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Sex-Specific Warning Symptoms of Cardiac Arrest

September 11, 2023
by Lisa Freed

A study published in The Lancet Digital Health Journal on August 26, 2023, and reported by Fox News Digital, found that warning symptoms of cardiac arrest can appear 24 hours prior and are different in women and men.

Women’s Health Research at Yale asked Lisa Freed, MD, the director of Yale’s Women’s Heart and Vascular Program, for help with this headline.

What is the most important heart health “takeaway” from this study?

Out-of-hospital sudden cardiac arrest is a common cause of death with a high fatality rate of greater than 90%. Approximately half of patients who suffer a sudden cardiac arrest experience telling symptoms in the hours, days, or weeks before their cardiac arrest. People who call 911 before a collapse from sudden cardiac arrest are more than five times more likely to survive. Identifying these warning symptoms is critical to the triage of those who may prevent imminent death by calling 911. In other words, data from studies like these may lead to a new paradigm for the prevention of sudden cardiac death.

What did the study reveal about women and the influence of sex and gender on health outcome?

This study demonstrated that the prevalence of warning symptoms is sex-specific and also differed significantly between patients with sudden cardiac arrest and those who did not suffer a cardiac arrest. Among women, dyspnea (or shortness of breath) was significantly associated with sudden cardiac arrest. Among men, chest pain, dyspnea, and diaphoresis (sweatiness) were all significantly associated with sudden cardiac arrest. This difference between women and men has been shown in previous studies and once again emphasizes the importance of considering the gender of the patient presenting. If gender is not taken into account, there exists the potential for missed recognition of imminent cardiac events in women.

What are the strengths and limitations of this study?

The greatest strength of this study is the large number of people studied. It was conducted in a U.S. population of approximately 850,000 residents and was replicated in another U.S. community of approximately 800,000 residents. There were over 400 sudden cardiac arrests in each community. This adds to the precision and power of the data and adds to the ability to assess sex-specific differences. In addition, this was the first community-based study to evaluate the association of warning symptoms and sudden cardiac arrests.

The limitations include the fact that chest pain and shortness of breath are common symptoms and not all people who experience these symptoms suffer sudden cardiac arrest. If everyone who experienced these symptoms called 911, emergency medical services could be overwhelmed by false positives. This particular limitation serves to reinforce that more study needs to be done to help to sort between the dangerous and benign versions of these symptoms.

Other limitations include the potential lack of reliability and comprehensive nature of symptoms reported to EMS at the time of the emergency. In addition, the symptoms analyzed came from a predefined list of symptoms, which may have precluded the discovery of potential new symptoms of sudden cardiac arrest. Finally, the findings of this study may or may not be generalizable to other regions of the U.S. or world and race and ethnicity data were not available for most participants.

What practical actions, if any, should the public take based on these findings?

Take warning symptoms seriously and act on them- seek medical attention, report them to your doctor, or go to your local Emergency Department.

Also, it is important to note that the warning symptoms reported in this study are common and the authors of the study emphasize that they will need to be augmented with additional features, such as the clinical profile and biometric measures, for improved prediction of imminent sudden cardiac arrest. They note that in the future, a smartphone-based platform could collate features such as warning symptoms data with demographic data, the individual’s clinical profile, physiological measurements from biometric sensors, and a smartphone-generated electrocardiogram to generate a risk score for impending sudden cardiac arrest.

The information provided here may help you make more informed choices. However, it is not a substitute for an individualized medical opinion or diagnosis, and everyone should always consult with their personal physicians to make decisions about their condition or treatment.

Submitted by Jessica Quistorff on September 11, 2023