Addressing disparities in sudden cardiac arrest care and the underutilization of effective therapies.

Sudden cardiac arrest (SCA) is the most common cause of death in the Unites States. Despite its major impact on public health, significant challenges exist at the patient, provider, public, and policy levels with respect to raising more widespread awareness and understanding of SCA risks, identifying patients at risk for SCA, addressing barriers to SCA care, and eliminating disparities in SCA care and outcomes. To address many of these challenges, the Duke Center for the Prevention of Sudden Cardiac Death at the Duke Clinical Research Institute (Durham, NC) held a think tank meeting on December 7, 2009, convening experts on this issue from clinical cardiology, cardiac electrophysiology, health policy and economics, the US Food and Drug Administration, the Centers for Medicare and Medicaid Services, the Agency for Health Care Research and Quality, and device and pharmaceutical manufacturers. The specific goals of the meeting were to examine existing educational tools on SCA for patients, health care providers, and the public and explore ways to enhance and disseminate these tools; to propose a framework for improved identification of patients at risk of SCA; and to review the latest data on disparities in SCA care and explore ways to reduce these disparities. This article summarizes the discussions that occurred at the meeting.

Experiences of sudden cardiac arrest survivors regarding prognostication and advance care planning.

OBJECTIVE: We sought to better understand SCA survivors' beliefs about complex issues that arise in the immediate post-arrest period and explore advance care planning. Specifically, we wished to explore four themes: (1) patient and family perception of medical providers' prognostication in the immediate post-arrest phase; (2) patient definitions of death; (3) use of advance directives (ADs); and (4) perceptions of health and organ donation. METHODS: We conducted a qualitative study of adult arrest survivors using semi-structured telephone interviews. Participants were recruited from a nonprofit national organization for SCA. RESULTS: Nine of 11 subjects contacted completed the survey. In the immediate post-arrest phase, subjects believed that medical professionals made errors in giving poor prognosis early in the course of resuscitation. While some subjects felt they had experienced "death," some subjects felt the term "death" was an inappropriate term to describe their experience. The majority of the subjects did not have an AD prior to their SCA and no subjects reported having a conversation about ADs with their medical team. While the majority of subjects classified their health as "very good" or "excellent," few subjects were registered organ donors, citing comorbidities and skepticism about future resuscitative efforts as rationale. CONCLUSIONS: Our study elucidated the attitudes and experiences of SCA survivors. Variability in prognostication timing and inconsistency in describing SCA can complicate discussions between the medical team and families. AD and organ donation discussions may help to provide sensitive care concordant with a patient's wishes.