title: Warning Symptoms Are Associated With Survival From Sudden Cardiac Arrest.
abstract: BACKGROUND
  Survival after sudden cardiac arrest (SCA) remains low, and tools for improved prediction of patients at long-term risk for SCA are lacking. Alternative short-term approaches aimed at preemptive risk stratification and prevention are needed.
  
  
  OBJECTIVE
  To assess characteristics of symptoms in the 4 weeks before SCA and whether response to these symptoms is associated with better outcomes.
  
  
  METHODS
  Ongoing prospective population-based study.
  
  
  METHODS
  Northwestern United States (2002 to 2012).
  
  
  METHODS
  Residents aged 35 to 65 years with SCA.
  
  
  METHODS
  Assessment of symptoms in the 4 weeks preceding SCA and association with survival to hospital discharge.
  
  
  RESULTS
  Of 839 patients with SCA and comprehensive assessment of symptoms (mean age, 52.6 years [SD, 8]; 75% men), 430 (51%) had warning symptoms (50% of men vs. 53% of women; P = 0.59), mainly chest pain and dyspnea. In most symptomatic patients (93%), symptoms recurred within the 24 hours preceding SCA. Only 81 patients (19%) called emergency medical services (911) to report symptoms before SCA; these persons were more likely to be patients with a history of heart disease (P < 0.001) or continuous chest pain (P < 0.001). Survival when 911 was called in response to symptoms was 32.1% (95% CI, 21.8% to 42.4%) compared with 6.0% (CI, 3.5% to 8.5%) in those who did not call (P < 0.001).
  
  
  CONCLUSIONS
  Potential for recall and response bias, symptom assessment not available in 24% of patients, and missing data for some patients and SCA characteristics.
  
  
  CONCLUSIONS
  Warning symptoms frequently occur before SCA, but most are ignored. Emergent medical care was associated with survival in patients with symptoms, so new approaches are needed for short-term prevention of SCA.
  
  
  BACKGROUND
  National Heart, Lung, and Blood Institute.
authors.forename: Eloi
authors.initials: E
authors.lastname: Marijon
authors.forename: Audrey
authors.initials: A
authors.lastname: Uy-Evanado
authors.forename: Florence
authors.initials: F
authors.lastname: Dumas
authors.forename: Nicole
authors.initials: N
authors.lastname: Karam
authors.forename: Kyndaron
authors.initials: K
authors.lastname: Reinier
authors.forename: Carmen
authors.initials: C
authors.lastname: Teodorescu
authors.forename: Kumar
authors.initials: K
authors.lastname: Narayanan
authors.forename: Karen
authors.initials: K
authors.lastname: Gunson
authors.forename: Jonathan
authors.initials: J
authors.lastname: Jui
authors.forename: Xavier
authors.initials: X
authors.lastname: Jouven
authors.forename: Sumeet S
authors.initials: SS
authors.lastname: Chugh
mesh_terms: D000328:Adult; D000368:Aged; D002637:Chest Pain / Q000209:etiology; D004417:Dyspnea / Q000209:etiology; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D006323:Heart Arrest / Q000175:diagnosis* / Q000401:mortality* / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D015205:Northwestern United States / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors