Prodromal symptoms and health care consumption prior to out-of-hospital cardiac arrest in patients without previously known ischaemic heart disease

Abstract

Aims: To describe prodromal symptoms and health care consumption prior to an out-of-hospital cardiac arrest (OHCA) in patients without previously known ischaemic heart disease (IHD).

Background: The most common lethal event of cardiovascular disease is sudden cardiac death, and the majority occur outside hospital. Little is known about prodromal symptoms and health care consumption associated with OHCAs.

Design: Case-crossover study.

Methods: Medical records of 403 OHCA cases without previously known IHD, age 25-74 years in the MONICA myocardial registry in Norrbotten County 2000-2008, were reviewed. Presenting symptoms and emergency visits at public primary care facilities and internal medicine clinics in Norrbotten County were analyzed from the week prior to the OHCA and from the same week one year previously, which served as a control week. Unlike most studies we included unwitnessed arrests and those where no cardiopulmonary resuscitation (CPR) was attempted.

Results: Emergency visits were more common during the week prior to the OHCA than during the control week, both for visits to primary care (29 vs. 6, p<0.001) and to internal medicine clinics (16 vs. 0, p<0.001). Symptoms were more prevalent during the week prior to the OHCA (36.7 vs. 6.7%, p<0.001). The most prevalent symptoms were chest pain (14.6 vs. 0%, p<0.001), gastrointestinal symptoms (7.7 vs. 1.2%, p<0.001) and dyspnoea/peripheral oedema (6.9 vs. 0.2%, p<0.001).

Conclusions: Patients who suffer an OHCA seek health care and present prodromal symptoms significantly more often the week prior to the event than the same week one year earlier.

Keywords: Health care consumption; Out-of-hospital cardiac arrest; Prodromal symptoms; Sudden cardiac death.