Changing approaches to the treatment of sudden cardiac arrest

The second part of the SCA issue is dealing with the family and the patient after an arrest and really trying to figure out what caused it. 

"This is where things like autopsy really matter and are really underutilized in the United States and everywhere else," Albert said. 

There has been a lot of focus on how coronary disease can cause cardiac arrests, but there are several other causes. While we have gotten better at treating coronary disease, there are still a sizable number of arrests occurring. 

Sudden cardiac arrest is a multidisciplinary challenge

SCA is a complex and multidisciplinary challenge. Albert emphasized the need to address it comprehensively, from prevention to post-event care. Traditionally, the focus has been on preventing cardiac arrests, primarily through managing risk factors like coronary artery disease. However, Albert and her colleagues stress the importance of identifying individuals at risk of SCA in the short term, even hours before an event using new technologies.

Preventing and responding faster to sudden cardiac death

Preventing SCA is a critical goal and this involves managing risk factors like hypertension, hyperlipidemia and diabetes. Albert said it also involves addressing genetic predispositions and congenital heart conditions that can cause SCA. She highlighted the potential of wearable technology and artificial intelligence (AI) in identifying patterns in cardiac rhythms that could predict impending SCA. Early detection could lead to timely interventions, potentially saving lives.

One of the key aspects of SCA management is improving the survival rate. Currently, SCA survival rates remain relatively low, with only about a 10% overall survival rate, Albert said. So, she said rapid response and resuscitation are vital in enhancing these numbers. Initiatives to expedite resuscitation efforts, such as advanced technology to alert EMS systems are being explored. 

"If you have ventricular fibrillation at the time of the arrest, then you can get survival up to in the high twenties, in certain places where they have advanced EMS systems. But if you are in a rural area or a lower or middle income country, there isn't such a thing. So most of those people will pass away from a cardiac arrest. Really, what we need is prevention," Albert said.

The role of autopsies in deciphering sudden cardiac arrest

To gain deeper insights into SCA causes, post-event investigations, including autopsies, play a pivotal role. Albert emphasized the need for more autopsies, particularly in individuals under 50, to understand the diverse range of factors contributing to SCA. While coronary artery disease remains a common cause, emerging data suggests that other substrates in the myocardium may be responsible for a significant proportion of SCA cases.

"There is some data suggesting that in younger age groups, especially amongst women, sudden cardiac arrest may not be declining at all, and so we need to get better handle on that," Albert said.

Collaborative research and registries are needed for SCA

Collaboration and data-sharing are essential in the study of SCA due to its relatively rare occurrence. Albert advocates for the establishment of comprehensive registries and collaborative research efforts. By pooling resources and sharing data, researchers can gain a more holistic understanding of SCA's causes and risk factors, ultimately leading to more effective prevention and treatment strategies.

Both Europe and the United States have established guidelines for SCA management, with a focus on primary prevention and the use of defibrillators. However, Albert stresses the importance of continuously refining and updating these guidelines to reflect the evolving landscape of SCA research and technology. But more clinical data is needed to power better informed guidelines.

"We track all kinds of reportable illnesses, right? Sudden cardiac arrest should be a reportable illness," Albert said. "This happens and we don't know why, and it is really, really common and it's a major cause of mortality. So why aren't we tracking it?"