Oregonian, The (Portland, OR)
September 15, 2004 COUNTY IS A HEART-DISEASE LAB
Author: ANDY DWORKIN - The Oregonian Summary: Scientists examine cardiac arrest data gathered by hundreds of medical professionals and find insights with far-reaching value Marc Schlotthauer's honeymoon ended with the shock of his life. In 1998, the newlywed had just returned from California and fallen asleep in his Stayton bedroom when his heart stopped cold. "My wife happened to be in the room. I sat up and she said my head looked like an eggplant. It was purple and bloated," starved of air, he said. "She actually reached into my mouth and yanked on my tongue, and it popped like the seal on a canning jar." Fortunately, paramedics from a nearby fire house arrived in two minutes to send electric shocks to the dying heart. It resumed beating on the sixth jolt. Schlotthauer, now 37, is a rare survivor of "sudden cardiac arrest" -- an unexpected halt to the heart's steady beat. Each year, that tragedy strikes at least 150,000 U.S. residents, from infants! and high school athletes to the elderly. Most die. And doctors don't know what causes the problem, just how common it is or who is at greatest risk. But a pioneering study that has made Multnomah County a living heart-disease laboratory is teaching scientists about these deaths. Since 2002, paramedics, coroners and doctors have investigated every unexpected cardiac death among the county's 675,000 residents, seeking clues to predict and prevent the crises. Two early, surprising findings appear in today's Journal of the American College of Cardiology: Sudden cardiac deaths, although common, are much less common than previously thought. And women suffer almost as much as men, though many doctors thought they were three times less prone to the condition. Such insights should be the first of many gleaned from the medical records, blood and autopsied hearts of Oregonians, said Dr. Sumeet Chugh, the Oregon Health & Science University Heart Center researc! her leading the study. "The goal is to make Multnomah County al most like a model county for the nation," he said. Chugh hopes the effort can rival the famous Framingham Heart Study, now in its 56th year. That research project has tracked more than 10,000 Massachusetts residents to establish some now basic heart-health ideas, such as links between cholesterol and heart disease and smoking and heart disease. So far, the Multnomah County study has recorded about 850 cases of what Chugh calls "the ultimate heart rhythm problem." Just 8 percent of county residents survive, said Chugh -- slightly better than the U.S. average. Of course, all deaths involve the heart stopping. Sudden cardiac death is defined as death from heart rhythm problems within an hour of the first symptoms -- or, for those who die alone, within 24 hours of being seen alive and symptom-free. The rhythm problem differs from a heart attack, which hits when clots or fatty deposits block vessels to the heart. Federal tally thought high
Doctors ! long thought that about 300,000 Americans every year suffered sudden cardiac arrest. But in 2000, federal Centers for Disease Control and Prevention scientists tallied death certificates and made a much higher annual estimate: about 450,000 U.S. cases. Suspicion of that estimate fed Chugh's interest in carefully tracking cardiac deaths as they happen instead of through historic records. That meant gathering millions of dollars in grants and hundreds of collaborators: the Multnomah County medical examiner, workers at 16 area hospitals and every county paramedic. When any of those people found a likely case of cardiac arrest, they contacted Chugh's group. With permission from survivors or family, three cardiologists reviewed medical records to check which cases met the definition of sudden cardiac arrest. Then they compared their results against death certificates. The doctors found 353 sudden cardiac arrests, leading to 325 deaths, in Multnomah County fr! om Feb. 1, 2002, through Jan. 31, 2003. That covers 5.2 percent of the 6,255 county residents who died in that span. Oregon death certificates vastly overcounted, listing 1,007 sudden cardiac deaths. Still, they missed some cases, Chugh said. "A death certificate is not scientifically accurate," he said. "It should be. But it's not." If other regions can duplicate the findings -- which Chugh hopes will happen -- then the annual U.S. death toll from sudden cardiac arrest would be about 200,000, half the Centers for Disease Control estimate. Women, people alone
The Multnomah County study yielded other notable numbers: Women had about 43 percent of sudden cardiac arrests, well above the 25 percent many doctors had expected. Roughly half of all victims were alone when their hearts stopped. And more than four-fifths of the crises happened at home. The condition's private nature is a problem, since most automatic defibrillators -- tools that can revive stopped hearts -- are in public spaces such as malls. Peopl! e whose hearts halted in public were three times more likely to survive. Those data reinforce county efforts to put automatic defibrillators in more public areas, said Dr. Jonathan Jui, medical director of Multnomah County Emergency Medical Services and one of the study researchers. Portland International Airport is getting automated defibrillators this year, he said. Learning CPR can also help others' odds of surviving sudden cardiac arrest, Jui added. Chugh is hoping that the study's coming years will increase doctors' odds of predicting who will suffer sudden heart death. Today, the known risks are advancing age and having a heart weakened by disease, Chugh said. That covers far too many people to treat, since prevention involves implanting a defibrillator surgically. Some studies suggest that parents pass risk of sudden cardiac death to children, Chugh said. So OHSU researchers, with partners at Johns Hopkins University, will use advanced computers ! to screen DNA for genetic mutations in blood samples collected from ev ery county cardiac death victim. Researchers also recorded about 600 pieces of demographic information on every sudden cardiac death victim. Soon they hope to run the data through a computer program that can highlight trends. That could tell whether the disease risk is affected by a host of factors including income, profession and weight. Knowing your risk would be a boon to people such as Schlotthauer, whose father died of sudden cardiac arrest at age 32. The Stayton man knows he was fortunate to have lived near paramedics when his heart stopped. Within weeks of his crisis, he was back at work, with no restrictions on his normal life and a defibrillator in his chest. That device has to shock his heart into order about every six months, an event both nervous and almost joyful. "Every time that happens," he said, "is basically a death experience averted." Copyright (c) 2004 Oregonian Publishing Co.
Record Number: 0409150124 | 
