2023-09-02 11:09:03
by Ruggiero Corcella
A study in Lancet Digital Health identified the most common symptoms, but different between genders: shortness of breath, in women, and chest pain, in men. Now they are looking for others to allow digital devices to catch them and alert the rescue
Think about it: how much would you be willing to pay for a wearable device that can sense your heart is about to stop and automatically alert emergency services, possibly saving your life? If from the point of view of “hardware” technology, creating such a system is already feasible, as far as the “software” is concerned, however, it is still an open challenge.
Why? Smartwatches, bracelets and wearables in general at the moment are at most capable of measuring heart rate (to detect any signs of ventricular fibrillation) and of deriving one or more electrocardiographic traces, oximetry, temperature, ventilatory rate and some the respiratory mechanics. In cardiac arrest (or sudden cardiac death in English) it has not yet been possible to identify precisely what the real warning signs are.
And this is the line of research followed by a team from the Smidt Heart Institute of Cedars-Sinai (USA) coordinated by Sumeet Chugh, one of the leading international experts on this pathology. Who have now taken a step forward in looking for the “warning signs” of sudden death, as told by a study published in Lancet Digital Health. “The premonitory symptoms of arrest – write the authors – could be exploited using digital technology to potentially improve survival outcomes”.
The alert “sounds” 24 hours earlier
The study found that 50% of people who experience cardiac arrest also experience a significant symptom 24 hours before loss of heart function. And it turned out that this warning symptom differs between women and men. For women, the most obvious symptom of impending cardiac arrest is shortness of breath (dyspnea) while men experienced chest pain (angina). Smaller subgroups of both sexes experienced palpitations (palpitations), seizure-like movements, and flu-like symptoms.
“Out of 10 cardiac arrests, 7 concern male subjects and 3 female subjects, a substantial difference that has several possible causes but which must make us think – says Piergiuseppe Agostoni, full professor of Diseases of the cardiovascular system and director of the Specialty School in Cardiology, University of Milan, director of the Department of Critical Cardiology, Monzino Cardiological Center, IRCCS, Milan —. The symptoms most frequently associated with cardiac arrest, which proceed from it and which can be considered premonitory of cardiac arrest are precisely, in one case out of 3, dyspnoea, i.e. shortness of breath, and precordial pain, to be clear the classic typical chest pain of angina (which precisely means pain) and acute myocardial infarction. This figure is confirmatory of similar studies done in Japan and Germany. Dyspnea, etymologically difficult breathing, is present in both sexes while precordial pain is associated with sudden death in men but this is not true in women. This data is present regardless of the age of the subject.
Perform effective triage
Out-of-hospital cardiac arrest is fatal in 90% of people who suffer it and therefore there is an urgent need to better predict and prevent this pathology. “Using warning symptoms to effectively triage those who need to place a call to 911 would aid in early intervention, preventing sudden death,” says Chugh, director of the Center for Cardiac Arrest Prevention at the Smidt Heart Institute and senior author of the study. “Our findings could lead to a new paradigm for the prevention of sudden cardiac death.”
Population studies
For this scientific work, the researchers used two population studies, each developed by Chugh’s team: the Prediction of Sudden Death in Mul t i-Ethnic C ommunities (PRESTO) study underway in Ventura County, California, and the Sudden Unexpected Death Study (SUDS), in Portland, Oregon. Both studies provide Cedars-Sinai researchers with unique, population-based data to determine how best to predict cardiac arrest.
“We started the SUDS study 22 years ago and the PRESTO study eight years ago. These groups have provided invaluable information along the way,” adds Chugh, who is also Chief Medical Officer or Heart Rhythm Center in the Department of Cardiology and director of the Division of Artificial Intelligence in Medicine in the Department of Medicine. In both studies, researchers at the Smidt Heart Institute assessed the prevalence of individual symptoms and clusters of symptoms prior to cardiac arrest, then compared these results to control groups who also required emergency medical care.
The results
The Ventura study showed that 50 percent of 823 people who experienced cardiac arrest, witnessed by a bystander or an emergency medicine professional, such as an Emergency Medicine Service (EMS) responder, experienced at least one telltale symptom 24 hours ago. The study in Oregon showed similar results.
“This is the first population-based study to evaluate the association of warning symptoms, or sets of symptoms, with sudden cardiac arrest, using a comparison group with documented symptoms from EMS registered as part of emergency care of routine,” emphasizes Eduardo Marbán, executive director of the Smidt Heart Institute and professor emeritus of the Mark Siegel Family Foundation. This study, says Marbán, “paves the way for further prospective studies that will combine all symptoms with other characteristics to improve the prediction of impending sudden cardiac arrest.”
“Later we will complement these sex-specific key warning signs with additional features, such as clinical profiles and biometric measures, for better prediction of sudden cardiac arrest,” concludes Chugh. The goal, already outlined in a study published on Circulation in 2018 by Chugh himself, could be the creation of an app capable of evaluating through dedicated algorithms the possible presence of these warning signals (but also of parameters that indicate the “predisposition” to certain heart pathologies) and to start the chain of survival.
The importance of having certain and direct parameters
«This study is very important for two aspects – comments Professor Agostoni again -. The first – in an era of digital medicine, of smart phones that give us a multitude of information on our vital parameters – allows us to better classify alarm and danger signals as predictors of “possible” sudden death. The number of information arriving from the various wearable devices is enormous, difficult to understand and above all to manage by all the elements involved in monitoring, i.e. by the patient, the family doctor and the operations centre”.
«For this we need wearable devices that give certain and direct parameters. Furthermore, the practical application of the information obtained from this study, however, still needs to be verified and controlled, but this information is certainly an important step for effective “digital” prevention”.
Gender differences
«The second important point is the gender difference between the warning symptoms. In our university teachings, we have always privileged the male sex and considered all men. This discrimination begins in science studies and ends in the classroom. In large trials in cardiology, the female gender is underrepresented, women go to the doctor less frequently than men and are less inclined to prevention and medical checkups. Why? The problem is social, the majority of women do double work, office/factory and family which means managing children, shopping, home but also care and assistance for elderly parents and, therefore, objectively have less time”.
«This data has been recognized by the scientific community for some years but we have not yet systematically brought it into our university courses and clinical practice. In Italian universities there are one or two at most gender medicine chairs. The challenge of science is twofold, to discover but also to bring these discoveries into daily life. Both of these things are necessary and complementary to each other», concludes Agostoni.
September 2, 2023 (change September 2, 2023 | 11:08)
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