Sudden Cardiac Death (SCD)is a catastrophic event, which has a huge adverse impact on the health care system.
Sudden death is defined as natural death, in which the time and mode of death is unexpected, in an individual with or without pre-existing cardiac diseases, and which occurs within 1 hour of the onset of the beginning of symptoms. In the vast majority of the cases, the eventual cause of sudden death has been attributed to cardiac causes and several studies have used the terms 'sudden death' and 'sudden cardiac death' (SCD) synonymously.
The first data of SCD in India was obtained in 2012 which revealed that cardiovascular diseases were the leading causes of mortality, even in rural population. Although the number of causes for SCD in this study was very similar to other studies across the globe, the main difference in India and the world was that the proportion of SCD cases in the younger age groups was relatively higher, in India, which was seen to be because of the higher prevalence of heart disease in the young, in India.
India contributes to only 20 percent of the world population, but the heart disease burden in India is 60 percent of the world's, which is startling not just alarming!
Statistics reveal that it has become a major reason for death in the past couple of decades especially in the urban, educated and wealthy strata of our country! An Epidemic of sorts!
According to the World Health Report; Cardio-Vascular Disease (CVD) will be the largest cause of death and disability by 2021 in India. In 2021, 2.6 million Indians are predicted to die due to coronary heart disease which constitutes 54.1% of all CVD deaths. Nearly half of these deaths are likely to occur in young- and middle-aged individuals (30–69 years).
Dr Purshotam Lal (Padmavibhushan), Founder & Chairman, Metro Group of Hospitals, India, says, “What needs to be brought to the people’s attention is that the Covid-19 also affects the heart in many ways and having observed this, several national medical organizations including ICMR have formulated and issued the treatment protocols to manage cardiac cases during the Covid-19 pandemic’’.It is now evident that patients with pre-existing heart diseases, previous heart attacks, or low-pumping efficiency of the heart (heart failure) are at a greater risk of developing serious Covid-19 infection. Those above 60 years with hypertension or diabetes have a five times greater risk of dying from it. On the other hand, even a mild coronavirus infection can lead to the worsening of previously stable heart disease, which may require urgent medical care. Therefore, heart patients must protect themselves should not be afraid to seek medical attention.
“People with underlying medical conditions such as heart disease and diabetes were hospitalized six times as often as otherwise healthy individuals infected with the novel coronavirus during the first four months of the pandemic, and they died 12 times as often, according to a federal health report.”
“New observations show that the virus can affect the heart in previously healthy individuals also. The virus can cause severe inflammatory responses in the body that affect the arteries and, also causes an increased tendency for clotting. This can lead to heart attacks and strokes, and people of younger age groups may not be immune to that”, asserts Dr Sameer Gupta, Director- Interventional Cardiology, Metro Hospital & Heart Institute.
When Sudden Cardiac Arrest (SCA) happens, the person collapses, becomes unresponsive, and is breathing abnormally or not at all. Survival depends on the quick actions of people nearby (Bystanders) to activate Emergency Medical Services (EMS) and to start cardiopulmonary resuscitation (CPR), and if available, use an automated external defibrillator (AED) as soon as possible. About half of the cases are witnessed. Successful revival of the victim requires an organized set of inter-linked rescuer actions (the “chain of survival”), of which the initial links are immediate recognition of cardiac arrest and activation of the emergency response system, early resuscitation (CPR) with an emphasis on chest compressions, and rapid defibrillation. Bystander CPR (BCPR) has been shown to double or even triple survival from OHCA (Out of Hospital Cardiac Arrest). BCPR is a key link in the chain of survival for OHCA.
OHCA is one of the leading causes of death in India due to cardiovascular diseases. Around 98% of Indians are not provided with basic life-saving techniques of CPR at the time of SCA. The lack of knowledge of CPR skills and training among bystanders in the community is the main reason why most OHCA patients in India die. Hence, the outcome of OHCA in India is poor, as compared to other countries, where EMS systems are an integral part of the health-care system, which routinely provides CPR to every victim of cardiac arrest. However, in India, still, many victims of cardiac arrest are not getting help on time due to a lack of awareness on when to respond.
Dr. Dheeraj Garg, Senior Consultant – Cardiology at Dharamshila Narayana Superspeciality Hospital, Delhi, on being asked, “How can we prevent SCD?”, says, “Since our country has an alarmingly high prevalence of CAD, Hypertension, Diabetes, and Dyslipidemia, the incidence of SCD is on the rise. The hospital treatment of heart attack incidences has improved and reduced the in-hospital death rates of this disease. However, the out-of-the-hospital SCD still remains a major killer. Community education about healthy lifestyle, prevention and adequate treatment of the above-mentioned diseases form the cornerstone for prevention of SCD. Regular medical checks are essential for all so as to detect and treat CAD and its risk factors. Patients who are high-risk candidates, especially those with a decreased Left Ventricular Ejection Fraction (LVEF) less than 35%, should be counselled and educated about the risk of SCD. Drug treatment and ICDs should be offered to all these patients.
To conclude, the treatment and prevention of SCD is akin to preventing fatal car accidents. Adopting a healthy lifestyle (like following road safety rules), getting regular health checkups to keep the risk factors under control (like the periodic car maintenance), drug treatment for established CAD and ICDs for those at very high risk (like the presence of air-bags in case of fatal accidents) are the means to reduce SCD (like avoiding fatal accidents).
Mass education to empower the bystanders to recognize and respond early to this situation and government initiatives to install AEDs at high population density areas can achieve higher survival rates from this mounting threat to mankind.”
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