Medical Device Daily Executive Editor

DENVER — Around 95% of those struck by sudden cardiac arrest (SCA) die.

A new group, the Sudden Cardiac Arrest Coalition, would like to reverse this — to 90% saved with the use of defibrillation in 4 to 6 minutes after the heart stops because of an electrical "short" in the heart's system.

That is, pragmatically, the unrealistic estimate of the new coalition of the potential survival from SCA by the new coalition, its formation unveiled at a press conference last week at the scientific sessions of the Heart Rhythm Society (HRS; Washington). But given the number of medical and healthcare associations forming the SCA Coalition — nearly 30, and likely to grow — it may have a chance to significantly improve the dismal 5% rate of SCA survival. That is if it gets the necessary federal funding, it said.

Citing the huge mortality rate from SCA, Dwight Reynolds, MD, outgoing president of HRS, said that initiatives that are able to reduce that figure "to 75% even, that's a dramatic savings of lives in this country," based on 250,000 deaths from SCA annually in the U.S.

The "U.S. government," he said, "is the best hope for arming us, reaching the public to provide the level of awareness that can make a difference."

A statement by the coalition said that it will seek the funding "to develop and implement a comprehensive education and research program for SCA [that will] include a resolution to create a national Sudden Cardiac Arrest Week … to focus on this deadly killer."

The financing amount it will ask for was an undisclosed wild card, however.

The coalition said it will seek significant governmental support for federal research, such as to the Department of Health and Human Services and its member agencies, but the group's representatives said it was "still crafting" what amount of additional funding it will be requesting.

Juliet Johnson, a spokesperson for the coalition told Medical Device Daily that the group will offer "omnibus legislation" to Congress in about a month for the money to support various programs to improve public awareness and research.

The coalition is backing its push for funding with public opinion, at the press conference presenting surveys indicating — once respondents were made aware of the specifics of SCA risk — that about 94% support greater emphasis on SCA awareness and education; and about 77% agreed that more federal funding is needed for these efforts.

A survivor of SCA, Judy Sudmeir, a Denver nurse, was on hand to say this was her "third birthday," marking the years since she suffered SCA and was given rapid CPR and defibrillation, and noting that 650 people die each day in the U.S. as the result of SCA.

But the current therapies of AEDs and ICDs are frequently considered cost-ineffective because SCA hits so suddenly and with so little warning – as well as occurring mostly in the home, and when no witness is present, even if an AED were available for use, suggesting the need for broad ICD use.

Acknowledging these problems, Reynolds said that the "signs and symptoms [of SCA] are not often easily seen — most of the time there is no warning of an arrhythmia." But he also said that SCA is "not a random event; most victims have some kind of heart disease or some other event," providing some forewarning.

The coalition obviously may be a boon to AED and ICD manufacturers, but it should especially hearten those developing research on early risk stratification for SCA.

"We don't always have the tools at our disposal to detect those who are at high risk," Reynolds said, specifically citing the need for "a cost-effective screening tool to find people in general population" with increased risk based on genetic markers.

While he said that ICDs are 98% effective, he acknowledged the dual problem of not being able to identify those who would most benefit from the devices, and ICDs are implanted in many people who never need them.

Thus, he said, "We're striving with the tools that we have today, not to be putting defibrillators in those who are not at high risk [so as to] implant fewer defibrillators than is optimal.

"We're also very clearly saying many other measures need to be taken, such as teaching the public how to effectively resuscitate people."

Though not highlighted at the meeting, the window for effective resuscitation was described as narrower than previous assessments. While use of an AED was previously said to be needed within the first 10 minutes after SCA onset, the coalition presenters described the effective window as four to six minutes (given the mental and physical deficits that have been seen as the result of resuscitation providing survival but outside that four- to six-minute window).

Besides highlighting the mortality resulting from SCA, the coalition clearly is attempting to emphasize its survivability. The SCA Foundation is launching an online registry for survivors of SCA, calling it "the nation's first."

Michael Sayre, MD, of The Ohio State University Medical Center (Columbus), said in a statement that the registry — at www.sca-aware.org — "will give sudden cardiac arrest survivors and their families an opportunity to find others who have been through similar life-changing events, share their experiences and help one another in the healing process."

Other goals include fostering "awareness initiatives designed to help improve survival rates" and serving as a research tool by providing information concerning "location of arrest, types of interventions and outcomes."

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