AHA Releases Latest Statistics on Sudden Cardiac Arrest

There are more than 350,000 out-of-hospital cardiac arrests (OHCA)[1] annually in the U.S., nearly 90% of them fatal, according to the American Heart Association’s newly released “Heart Disease and Stroke Statistics - 2018 Update”. According to the report, the annual incidence of EMS-assessed non-traumatic[2] OHCA in people of any age is estimated to be 356,461.

There are a number of ongoing challenges to understanding the epidemiology of cardiac arrest in the U.S. Despite being a leading cause of death, currently there are no nationwide standards for surveillance to monitor the incident and outcomes of cardiac arrest. Thus, registries and clinical trials are used to provide the best estimates.[3]

Following are highlights from the report:

Adults:

• The estimated incidence of OHCA among adults is 347,322.
• After EMS-treated, survival to hospital was 29%, with higher survival rates in public places (39.5%) and lower survival rates in homes/residences (27.5%) and nursing homes (18.2%)
• Survival to hospital discharge was 10.8% among adults (9% with good neurological function).
• Large regional variations in survival to hospital discharge (range, 3.4%-22%) and survival with functional recovery (range, 0.8%-20.1%) are observed in 132 counties in the U.S. Variations in the rates of layperson CPR explained much of this variation.
• 25% of adults treated by EMS had no symptoms before the onset of arrest.
• The majority of OHCA’s occur at home (68.5%), followed by public settings at 21%, and nursing homes at 10.5%.
• For most cardiac arrest cases, the victim collapses without anyone witnessing it at 51%, followed by 37% of cases witnessed by a bystander, and sadly only 12% were witnessed by an EMS provider.
• Among EMS-treated OHCA patients, 19.8% had a rhythm (Ventricular Fibrillation or Ventricular Tachycardia) that was shockable by an automated external defibrillator (AED).
• Among the 10.9 million registered participants in 40 marathons and 19 half-marathons, the overall incidence of cardiac arrest was 0.54 per 100,000 participants. Those with arrest were more often male and were running a full marathon versus a half. Among those runners who succumbed to cardiac arrest, 71% died; and those who died were younger than the patients who survived.

Annual Incidence of EMS-Assessed OHCA

Children:

• Studies show that the annual incidence for EMS-assessed “Out of Hospital Cardiac Arrest” among children (<18 years of age) ranks at 7,037.
• Survival to hospital discharge was a mere 10.7% among children, with only 8.2% of pediatric patients having good
• neurological function).
• The location of EMS-treated OHCA was at home for 89.5% of children <1 years old, 77% of children 1-12 years old, and 72.9% for children 13-18 years old.
• The most common causes of Sudden Cardiac Death (SCD) among young athletes are Hypertrophic Cardiomyopathy (36%), Coronary Artery Abnormalities (19%), Myocarditis (7%), Arrhythmogenic Right Ventricular Dysplasia (5%), Coronary Artery Disease (4%), and Commotio Cordis (3%).
• The incidence of SCD was 0.24 per 100,000 athlete years in high school athletes screened every three years between 1993 and 2012 in Minnesota.
• The incidence of non-traumatic Out of Hospital Cardiac Arrest was 1 per 43,770 participant-years among athlete students 17-24 years old participating in NCAA sports from 2004-2008. The occurrence of cardiac arrest was higher among African Americans, than Caucasians and affected males more than females.

Characteristics of and Outcomes for OHCA

	Adults	Children
Survival to hospital discharge	10.8	10.7
Good functional status at hospital discharge	9.0	8.2
VF/VT shockable	20.2	7.2
Public setting	21.1	16.1
Home	68.1	83.6
Nursing home	10.8	0.3

Risks:

• A family history of cardiac arrest in a first-degree relative increases the risk of cardiac arrest by two-fold.
• According to 2017 figures from the CDC, Sudden Cardiac Death appears among the multiple causes of death on 13.5% of death certificates, which suggests that 1 of every 7.4 people in the U.S. will die of SCD. Among adults, the risk of Sudden Cardiac Death increases exponentially with age.

Trends:

• Unadjusted survival to hospital discharge after EMS-treated OHCA increased from 10.2% in 2006 to 12.4% in 2015.
• Rates of layperson-initiated CPR and layperson use of AEDs have increased over time. In 2016, laypersons initiated CPR in 40.7% of cases (up from 36.5% in 2006). Laypersons used AEDs in 5.7% of cases (up from 3.2% in 2006).

Complications:

• Survivors of cardiac arrest experience multiple medical problems including impaired consciousness and cognitive deficits. As many as 18% of Out of Hospital Cardiac Arrest survivors have moderate to severe functional impairment at hospital discharge. Functional recovery continues over the first 6-12 months after OHCA in adults.

Healthcare Utilization and Cost:

• The estimated societal burden of SCD in the U.S. was 2 million years of potential life lost for males and 1.3 million potential life lost for females, accounting for 40-50% of the years of potential life lost from all cardiac diseases.
• Among males, estimated deaths attributed to SCD exceeded all other individual causes of death, including lung cancer, accidents, chronic lower respiratory disease, cerebrovascular disease, diabetes mellitus, prostate cancer, and colorectal cancer.

Awareness and Treatment:

• The median annual CPR training rate for U.S. counties was 2.39%, based on data from the AHA, American Red Cross and the Health & Safety Institute, the largest providers of CPR training in the U.S. The prevalence of reported current CPR training was 18%, and the prevalence of having CPR training at some point was 65%. Training rates were lower in rural areas, areas with high proportions of black or Hispanic residents, and counties with lower median household incomes.

Future Research:

• The absence of standards for monitoring and reporting the incidence and outcomes of cardiac arrest remains a barrier to population research in the U.S. Increasing the rigor of reporting cardiac arrest will improve understanding of the epidemiology of this syndrome.

ORIGINAL SOURCE: American Heart Association; Summary compiled by Mary Newman, MS, Sudden Cardiac Arrest Foundation

________________________________________

[1] “Cardiac arrest is the cessation of cardiac mechanical activity, as confirmed by the absence of circulation,” according to the report. “SCA (Sudden Cardiac Arrest) is unexpected cardiac arrest that might result in attempts to restore circulation. If attempts are unsuccessful, this situation is referred to as SCD” (Sudden Cardiac Death).

[2] A consensus statement by the International Liaison Committee on Resuscitation recommends categorizing cardiac arrest into events with external causes (drowning, trauma, asphyxia, electrocution and drug overdose) or medical causes.

[3] The statistical update is produced using the most recent data available compiled by the AHA, the National Institutes of Health, the Centers for Disease Control and Prevention, and other government sources. OHCA statistics are derived primarily from the Resuscitation Outcomes Consortium (ROC) Epistry, a prospective population-based registry of EMS-attended calls for patients with OHCA in eight U.S. and three Canadian regions from 2005-2015, and the ongoing Cardiac Arrest Registry to Enhance Survival (CARES), at Emory University School of Medicine, which works with the CDC.