Warning Symptoms Are Associated With Survival From Sudden Cardiac Arrest

Ann Intern Med. 2016 Jan 5;164(1):23-9. doi: 10.7326/M14-2342. Epub 2016 Dec 22.


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.

Design: Ongoing prospective population-based study.

Setting: Northwestern United States (2002 to 2012).

Patients: Residents aged 35 to 65 years with SCA.

Measurement: 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).

Limitation: Potential for recall and response bias, symptom assessment not available in 24% of patients, and missing data for some patients and SCA characteristics.

Conclusion: 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.

Primary funding source: National Heart, Lung, and Blood Institute.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Chest Pain / etiology
  • Dyspnea / etiology
  • Emergency Medical Services / statistics & numerical data
  • Female
  • Heart Arrest / diagnosis*
  • Heart Arrest / mortality*
  • Heart Arrest / prevention & control
  • Humans
  • Male
  • Middle Aged
  • Northwestern United States / epidemiology
  • Prospective Studies
  • Risk Factors
  • Survival Analysis
  • Time Factors