This is the second in a series of articles addressing the issue of sudden cardiac death. Why has the Florida Heart Research Institute chosen to focus our energies on this issue? Despite dramatic advances in diagnosis and treatment, cardiovascular disease remains the leading killer of men and women in the United States and increasingly throughout the entire world. Although FHRI maintains a leadership role in the advancement of cutting edge scientific discovery, our review of the information already available revealed that this lethal disease is, to a very large degree, preventable. We therefore launched an aggressive program of education and prevention, parallel to our research efforts, to better inform and empower our community to fight this ominous, yet preventable threat. Since that time we have helped thousands of our fellow citizens from all social strata and walks of life to better understand their cardiovascular risk, while providing them with the opportunities, both educationally and professionally, to improve their lives and their health.
In a similar vein, recent scientific evidence has exposed a similar opportunity to help save countless lives. Sudden cardiac death is estimated to claim between 250,000 and 325,000 lives each year. This is a death toll greater than AIDS, lung cancer and breast cancer combined. Yet the evidence suggests that, with the information already available, half or more of these deaths might well be preventable. Reported survival from out of hospital cardiac arrest is generally reported to be less than 8%, with some urban areas reporting as low as 1.8%. However, concerted community efforts have been able to improve these outcomes closer to 25% in Seattle and approaching 50% in Rochester, MN. How is this possible? Or, perhaps, more compelling, why is it so difficult to translate the best results on a broader level?
Last month we discussed some of the challenges intrinsic to the event – the fact that every minute of untreated arrest decreases the chance of survival by approximately 10%, the fact that the event in a given individual is usually completely unpredictable and unpredicted, the fact the victim cannot himself summon help, and the fact that most bystanders do not know what to do. Whereas it is true that successful cardiac prevention strategies would likely reduce, perhaps dramatically, the population at risk, the reality for the foreseeable future is that this problem is not going away. So, in addition to primary prevention, what are the steps that current evidence suggests must be taken to improve survival? This is where the “chain of survival” concept becomes critical. Because out of hospital cardiac arrest can and does happen anywhere, and because it requires an immediate and informed response, the solution is not the sole responsibility of the victim, the bystander, the local governmental agencies, nor the health care system. Rather, what is essential is a coordinated effort at every level to maximize performance and outcomes.
Less than one quarter of witnessed arrests result in bystander resuscitation efforts. Careful study of resuscitation efforts even amongst medical personnel during in-hospital cardiac arrest demonstrates disturbing levels of inadequate technique. Community deployment of defibrillation devices (also known as AEDs – automatic external defibrillators) is variable, and there is no organized system for informing the public or even 911 where the nearest AED may be located. Even the most heroic fire-rescue efforts are frequently hampered by access to high floors and traffic patterns in urban settings. Hospital protocols and teams for applying recently discovered techniques of hypothermia for comatose patients are variable at best. And, perhaps most daunting of all, there is no universally accepted information system that records the outcomes from arrest to hospital discharge. Those that are available have limited participation, and even the participants are challenged by current budget restrictions to adequately record the data. Information is power. Without understanding what we are and are not doing, we have little chance to effectively improve.
It is apparent that the challenges are great – great, but clearly not insurmountable. Inspired by the results in other select communities, informed by recent advances in our understanding of resuscitation and treatment of comatose survivors, and encouraged by our success as a leader in both research and in education and prevention, FHRI is committed to overcoming the obstacles and summoning the community resources to help improve outcomes, save lives and help make Florida the “State of the Heart.”
This is the second in a series of articles addressing the issue of sudden cardiac death. Why has the Florida Heart Research Institute chosen to focus our energies on this issue? Despite dramatic advances in diagnosis and treatment, cardiovascular disease remains the leading killer of men and women in the United States and increasingly throughout the entire world. Although FHRI maintains a leadership role in the advancement of cutting edge scientific discovery, our review of the information already available revealed that this lethal disease is, to a very large degree, preventable. We therefore launched an aggressive program of education and prevention, parallel to our research efforts, to better inform and empower our community to fight this ominous, yet preventable threat. Since that time we have helped thousands of our fellow citizens from all social strata and walks of life to better understand their cardiovascular risk, while providing them with the opportunities, both educationally and professionally, to improve their lives and their health.
