The Unchanging Landscape of Sudden Cardiac Deaths

Despite ongoing efforts to place more AEDs in public locations, teach people how to use them, and train more citizens to do CPR, the number of sudden cardiac arrest deaths and survival rates have not changed significantly in the past five years. Why?

Statistics

Year  SCA out of hospital Survival rate
2012 382,800 11.40%
2013 359,400 9.50%
2014 424,000 10.40%
2015 326,000 10.60%
2016           >350,000 12%

The degree of fluctuation from year to year (for instance, from 359,400 in 2013 to 424,000 in 2014, and then back down again in 2015) might simply be due to in the lack of consistency in how SCA is classified and reported. It is possible in 2014 more deaths were attributed to SCA than in other years where other causes of death were listed. In 2012, the 11.4% survival rate may hinge on defining survival as resuscitating the patient in the field, even if they did not leave the hospital ultimately.

Why don’t the statistics change much?

They do, actually, albeit subtly. The population of the US grew by approximately 12 million people from 2012 to 2016, yet the number of deaths from SCA decreased by about 32,000, and survival rates increased about one percent. It’s not a huge win, but it’s a win nonetheless!

Unfortunately, there are a number of factors which cannot be controlled by the number of AEDs in the world, or the number of people who know CPR. First and foremost, there is no “cure” for sudden cardiac arrest, as it’s not a disease. Sudden cardiac arrest is a culmination of multiple factors, some of which we may be able to control, and others which are out of our control.

What can we control?

Diet

Our diet, how much we move, and general overall health are factors we have some control over. A diet rich in fatty or sugary foods and a sedentary lifestyle can lead to factors like obesity and diabetes which contribute to heart disease and ultimately lead to cardiac arrest. Smoking also greatly increases your risk of heart disease and sudden cardiac arrest.

Cardiac Warning Signs

Paying attention to our body’s signals is also something we can control. Being able to recognize the early warning signs of heart disease or imminent heart attack, then taking our concerns to a physician for their expert analysis could mean the difference between preventing a sudden cardiac arrest or being taken by surprise.

Women should be especially vigilant, as their symptoms can be different than the symptoms men experience. The universal belief is a heart attack is signaled by numbness of the left arm, crushing pain in the chest, and dizziness. Women usually experience these things, but may also experience jaw pain, back and/or shoulder pain, profuse sweating, and faintness, all of which they may attribute to aging or some other condition which makes them less likely to seek help. Women frequently report they did not feel the crushing chest pain at all and were surprised when told they had a heart attack.

Appropriate Exercise and Activity 

Understanding your limits is also critical to preventing sudden cardiac death. If you have had quadruple bypass surgery and are advancing in age, going out to shovel 8 inches of wet snow from your drive in the winter or going for a 10-mile hike in the desert in July are probably activities you will want to avoid.

By all means, exercise is important, but have a discussion with your physician on the best exercises for you. Even if you are relatively healthy, if you live a fairly sedentary lifestyle most of the time, jumping right in with a rigorous fitness plan may put undue strain on your heart. Again, always check with your doctor before making any drastic changes to your exercise routine.

What can we NOT control? 

Genes 

Heredity has to be #1 in this category. Heart disease, unfortunately, tends to run in families. Share your family history with your physician and be sure to discuss immediate family members who have had a heart attack, stroke, diabetes or other illnesses like diabetes, which can ultimately lead to sudden cardiac arrest. Heart conditions such as Marfan’s syndrome, Long QT syndrome, hypertrophic cardiomyopathy, and others, are typically passed down through family lines. Many people live with these conditions their whole lives without any complications, while autopsies reveal others have paid the ultimate price. The only upside is when the revelation of these conditions prompts family members to get tested. If tests reveal they have the same condition, they can be prepared by knowing what signs to look for and take precautions.

Location and Timing

We also can’t control when and where a sudden cardiac arrest occurs. The reason so many people pass from SCA and receive no immediate care is they are home alone or in a room alone when it occurs. Since the window of time for effective resuscitation is so small, discovering a person who has died of sudden cardiac arrest after 10 minutes of unconsciousness means there is little to no chance of survival.

Many nursing homes also do not have AEDs on site, except in states where it is required by law. When asked why, a representative at one nursing home in Wisconsin explained many of their patients have “do not resuscitate” (DNR) orders and they don’t want to risk accidentally reviving someone who does not wish to be, which could lead to difficulties with the resident’s family. Instead, nursing homes put strict “911 only” policies in place whereby 911 is called upon realization someone has gone into sudden cardiac arrest and employees do not intervene at all.

An Aging Population

A census bureau estimate released in June of 2017, states the number of people over the age of 65 in 2016 in the US was 49.2 million, which is over 15% of the population. It is no secret older people are more prone to health problems, including those which can lead to sudden cardiac arrest. As an aging population increases, the number of sudden cardiac arrests would exponentially rise. The chance of resuscitation in the case of elderly patients also declines for several reasons:

  1. As we mentioned earlier, the patient may have a do not resuscitate order on file. This means CPR will not be performed and an AED will not be used.
  2. CPR pays a heavy toll on the body. Many times, especially in the elderly when bones are brittle, ribs will be broken, bruises will be plentiful, there could be damage to the airway and internal organs, and their overall recovery time is likely much longer than with a younger patient.
  3. Elderly patients also tend to live alone, with another elderly person, or in group homes. CPR is physically demanding and an elderly person may not have the strength to perform it effectively on another elderly person.
  4. It is not uncommon for elderly people to pass in their sleep and are, therefore, found too late to take action.

Moving the Needle

Increasing survival rates is not impossible. With the placement of more AEDs in public spaces and an increase in people trained to perform CPR and use an AED, hopefully, there will be more bystanders willing to jump in and take action. Time is critical in cases of sudden cardiac arrest, and witnessed cardiac arrests have the biggest potential for survival. Knowing what to do when the time comes and having the confidence to act is what saves lives.  

Many states have mandated CPR/AED training as a requirement for high school graduation. This means even more private citizens in their homes can provide help to family and friends quicker. Just calling 911 delays treatment by 8 – 10 minutes on average. If someone in the home is trained, care can begin immediately which equals more potential survivors. In addition, home AEDs are becoming more prevalent, especially in cases where people have a known heart condition or where those with compromised health live. It would be great if AEDs became as standard in a home as a first aid kit and a fire extinguisher.  

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