By Dr Richard Charles
October is Sudden Cardiac Arrest (SCA) awareness month – an annual campaign which raises awareness of the condition that affects 100,000 people in the UK each year. Unlike a heart attack, which is caused by impeded blood flow through the heart, SCA is caused by a structural or electrical problem with the heart, usually as a result of an underlying condition.
For up to fifty per cent of those that suffer SCA, it is the first indication that there is anything wrong with their heart. As such, there has been a concerted focus among health authorities in the UK and globally on prevention and screening, to predict major problems before they occur and work to stratify groups based on risk.
Let’s take an example of a broad approach to this, stepping away from SCA for the moment. Since the beginning of September this year, community pharmacists in England have offered free, on-the-spot heart check-ups, including blood pressure and cholesterol tests, with the aim of preventing up to 150,000 heart attacks and strokes within a decade. These high street heart checks aim to meet ambitious targets the NHS in England has set itself as part of its Long Term Plan to improve a range of health outcomes.
Basic screening for risk factors is a fantastic contribution to early detection of problems that could become more serious, and makes positive, closer links between the cardiology community and pharmacy colleagues. However, while basic general population screening is an important part of improving outcomes, there is still a lot of work to be done in risk stratifying patients across a range of cardiac conditions, even within groups already determined to be at risk.
Let’s return again to SCA to examine this challenge in more detail. Within a group of patients determined to be at risk of sudden cardiac death under current guidelines, we know that only a small proportion of patients subsequently suffer a ventricular arrythmia. But at the point a clinician determines the appropriateness of implanting a patient with a cardioverter defibrillator — a potentially life-saving device in the event of an arrythmia occurring — they can’t say with any degree of accuracy whether or not that patient will experience SCA. This means that there is on the one hand a group of patients with expensive and intrusive devices that are never ultimately required and, on the other, those who didn’t have one fitted who will potentially die of SCA.
This time last year Creavo stated that it was hoping to assess the potential for magnetocardiography (MCG) technology to more accurately predict which patients will develop a ventricular arrhythmia that requires therapy from an implantable cardioverter defibrillator (ICD). I’m pleased to announce that a major study is now underway, which Creavo will be sharing further detail on very shortly.
Broadly speaking, the study will assess the potential to stratify within a group already determined at risk of sudden cardiac death. If such studies among those with ICDs or other high-risk groups were successful, we could then begin to look at using MCG to screen a much wider population.
This brings us back to the importance of broader population screening initiatives. Heart health screening should be an urgent item on the public health agenda and as physicians, we should be continuously looking at ways in which innovative technology can play a role.
In the meantime, it’s imperative that we continue to raise awareness of the known risk factors for arrhythmias and heart disease, including obesity, high cholesterol, smoking and high blood pressure. Only by focusing on prevention and screening can we radically improve overall heart health and increase survival rates.
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By Dr Richard Charles