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What to know about Sudden Cardiac Arrest

The American Heart Association quotes more than 356,000 out-of-hospital cardiac arrests annually; 347,422 adults and 7,037 children under age 18 (2018). This equates to one youth stricken, nearly every hour, every day, each year.

But what most parents don’t know is that Sudden Cardiac Arrest (SCA) is:
1) The #1 killer of student athletes and contributes to the #2 medical cause of death among youth under 25
2) The American Heart Association reports that up to 9,500 (2A) youth are affected annually by what the
National Heart, Lung and Blood Institute calls a critical public health issue. One student athlete dies every three days.
3) SCA is the leading cause of death on school campuses. 
4) 1 in 300 youth have an undetected heart condition that puts them at risk for sudden cardiac arrest.
(4A - see grid of referenced studies below)








SCA is not a heart attack – it’s an electrical or structural problem that causes a fatal arrhythmia – a deadly heartbeat. The underlying condition is something you’re born with (often inherited) and/or can develop as young hearts grow. The first symptom of SCA is often death, either because the warning signs of an underlying heart condition were not recognized or help was not administered within minutes of the event.
In fact, about 91% of SCA victims die because there was a delay in emergency response. Every minute of delay decreases the chance of survival by 10%. (4B)

Yet, of the leading causes of youth death (accidents, suicide, homicide, cancer and heart conditions), sudden cardiac arrest is arguably the only one that can be prevented through primary and secondary prevention strategies.

A variety of research and data validates the critical need for primary and secondary prevention programs and outreach campaigns that Parent Heart Watch initiates.
* An abstract from the 2014 IOC World Conference on Prevention of Injury & Illness in Sport warned that SCA rates in U.S. high schools are at least 50% greater than reported by media. (5)
* The National Center for Catastrophic Sport Injury Research stated that more athletes die from a cardiac arrest than from incurring injuries while playing sports. (5A)
* An American Board of Family Medicine study noted that 72% of students who suffered from SCA were reported by their parents to have at least one symptom before the event—they just didn't recognize it as life threatening. (6)
* The standard approach to youth checkups is a non-cardio focused physical exam/history that misses 96% of youth at risk for SCA. (6A)
* In Italy, screenings for high school athletes has led to a 90% reduction in sudden cardiac deaths. (7)
* With respect to criticism that ECG screening is cost-prohibitive, a U.S. based study by Stanford University of Medicine projected the cost of screening in this country at about $88 per student athlete and calculated two lives would be saved per 1,000 teens screened, concluding that screening is worth it. (7A)
* ECGs are the most effective tool to identify youth and student athletes at risk for sudden cardiac arrest with the lowest false positive rate. (8) A further 2019 study not only confirms ECG superiority, but underscores that standard history and physical using the AHA-14-point evaluation to determine cardiac risk will miss the majority of athletes with relevant conditions.
* The AHA 14-point evaluation performs poorly compared to ECG for cardiovascular screening of high school athletes.
* The AHA 14-point evaluation produces a high number of false-positive results with a poor sensitivity and low positive predictive value.
* ECG outperforms the AHA 14-point by all measures of statistical performance when interpreted by experienced clinicians.
* Cardiovascular screening using only the AHA 14-point evaluation will miss the majority of athletes with conditions at risk of sudden cardiac death.
* Recommendation for the routine use of the AHA 14-point evaluation, or similar history-based questionnaires, as the principal tool for pre-participation cardiovascular screening of young athletes should be re-evaluated. (8-1)
* U.S. News & World Report published that 70% of Americans either don’t know or have forgotten how to
administer CPR—an alarming statistic, given one quarter of Americans say they’ve been in a situation when someone needed CPR.
* The Institute of Medicine/National Academy of Sciences cites that each year less than 3% of the U.S. population receives CPR training, leaving bystanders unprepared to respond to a cardiac arrest. (8B)
* According to the National EMS Information System, it takes an average of 6 minutes (urban/suburban) and 13 minutes (rural areas) for first responders to arrive. (8C) But every minute delayed in treating an SCA victim decreases survival by 10%. A University of Washington study found that when CPR and an AED are used immediately, the survival rate jumps to 64%—so training is literally a life-saving initiative.
* “A second, more general issue relates to the broader perspective of cardiac arrest as a public health burden. Much of the emphasis in this report, as well as in the Institute of Medicine (IOM) report on the status of cardiac arrest in the United States, focused on the response to an impending or actual cardiac arrest. A much larger epidemiological problem is the prediction and prevention of cardiac arrest, which is an aspect of OHCA that is complementary to improvements in response strategies. A larger cumulative benefit to society would be achieved by both reducing the number of OHCAs and achieving better outcomes from those that do occur (Figure 1). The IOM report on cardiac arrest provides a roadmap for improving responses to cardiac arrest, an example of which is evident in the study by Sun et al. “We now need a parallel effort to develop a roadmap for improving prediction and prevention of OHCA.” (9)
* Sudden cardiac arrest is one of medicine’s most catastrophic and little-understood events. (10)
* Conviction that SCA has become of paramount concern for young hearts is further evidenced by a  collaboration between the National Institute for Health and the Centers for Disease Control and Prevention to create a Sudden Death in the Young Registry to more fully measure the impact this syndrome is having. Preliminary results will be released in 2016 with final results in 2020. (11)
* “School systems across the United States should have a clear and concise district-wide cardiac emergency response plan that meets laws, standards and safety practices, according to an American Heart Association (AHA) policy statement. “ This brief notes that the goal of a cardiac emergency response plan is to increase the chance of survival after sudden cardiac arrest and decrease the incidence of sudden cardiac death. (12)

(1) Journal of Athletic Training 2017;52(4):000-000 Harmon et al DOI: 10.1161/CirculatoinAHA.115.015431’
(2) https://www.cdc.gov/injury/wisqars/pdf/10lcid_all_deaths_by_age_group_2010- a.pdf
(2A) Heart Disease & Stroke Statistics 2014 Update – A report from the American Heart Association.
(3) http://circ.ahajournals.org/content/125/20/2511
(4) https://www.nata.org/sites/default/files/outcomessuddencardiacarrest.pdf
(4B) http://www.sca-aware.org/about-sca
(5) http://bjsm.bmj.com/content/48/7/605.1.abstract
(5A) https://nccsir.unc.edu/files/2013/10/NCCSIR-33rd-Annual-All-Sport-Report-1982_2015.pdf
(6) http://www.medscape.com/viewarticle/767325
(6A) Maron et al “Autopsy Study of Athletes with SCD (JAMA276:199-204;1996)
(7) J Am Coll Cardiol. 2008 52(24) doi:10.1016/j.jacc.2008.06.053
(7A) https://med.stanford.edu/news/all-news/2010/03/ecg-testing-of-young-athletes-cost-effective-in-preventing-deathsstudy-shows.html
(8) Canadian Journal of Cardiology dx.doi.org/10.1016/j.cjca.2016.06.007
Drezner et al Am J Cardiol 2016; 118:754-759
Drezner et al BJSM 10.1136/bjsports 2016 096606
Journal of Athletic Training 2013;48(4):546-553 doi: 10.4085/1062-6050-48.4.12
(8-1) https://www.ahajournals.org/doi/full/10.1161/JAHA.119.012235
(8B) http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=21723
(8C) Mell et al, 2017, Emergency Medical Service Response Times in Rural, Suburban and Urban Areas. JAMA Surgery, 152(10),983-984

(9) Myerburg, Journal of the American College of Cardiology dx.doi.org/10.1016/j.jacc.2016.03.611
(10) http://www.wsj.com/articles/clues-to-a-familys-heart-disease-1461618257
(11) http://www.nih.gov/news-events/news-releases/nih-cdc-launch-registry-sudden-death-young
(12) http://cpr.heart.org/idc/groups/heart-public/@wcm/@ecc/documents/downloadable/ucm_487599.pdf

ECG Interp graph.jpg