest outside of hospital in Denmark between 2001 and 2014. Using the unique civil registration number assigned to all Danish citizens, the investigators linked information from several national administrative registries, including dates of GP and hospital contacts.
A total of 28,955 people had an out-of-hospital cardiac arrest during the 14-year study period. The median age of patients was 72 years and 67% were men. To compare the results in cardiac arrest patients with the overall population in Denmark, each patient was matched by age and sex to nine people from the general public.
Each week during the year before the cardiac arrest, the percentage of patients in contact with their GP was relatively constant (26%), until 2 weeks before when it rose to 54%. Every week during that same year, just 14% of people in the matched population contacted their GP.
Hospital contacts in the year before the arrest were relatively constant for the first 6 months with approximately 3% of patients contacting a hospital each week. During the next 6 months, weekly contacts gradually increased and peaked at 2 weeks before the arrest, when 6.8% of patients contacted a hospital. Every week during that same year, just 2% of people in the matched population contacted a hospital.
Dr. Zylyftari stated in the ESC announcement, “To our knowledge this was the first study to assess cardiac arrest victims’ attempts to get help from both GPs and hospitals throughout the year before the event and compare them with the general population. We show that the proportion of patients who contacted GPs and hospitals were higher every week throughout the year before their event compared to the matched population in the same year.
“It was surprising to see that in the 2 weeks prior to the cardiac arrest there was an increase in contacts especially with their own doctor.”
The ESC further reported that in a separate analysis, the investigators examined all contacts made to the health care system (either GP, hospital, or both) during the 2-week period before the cardiac arrest. This showed that 58% of cardiac arrest patients had contacted the health care system compared with 26% of the matched population.
Although information was not collected on the reasons why cardiac arrest patients sought medical advice, the data show that of those who communicated with their GP during the 2-week period before the event, 72% did so by phone or email and 43% had a face-to-face consultation. (Some patients did both, therefore the total exceeds 100%.) Meanwhile, 25% of the cardiac arrest patients who visited hospital during the 2-week period before the event had cardiovascular disease.
“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,” advised Dr. Zylyftari in the ESC press release.