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Sudden cardiac arrest may not be so sudden

December 21, 2015

1. Sudden cardiac arrest may not be so sudden

Warning signs are common, but are often ignored, in the weeks preceding a heart attack


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According to an article published in Annals of Internal Medicine, sudden cardiac arrest may not be an entirely unexpected event. Warning signs are common in the days and weeks leading up to a heart attack, but those symptoms are often ignored. Attention to symptoms and early interventions may improve survival.

Sudden cardiac arrest is almost always fatal, so finding ways to prevent it is important. Researchers hypothesized that the presence of and response to warning symptoms that occur in the hours, days, and weeks preceding heart attack may be associated with better survival. They collected information about the 4 weeks before sudden cardiac arrest from survivors, family members, friends, medical records, and emergency response records to determine what symptoms, if any, were present. Symptoms were classified as chest pain (typical or atypical), difficulty breathing, palpitations, sudden drop in blood pressure/loss of consciousness, and other (including abdominal pain, nausea or vomiting, back pain).

The researchers found that about one half of patients with available information had warning symptoms in those 4 weeks that often recurred during the 24 hours before sudden cardiac arrest. Most patients ignored their symptoms, but the patients who called 911 significantly increased chances for survival. The authors suggest that these findings highlight the potential importance of developing new community-based strategies for short-term prevention of sudden cardiac arrest.

Note: For an embargoed PDF, please contact Cara Graeff. To interview the lead author, please contact Sally Stewart at or 310-248-6566.

2. Patient and provider interventions yield modest improvements in osteoarthritis outcomes


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A low-intensity combined patient and doctor intervention may help to improve physical function and physical activity for patients with knee or hip osteoarthritis. The research is published in Annals of Internal Medicine.

Adequate management of hip and knee osteoarthritis requires both medical and behavioral strategies, but recommended therapies are underused. Researchers sought to determine if a combined patient and provider intervention could improve osteoarthritis outcomes.

Researchers randomly assigned 300 patients and providers at a cluster of 30 VA outpatient clinics to either an intervention group plus usual care or usual care alone. The telephone-based patient intervention focused on weight management, physical activity, and cognitive behavioral pain management. The provider intervention involved delivery of patient-specific osteoarthritis treatment recommendations to primary care providers through electronic medical records.

At 12 months, patients in the intervention group reported modest improvements in physical function and physical activity, two important components of osteoarthritis management. Providers in the intervention group increased use of proven therapies, especially referrals for behavioral and rehabilitative programs. The authors note that the intervention was low-intensity. They suggest that higher-intensity interventions are needed to make more meaningful improvements in outcomes.

Note: For an embargoed PDF, please contact Cara Graeff. To interview the lead author, please contact Megan Warren Moore at or 919-286-0411 x6986.

Also in this issue:

Striking the Right Balance in Heart Failure

Monica R. Shah, MD, and Michael S. Lauer, MD

Ideas and Opinions

American College of Physicians

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