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Text sizeSeattle, WA - In patients resuscitated after sudden cardiac arrest (SCA), long-term survival increased substantially over time, probably due to technical advances and improvements in secondary prevention, according to a retrospective study of SCA survivors, published as a rapid track release on the Circulation website on August 26, 2003.1 Specifically, cardiac mortality, the researchers found, has dropped about 60% from the 1976-1980 to the 1995-2001 period, which accounts for the steady survival benefit. "Our findings suggest that something is occurring over time that is producing a better prognosis for these patients," says lead researcher Dr Thomas Rea (University of Washington, Seattle).
Our findings suggest that something is occurring over time that is producing a better prognosis for these patients.
Each year in the US hundreds of thousands die due to SCA, which accounts for about 50% of all deaths from coronary heart disease. Little is known to date about changes in survival of persons resuscitated after SCA and discharged from the hospital alive. The authors retrospectively compared survival in 2035 SCA patients between 1976 and 2001 who were resuscitated after out-of-hospital cardiac arrest and discharged from hospitals in Kings County, WA. They divided the entire time period into four intervals and compared long-term survival:
1976-1980 (reference).
1981-1985.
1986-1990.
1991-1995.
1996-2001.
They found cardiac mortality to have dropped by 21% and all-cause mortality to have decreased by 13% for each time interval among men and women and all age groups. In accordance with Rea's findings on decreasing mortality in SCA patients, mortality and morbidity rates after MI have also dropped over time, as reported by heartwire.
Prevention and intervention improved
The authors assume the reason for continuously decreasing mortality rates over time to be "multifactorial." New therapies, such as bypass surgery or percutaneous intervention, as well as the use of medications shown to reduce CHD mortality and implantable cardioverter defibrillators (ICDs), were developed and increased in use during the past 25 years. In terms of heart-healthy behavior, the prevalence of smoking has clearly been reduced over the years, but trends in physical activity and dietary pattern are unclear.
At the end of their report, Rea et al point out that, although the survival benefit shown in this long-term analysis is "encouraging, it might incur more cost," because due to an increased number of procedures among survivors of SCA, hospital costs also rose steadily over the time periods evaluated. They said their results could "have public-health implications that could translate to additional life-years if the findings are generalizable to other communities." The next step would be to determine exactly which factors contribute to the decreasing cardiac mortality in SCA and find new therapies for an even better prognosis in these patients.
