1500 people die suddenly every day! National experts discuss new countermeasures against sudden cardiac death

Wen/Map Yangcheng Evening News All Media Reporter Zhang Hua Correspondent Huang Rui

Sudden cardiac death is the main cause of death due to cardiovascular disease. Epidemiological surveys in China show that more than 540,000 people die from sudden cardiac death every year, which is equivalent to more than 1,500 people dying from it every day, but the prevention and treatment work in China is not satisfactory.

On August 6, at the event of "Sudden Cardiac Death Comprehensive Prevention and Control (PSCD) Project National Tour - Guangdong Station", Professor Hua Wei of Fu Wai Hospital, Chinese Academy of Medical Sciences, the director of the Cardiac Electrophysiology and Pacing Branch of the Chinese Medical Association, pointed out in an interview that the prevention and treatment of sudden cardiac death focuses on prevention. In addition to the timely initiation of cardiopulmonary resuscitation when sudden cardiac arrest occurs, it is more important to identify people at high risk of sudden cardiac death and give timely ICD (implantable cardioverter-defibrillator) treatment to minimize the occurrence of sudden death.

The success rate of out-of-hospital resuscitation for cardiac arrest patients is less than 1%

Once a cardiac arrest occurs and the patient is seen on the ground, the customary practice is to call 120 emergency number and wait for rescue or carry the patient to the hospital. The only effective way is to resuscitate the patient in situ, such as performing cardiopulmonary resuscitation, which is called emergency first resuscitation in medicine, and whoever sees it.

Secondly, Professor Huang Congxin said that we should currently deploy AEDs in public places, especially in places where there is a high flow of people, that is, external automatic defibrillators, using this equipment to defibrillate patients through a few simple steps, thus helping patients to restore a normal heartbeat and effectively avoid sudden death.

Prof. Hua Wei introduced that a foreign statistic shows that 160,000 people have sudden cardiac arrest, 60% of them are rescued by ambulance, but only 6.4% of the patients are successfully rescued. The reason why the success rate is so low is that, even if the brain is deprived of blood for 4 minutes, the brain is deprived of blood for a long time, resulting in the death of brain cells, which can leave serious sequelae. In the case of 10 minutes of cardiac arrest, the success rate of resuscitation is almost zero.

Therefore, overall, the success rate of resuscitation in cardiac arrest is very low, especially outside the hospital, and when the ambulance arrives on the scene to perform emergency treatment, the patient basically has no chance of recovery.

Identify high-risk groups and implant ICD to prevent sudden death

The first cause of sudden cardiac death is coronary heart disease, followed by heart failure (heart failure for short), and the third is hereditary heart disease. According to Prof. Hua Wei, we are faced with the problem of how to identify people at high risk of sudden cardiac death in patients or groups who have not experienced sudden cardiac arrest and to implant an in vivo defibrillator in a timely manner, which is one of the most effective ways to prevent sudden cardiac death.

However, such a very effective method has not been promoted well in China. According to Professor Wang Jingfeng, Director Electrophysiology and Pacing Branch of the Chinese Medical Association and Director Designate of Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, the identification and referral rate of people at high risk of former sudden cardiac death is low, and the percentage of patients who end up with an ICD implanted even after referral is even lower.

With ICDs, the success rate of 20-second defibrillation is as high as 99%, and patients with ventricular fibrillation are likely to recover a normal heartbeat after an electric shock, thus avoiding sudden death. In general, patients who have had a myocardial infarction, heart failure, cardiomyopathy, and have a family history of sudden cardiac death are at high risk for sudden cardiac death. Experts believe that many of these patients may require ICD implantation, but because of the lack of knowledge about sudden cardiac death prevention and the lack of understanding of ICDs among the general public, the rate of implantation is low. For example, 200000 ICDs are implanted in the United States each year, while the population base in China is much larger than in the United States, but only 8000 are implanted each year. "Compared to the more than 540000 people who die each year because of sudden cardiac death, our 8000 ICD procedures appear to be far too few." Professor Huang Congxin said while shaking his head.

Talking about the identification of people at high risk of sudden cardiac death, Prof. Wang Jingfeng deeply lamented the delayed treatment of one patient. "Last year, the president of a university college, who had an examination of his coronary arteries, found a 75% stenosis of the blood vessels. The doctor suggested him to have further coronary angiography to solve the stenosis problem in time, but he had an important project to finish at hand, so he said he would wait for another two months to have the angiography. However, a month later, he collapsed in cardiac arrest while walking on the crosswalk in the afternoon after work, and people around him immediately called the 120 emergency number, but in the end, he was not saved. If his vascular problem could have been solved early or there was an AED nearby for timely defibrillation and CPR, the tragedy may have been avoided.

Professor Wang Jingfeng said that Sun Yat-sen Memorial Hospital of Sun Yat-sen University has made outstanding achievements in the prevention of sudden cardiac death and is at the leading level in China. In addition to carrying out ICD and CRTD implantation procedures at a very early stage in China, it is also the first in the country to carry out new therapies and technologies such as full subcutaneous ICD (S-ICD) implantation. It is also a Society-certified training base for new technologies, and is responsible for training for a wide range of physicians.

Young people under 40 years of age should pay particular attention to cardiac hypertrophy

In recent years, the news of sudden cardiac death in young people under 40 years old has been in the press repeatedly. This group of people are young and strong, and belong to the backbone of society, and sudden cardiac death has to be regretted. Is it related to overexertion?

Wang Jingfeng pointed out that from clinical experience, most young people have sudden cardiac death, on the one hand, because of the heart itself disease, just not found; the second is that the heart function and structure is not too big a problem, but due to excessive fatigue, such as staying up late and working overtime or strenuous exercise, changed the normal environment of the heart, vascular activity, induced heart disease. "Young people should pay particular attention to early-onset coronary heart disease and hypertrophic cardiomyopathy, and we currently encounter some patients with early-onset coronary heart disease and young cardiomyopathy from time to time in our outpatient clinics, which requires a combination of the patient's symptoms, risk factors, and electrocardiogram, ambulatory electrocardiogram, and cardiac ultrasound to further clarify the diagnosis and determine risk."

Previously, patients with coronary heart disease were in their 50s and 60s, but nowadays the incidence of coronary heart disease is also getting younger, with young people in their 30s and 40s developing early-onset coronary heart disease, which is related to the fast pace of work and life, abnormalities in blood lipids, blood pressure and blood sugar that lead to easy atherosclerotic stenosis of blood vessels.

According to Professor Huang Congxin, the integrated prevention and treatment of sudden cardiac death should strengthen the multidisciplinary linkage and the up-and-down linkage. Because the prevention and treatment of sudden cardiac death is focused on prevention, it is often very passive when it comes to governance. It is important to really screen out high-risk and intermediate-risk populations for accurate prevention. In addition, it is important to effectively promote and popularize the knowledge of unassisted cardiopulmonary resuscitation to the social population and seize the golden time for emergency treatment. For cardiac electrophysiology and pacing doctors, it is necessary to fully grasp the indications and strengthen the standardized management of the application of ICD and other corresponding life-saving measures.

According to the reporter's understanding, in this tour meeting, national experts discuss new countermeasures for the prevention and treatment of sudden cardiac death. From treatment concept to treatment strategy, from drugs to devices, the comprehensive prevention and treatment level of sudden cardiac death will be improved to reduce the occurrence of sudden cardiac death. (For more news and information, please pay attention to yangcheng pai.ycwb.com)

Source | Yangcheng Evening News-Yangcheng Pai

Editor | Niu Zhijie

Proofreading | Zhao Dandan