Purpose: Some patients of sudden cardiac arrest (SCA) have warning symptoms (WS) prior to arrest event. This meta-analysis was conducted to investigate the incidence of various WS of SCA.
Methods: Databases including PubMed, EMBASE, and Web-of-Science (WOS) were searched till March-12, 2021. The search was limited to the studies of adult (age>18 years) SCA patients that reported the number of patients with WS before arrest. Case reports, reviews, and editorials were excluded. Total number of SCA patients with WS (numerator) and total number of SCA patients (denominator) were extracted to calculate the proportion. These were summarised using random-effects meta-analysis. Heterogeneity was assessed using I2 statistics. Subgroup analysis, according to the study type, definition of WS, mean age, and proportion of witnessed SCA was undertaken.
Results: Out of 3020 studies, only 23 studies were selected for this meta-analysis, having 23157 patients (mean age-59.5 years, 64.5% males). The definition of WS differed significantly among the studies, with majority of studies (8/23) defining WS as a new-onset symptom experienced within 24-hours of the event. Our meta-analysis showed that 62% (95%CI:57%-68%) of SCA patients had at least one WS. The most common WS reported was chest pain (23%), followed by breathlessness (16%) and altered mentation (15%). Less reported (<10%) WS include fatigue, syncope, gastrointestinal symptoms, giddiness, and palpitation. It was found that the aged patients (mean age > 60years) tend to have more (p–0.05) WS 66% (95%CI: 59%-73%), as compared to younger patients (55%, 95%CI:46%-64%). Significant statistical heterogeneity was found (I2–98%), but none of the subgroup analyses led to a decrease in heterogeneity.
Conclusion: One-half to two-thirds of SCA patients were found to have WS. Future studies should be conducted focussing on WS of SCA, which can lead to the development of a new link to the 'Chain-of-survival of SCA', i.e., prevention.

Sudden Cardiac Arrest is not Sudden – A Meta-analysis of Warning Symptoms of Cardiac Arrest

Implementation of the Guidelines - How do we put the new ERC Guidelines into practice?

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