More Than Half of Patients See a GP in the 2 Weeks Before OHCA

More than half of patients who experience out-of-hospital cardiac arrest (OHCA) visit their general practitioner within the 2 weeks prior to their event, according to new Danish registry data.

The findings, to be presented as a poster during the virtual European Society of Cardiology Congress 2020, should “open the door for other studies in the future to focus [on] what lies before the event itself leading to a potential intervention,” primary investigator Nertila Zylyftari, MD (Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark), told TCTMD. “For example, we didn't have information on the clinical reasons why these patients were in contact with their general practitioners. . . . So, studies in the future that have information on symptoms of course could help with understanding much more [about] the etiology and the cause of cardiac arrest.”

Mony Shuvy, MD (Shaare Zedek Medical Center, Jerusalem, Israel), whose own research has found that as many as one in four OHCA patients are examined in an emergency department in the 90 days leading up to their event, said these findings were not surprising. “This suggests that, as we saw before, patients with arrests are a very heterogeneous group—it includes patients with heart failure, coronary disease, and patients with comorbidities,” he said, commenting on the new study. “But there is also a group of patients that were healthy before and the arrest came out of nowhere.”

These cohorts need to be examined separately in order to home in on the ultimate cause of arrest, Shuvy advised TCTMD. “When you are look at them as one group, you cannot really know how to explain the results.”

For this study, Zylyftari and colleagues matched 28,955 adult patients who experienced OHCA in Denmark between 2001 and 2014 with 260,959 controls by age, sex, and event date. Overall, 94.6% and 61.7% of the study population had contact with a general practitioner or hospital, respectively, in the year prior to their event.

The researchers observed substantial increases in both general practitioner and hospital contact among those who experienced cardiac arrest versus controls, rising from a steady 26% in the year prior to 54% in the 2 weeks before to the event. Only 14% of the general population contacted their physician during the same time period.

Specifically, more than 50% of study patients had a consultation with their clinician, more than 25% had a home visit, 72% communicated with their clinician via phone or email, and 20% had some other kind of contact. Notably, patients with ischemic heart disease (8%) and heart failure (4.5%) had the greatest amount of hospital contact prior to their event.

Future Focus on Subgroups

What makes OHCA arrest especially difficult to predict is the fact that even those who do have healthcare contact prior to their event report vague, nonspecific symptoms. “Even if you look at the causes of hospitalization in the abstract, around 15% came with related symptoms like heart failure hospitalization,” Shuvy said. “[This] makes it very difficult to try to divide these patients and say, ‘This guy is going to have an arrest in 3 months. Let's try to see how we can avoid it.’”

There lies the biggest limitation of this and similar previous studies in this space, he continued. “We know that something happens. We know that people don't feel well. We know that they go to hospitals. We know that they go to their physicians. But we still cannot predict that something is going to happen. The next step is to try to better define the symptoms that are related to the future arrest, which is still very difficult, and we don't really know how to do it.”

Shuvy advocated for more research looking at subgroups of patients who have OHCA, specifically young people with no comorbidities and those with heart failure. In the meantime, he said, prevention of coronary artery disease will be important as it is a root cause of many of these events.