Sudden Cardiac Death:

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Sudden Cardiac Death Whos at Risk?
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Why did you enter into the medical profession?
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Todays Presentation

• Sudden Cardiac Arrest (SCA) Background
• Surviving SCA
• What Can You Do?
• QA

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SCA Background
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What Is SCA?

• Electrical system in heart malfunctions
• Heart unexpectedly, abruptly stops beating
• Often caused by an abnormal heart rhythm called
  ventricular fibrillation (VF)
• VF accounts for half of all cardiac deaths
• Rapid, chaotic heartbeat
• Lower heart chambers, or ventricles, spasm
• Heart functioning stops
• Lack of oxygen in body, brain is dead

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SCA Is NOT a Heart Attack

• Myocardial Infarction (MI)
• Plumbing
• Blockage problem
• Blockage in blood vessel prevents blood flow to
  heart
• Heart muscle dies

• SCA
• Electrical
• Rhythm problem
• Rhythm disturbance prevents heart from delivering
  blood to brain, organs

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Sudden Cardiac Arrest (SCA) Basic Facts

• SCA claims an estimated 335,0001 lives in the
  U.S. each year
• 1,000 lives every day, one life every two minutes
• xxxx of xxxx each year
• SCA accounts for half of all cardiac-related
  deaths
• More than half of SCA victims have no prior
  symptoms
• Survival requires emergency medical intervention
  and defibrillation within the first minutes
  following arrest
• The survival rate is as high as 90 percent if
  treatment is initiated within the first minutes
  following arrest
• An estimated 95 percent of SCA victims die before
  they reach a hospital or other source of
  emergency help

1 American Heart Association. 2005 Heart and
Stroke Statistics Update.
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Leading Causes of Death in the US in 19991-2
Septicemia
SCA is the second leading cause of death after
ALL cancers combined.
Nephritis
Alzheimers Disease
Influenza/pneumonia
Diabetes
Accidents/injuries
Chronic lower respiratory diseases
Cerebrovascular disease
Other cardiac causes
Sudden cardiac arrest (SCA)
All cancers
1 National Vital Statistics Report, Vol 49 (11),
Oct. 12, 2001 2 MMWR. State-specific mortality
from sudden cardiac death US 1999. Feb 15,
200251123-126.
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Who Is at Risk for SCA?

• People who have had a prior Sudden Cardiac Arrest
• People with a family history of Sudden Cardiac
  Arrest
• People who have had a heart attack (Myocardial
  Infarction or MI)
• People with Congestive Heart Failure (HF)
• People with Ejection Fraction (EF) less than 35

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Ejection Fraction

• Proportion, or fraction, of blood your heart
  pumps with each beat
• Normal heart pumps half hearts blood volume with
  each beat
• Normal EF 55 or higher

EF Below 35
See a Cardiologist or Heart Rhythm Specialist
?
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SCA and Ejection Fraction

• Low EF remains the single most important risk
  factor for overall mortality from SCA. One in 13
  people with EF below 30 will experience SCA. The
  vast majority who experience an out-of-hospital
  cardiac arrest will die.

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7.5
7
6
5.1
5
4
SCA Victims
2.8
3
2
1.4
1
0
0-30
31-40
41-50
50
EF Number
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In people diagnosed with heart failure, sudden
cardiac death occurs at 6-9 times the rate of the
general population1.
1 American Heart Association. Heart and Stroke
Statistical 2003 Update. Dallas, Tex.. American
Heart Association. 2002.
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People who have had a heart attack have a sudden
death rate that is 4-6 times that of the general
population1.
1 American Heart Association. Heart Disease and
Stroke Statistics 2003 Update. Dallas, Tex.
American Heart Association. 2002.
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Surviving SCA
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Urgency of Sudden Cardiac Arrest

• Resuscitation Success vs.Time

100
100
100
90
90
90
80
80
80
Chance of success reduced 7-10 every minute
70
70
70
60
60
60




50
50
50
Success
Success
Success
Success
40
40
40
30
30
30
20
20
20
10
10
10
0
1
2
3
4
5
6
7
8
9
0
1
2
3
4
5
6
7
8
9
0
1
2
3
4
5
6
7
8
9
Time (minutes)
Time (minutes)
Adapted from text Cummins RO. Ann Emerg Med.
1998181269-1275.
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Sudden Cardiac Arrest
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SCA Survival Early Defibrillation

• Only effective treatment for SCA is an electrical
  shock delivered by
• Automated external defibrillator (AED)
• Implantable cardioverter defibrillator (ICD)
• Time is critical each minute of delay before
  defibrillation reduces survival rates by about
  10

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Automated External Defibrillators (AEDs)

• Analyzes patients heart rhythm
• Recommends shock if detects
• Ventricular fibrillation (VF)
• Ventricular tachycardia (VT)
• Must be used within 6 to 9 minutes of SCA
• Some use voice and screen prompts to guide
  rescuers

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Implantable Cardioverter Defibrillators (ICDs)

• First-line therapy for patients at
• risk for SCA
• Size of a pager
• Todays devices are implanted pectorally, either
  subcutaneously or submuscularly in most patients
• Wires monitor heart rhythm
• Gives life-saving burst of electricity to heart
  when rhythm goes out of control
• About 80 of total implants in 1999 occur in the
  United States

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ICDs Restore Heart Rhythm
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Major Clinical Trial Conclusions

• Key to SCA prevention Identify, treat high-risk
  patients BEFORE they have a SCA event
• The majority of cases in patients with
• Coronary artery disease, previous heart attack
• Low LV EF
• Heart failure
• The Sudden Cardiac Death in Heart Failure Trial
  (SCD-HeFT) found that ICDs improve SCA survival
  and should be considered as FIRST-LINE THERAPY
  for high-risk patients

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Clinical Trial Implications

• Recent clinical trials have shown ICDs to be
  effective in a variety of patient populations
• Medicare has recently expanded coverage of ICD
  placement for up to 500,000 individuals
• Criteria for coverage include specific history
  of
• Cardiomyopathy
• Previous heart attack
• Heart failure
• Low Ejection Fraction (

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What Can You Do?

• Take 3 Steps Starting Today
• Learn
• Look
• Lead

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Step 1 LEARN

• Learn more about SCA
• Come to more of these classes throughout the year
• Talk with your cardiologists
• Learn from your patients by listening to what
  they say and dont say

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Step 2 LOOK

• Look for potential SCA risk factors in your
  patients
• Prior SCA
• Family history of SCA
• Prior heart attack (myocardial infarction, or MI)
• Congestive heart failure (HF)
• Ejection Fraction (EF) less than 35
• Collaborate with physicians to ensure risk
  factors are identified and addressed

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Step 3 LEAD

• Lead, with your physicians, patients with low EFs
  to specialists for evaluation

See a Cardiologist or Heart Rhythm Specialist
EF Below 35
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Whats the Bottom Line?

• SCA is a leading cause of death and can
  frequently be predicted and prevented
• Individuals with a prior SCA event, prior MI or
  heart failure are at risk for SCA
• EF is a key indicator of risk level for SCA. An
  EF number of 35 or less means someone is
  especially at risk
• Defibrillation is the only effective treatment
  option for SCA
• Working with us to alert and educate people will
  save lives

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Q APlease take handouts on your way out