Improving patient outcomes for sudden cardiac arrest
Technology-enhanced prediction tools, public awareness and training are key.
Sudden cardiac arrest (SCA) continues to be a major public health problem. Each year, approximately 400,000 people in the U.S. experience SCA, with a survival rate of only about 10%. Despite decades of research, patient outcomes remain dismal. Those staggering statistics drove a robust discussion during Friday’s session, “Tackling the Challenge to Improve Outcomes After Sudden Cardiac Arrest: Paradigms to Accelerate Detection and Deployment Earlier in the Chain of Survival (AHA Joint Sessions with Heart Rhythm Society).”
Speakers addressed the “why” as well as strategies for moving toward improved patient outcomes. Sana Al-Khatib, MD, FAHA, professor of medicine at Duke University School of Medicine in Durham, North Carolina, co-moderated the session to break it down. According to Al-Khatib, there are several factors responsible for the very low survival rates, starting with the paradox in the epidemiology of sudden cardiac death (SCD).
“The highest incidence of SCDis in high-risk groups, such as patients with heart failure and a prior myocardial infarction (MI). But the absolute number of SCD is highest in the general population (people who do not appear to be at an increased risk of SCD),” Al-Khatib said. “It has been shown that for some people who end up with SCD, there were symptoms that they ignored. So, we need to intensify efforts to raise awareness without creating anxiety, and then of course, efforts should focus on rapid detection of SCA and increased access to automated external defibrillators (AEDs), including making sure people know how to use AEDs and are not afraid to use them.”
Detection and quick response are key in addressing SCA, Al-Khatib said, particularly because prediction tools have been studied for decades and little progress has been made. Most existing tests designed to predict SCA are either not sensitive enough or not specific enough to gather the information clinicians need, she said. Currently, a low, left ventricular ejection fraction (LVEF) of 35% or less remains one of the most powerful predictors. She said she also sees promise in some of the work that is being done with wearables that could quickly identify patients in a life-threatening rhythm, potentially leading to quick dispatch of EMS and ultimately a significant improvement in patients’ survival. As for awareness, Al-Khatib said the American Heart Association (AHA) has done a great job in that area through training the masses in basic life support (BLS) as well as health care practitioners in advanced cardiovascular life support (ACLS).
“I am hopeful that with wearables, artificial intelligence (AI), heightened awareness, etc., we will be able to detect SCA and intervene promptly to save people’s lives,” Al-Khatib said.
In his presentation, “Prevention of Sudden Cardiac Death Beyond AEDs and ICDs,” fellow speaker Sumeet S. Chugh, MD, FAHA, discussed a new approach to prevent SCD that goes beyond AEDs and implantable cardioverter defibrillators (ICDs). Chugh is a professor of cardiology and medicine at the Cedars-Sinai Smidt Heart Institute in Los Angeles.
Chugh has proposed a novel strategy known as “near-term prevention” for preventing SCD. The strategy is designed to bridge the gap between ICDs and AEDs. This approach leverages warning symptoms that precede imminent SCA. Research from the Oregon Sudden Unexpected Death Study revealed that individuals who responded to warning symptoms by calling 911 had a significantly higher survival rate. However, the challenge lies in distinguishing SCA-related symptoms from those of other conditions to avoid overwhelming emergency services with false alarms. In his research on the topic, Chugh’s team compared symptoms reported before SCA with those from non-SCA emergency calls.
“We identified that symptoms such as dyspnea, chest pain, diaphoresis and seizure-like activity were more likely to be associated with SCA,” Chugh said. “These findings were sex-specific, with chest pain, dyspnea and diaphoresis being significant predictors in men, while only dyspnea was significant in women.” Like Al-Khatib, Chugh said the future of near-term prevention lies in the integration of smart devices and AI.
Smart devices, equipped with AI algorithms, have the potential to perform rapid triage based on an individual’s symptoms and prompt them to seek urgent care. Additionally, other devices such as smart speakers have shown promise in detecting agonal breathing, a sign of SCA, and distinguishing it from normal sleep sounds. This remote, non-contact detection could enable rapid emergency response and improve survival rates. Near-term prevention could also be deployed in emergency departments to better triage symptomatic individuals, Chugh said. This approach would help distinguish those who need immediate observation and further investigation from those who can be safely discharged with follow-up care.
“Although AEDs and ICDs remain crucial in SCD prevention, their effectiveness may have reached a plateau,” Chugh said. “Further research and clinical trials are needed to refine novel AI-powered approaches that predict imminent SCA and ensure their successful deployment in both community and clinical settings.”
