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Sex-Specific Symptoms Experienced Before a Sudden Cardiac Arrest

An anatomical model of a human heart.
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People who experience a sudden cardiac arrest can also experience sex-specific symptoms in the hours before the event, such as shortness of breath for women and chest pain for men, according to a new study. The research, which investigates the links between different symptoms and imminent sudden cardiac arrest, is published in The Lancet Digital Health.

Sudden cardiac arrest – a poor survival rate

Of those who have a sudden cardiac arrest outside of a hospital setting, approximately 90% do not survive, claiming the lives of at least 250,000 people in the US every year. Improvements in the prediction and prevention of the condition are urgently needed, as early responses can increase the chances of survival.

Digital technology could be the answer – but as symptoms of an imminent cardiac arrest could overlap with other conditions, specific symptoms must be identified to avoid false-positive calls that could overwhelm health services.

The current study, conducted by researchers from Cedars Sinai, investigated how best to predict imminent sudden cardiac arrest. They found that approximately 50% of people who experience a sudden cardiac arrest feel a telltale symptom in the 24 hours prior, and that these warning signs can differ between men and women.

“Harnessing warning symptoms to perform effective triage for those who need to make a 911 call could lead to early intervention and prevention of imminent death,” said Dr. Sumeet Chugh, senior author of the study and professor of cardiology at Cedars Sinai. “Our findings could lead to a new paradigm for prevention of sudden cardiac death.”

Identifying warning signs

The researchers analyzed data from two ongoing, community-based studies – Prediction of Sudden Death in Multi-Ethnic Communities (PRESTO) and Sudden Unexpected Death Study (SUDS) – which collect data on sudden cardiac deaths.

They analyzed the prevalence of individual symptoms or groups of symptoms in people prior to a sudden cardiac arrest. Importantly, the investigators also included a comparison group to help make the findings more relevant to the general population. This control group was formed of people who did not have a sudden cardiac arrest but were treated by emergency medical services (EMS) and had symptoms that could have been mistaken for an imminent cardiac arrest.

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The analysis indicated that small groups of people from both sexes experienced symptoms such as abnormal sweating or seizure-like activity prior to a sudden cardiac arrest. However, while for women the most prevalent symptom was shortness of breath, chest pain was most prevalent among men.

They also found that of the 823 people in the PRESTO study who had a sudden cardiac arrest witnessed by a bystander or EMS personnel, 50% experienced at least one telltale symptom beforehand.

“This is the first community-based study to evaluate the association of warning symptoms – or sets of symptoms – with imminent sudden cardiac arrest using a comparison group with EMS-documented symptoms recorded as part of routine emergency care,” said Dr. Eduardo Marbán, professor of cardiology at Cedars Sinai.

Could technology aid prediction?

These findings could pave the way for additional prospective studies to improve the prediction of imminent sudden cardiac arrest, potentially aiding the development of digital technology to triage the risks for sudden cardiac arrests.

“The prevalence of warning symptoms in our study was sex-specific and differed significantly between patients with sudden cardiac arrest and control participants,” the authors write in the paper. “Warning symptoms are common but will probably need to be augmented with additional features, such as the clinical profile and biometric measures, for improved prediction of imminent sudden cardiac arrest.”

Reference: Reinier K, Dizon B, Chugh H, et al. Warning symptoms associated with imminent sudden cardiac arrest: a population-based case-control study with external validation. Lancet Digit. 2023. doi: 10.1016/S2589-7500(23)00147-4

This article is a rework of a press release issued by Cedars Sinai. Material has been edited for length and content.