Download Sudden Cardiac Arrest Provider Fact Sheet

Sudden Cardiac Arrest Provider Fact Sheet
Sudden Cardiac Arrest (SCA) Is Responsible for a Significant Number of Deaths
that Are Preventable
• Each year there are 295,000 EMS-assessed out-of-hospital cardiac arrests in the U.S.1
• Defibrillation within 5 minutes is critical to survive SCA; every additional minute reduces the
chance of success by 7-10%. The median survival rate after ventricular fibrillation is 21%1
• Ventricular fibrillation and tachycardia as an initial rhythm of cardiac arrest (CA) is decreasing,
only about 23% of out-of-hospital CA is due to these shockable rhythms1
• Randomized clinical trials have not shown that antiarrhythmic drug therapy can effectively reduce
mortality in heart failure patients3
Primary Prevention of SCA
• MADIT-II (Multicenter Automatic Defibrillator Implantation Trial): 1,232 patients with prior
myocardial infarction (MI) and left ventricular ejection fraction (LVEF) ≤ 30% randomized to
optimal medical therapy alone or optimal medical therapy plus implantable cardioverter
defibrillator (ICD), with follow-up for 20 months
– Significant reduction in all-cause mortality seen with ICD versus optimal medical therapy alone4
• SCD-HeFT (Sudden Cardiac Death in Heart Failure Trial): 2,521 patients with New York Heart
Association (NYHA) Class II or III heart failure with ischemic or nonischemic etiology and LVEF
≤ 35% receiving optimal medical therapy, randomized to optimal medical therapy and placebo,
optimal medical therapy and amiodarone, or optimal therapy and ICD, followed for 45.5 months
– Decreased mortality with ICD therapy versus placebo or amiodarone5
• Risk of SCA increases exponentially when LVEF < 30%6
• Patients with mild heart failure should not be considered at lower risk for SCA; among patients
with NYHA Functional Class II heart failure symptoms, SCA accounts for 64% of all deaths7
How to Explain the Difference between SCA
and Heart Attack to Your Patients
• SCA is an electrical and rhythm problem
that causes the heart muscle to quiver and
not pump blood to the rest of the body
and brain
• Heart attack is caused by a blood flow
problem in the heart when one or more of
the arteries delivering blood to the heart
muscle become clogged or blocked.
Oxygen cannot get to the heart and the
heart muscle is damaged
ICDs are Recommended for the Following Patients 8-9
• With a life expectancy of greater than 1 year
• Class I (Level of Evidence A) Recommendations:
Current or prior symptoms of heart failure, reduced LVEF, and
– History of cardiac arrest
– Ventricular fibrillation
– Hemodynamically destabilizing tachycardia
Patients with ischemic heart disease†
– At least 40 days post-MI
– LVEF ≤ 30%, NYHA Class I symptoms; LVEF < 35%, NYHA Class II/III symptoms
Patients with cardiomyopathy of any origin†
– LVEF ≤ 30%
– NYHA Class II or III symptoms
•
Class I (Level of Evidence B) Recommendations:
Patients with nonischemic cardiomyopathy†
– LVEF < 35%
– NYHA Class II or III symptoms
†
On chronic optimal medical therapy.
See algorithms for details.
What Implanting Physician Needs to Know When Referring Patients for Further Evaluation
• LVEF and date – how assessed
• Length of time diagnosed with heart failure
• NYHA classification
• QRS duration
• History of syncope or VT
• Current or past atrial fibrillation
• Previous MI, CABG, and/or PCI and dates
• Most recent EKG, anticoagulation status, INR, serum Cr, and medication list
References
1
Heart Disease and Stroke Statistics – 2010 Update. American Heart Association; Dallas, TX; 2009.
Bayés de Luna A, Coumel P, Leclercq JF. Ambulatory sudden cardiac death mechanisms of production of fatal
arrhythmia on the basis of data from 157 cases. Am Heart J. January 1989;117(1):151-159.
4
Moss AJ, Zareba W, Hall WJ, et al; Multicenter Automatic Defibrillator Implantation Trial II Investigators. Prophylactic
implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med.
March 21, 2002;346(12):877-883.
5
Bardy GH, Lee KL, Mark DB, et al; Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) Investigators. Amiodarone
or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med. January 20, 2005;352(3):225-237.
6
Huikuri HV, Castellanos A, Myerburg RJ. Sudden death due to cardiac arrhythmias. N Engl J Med. November 15, 2001;
345(20):1473-1482.
7
Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart
Failure (MERIT-HF). Lancet. June 12, 1999;353(9169):2001-2007.
8
Hunt SA, Abraham WT, Chin MH, et al. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic
Heart Failure in the Adult – summary article: a report of the American College of Cardiology/American Heart Association
Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and
Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the
International Society for Heart and Lung Transplantation: endorsed by the heart Rhythm Society. Circulation.
September 20, 2005;112(12):e154-235.
9
Epstein AE, Dimarco JP, Ellenbogen KA, et al. ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac
rhythm abnormalities. Heart Rhythm. June 2008;5(6):934-955.
3
Developed by the SCA Prevention Medical Advisory Team.
Please refer to the manufacturers’ prescribing information and/or instructions for use for the indications, contraindications,
warnings, and precautions associated with the medications and devices referenced in these materials.
Sponsored by Medtronic, Inc.
April 2007
Revised September 2008
Updated by the AHA February 2010
UC200705819a EN