We've all heard about sudden cardiac arrests occurring among superfit elite athletes, especially footballers.
Just last week (December 2021), Algerian footballer Sofiane Loukar died after colliding with his goalkeeper during a match.
He resumed playing after treatment, but collapsed on the field 10 minutes later.
He was rushed to the hospital, but died of a heart attack on the way.
When a sudden cardiac arrest happens, there is loss of heart function, breathing and consciousness.
The condition usually results from a problem with the heart’s electrical system, which disrupts the heart’s pumping action and causes blood flow to cease to the rest of the body.
Statistics show that up to 90% of heart attack patients tend to develop an abnormal heart rhythm (arrhythmia) and one in four will most likely have a dangerous rhythm, leading to sudden cardiac death.
Heart rhythm problems occur when the electrical signals that coordinate the heart’s beats don’t work properly.
The faulty signalling causes the heart to beat too fast (tachycardia), too slow (bradycardia) or irregularly.
Timely response is crucial in all incidents of cardiac arrest, as the chance of survival decreases by 10% with each minute that passes without help.
Even if the sudden cardiac arrest occurs in a hospital with all the necessary equipment available for treatment, the outcome is poor if the patient is not attended to immediately.
Dr Sathvinder Singh Sidhu, a cardioelectrophysiology fellow at Hospital Serdang’s Heart Centre in Selangor, explains: “We only have one to three minutes to respond if the patient has an abnormal rhythm.
“Before Covid-19, most of these patients would be closely monitored in critical care units (CCU), which are equipped with sufficient staff.
“But during the pandemic, we had to reserve some beds for Covid-19 patients and send these cardiac patients to the general ward.“This created a gap in terms of treatment if they developed a sudden, fast rhythm.
“If a patient suffers from an event and we resuscitate, the chances of survival is only 23%, which is pretty low.”
In the United States, studies reveal that it takes three minutes for a healthcare worker to respond to a patient having an abnormal rhythm.
In Malaysia, it may take a bit longer, especially when you consider the shortage of cardiac care staff in public hospitals.
This is where the usage of Hospital Wearable Defibrillators (HWDs) can complement a hospital’s resuscitation protocol and provide timely defibrillation via an electrical shock.
Says Dr Sidhu: “We started using HWDs in Hospital Serdang last March (2021) when we found that we were losing patients under our close care because Covid-19 cases were going up and fewer intensive care unit (ICU) and CCU beds were available for other patients.
“That was one of the motivations for us to start using HWDs.
“We felt much more ‘safer’ sending patients at risk for cardiac arrest to the general ward where the monitoring may not be as close as for CCU or ICU beds.”
Unlike an implantable cardioverter defibrillator (ICD), the HWD is worn outside the body, rather than implanted in the chest.
It provides extra protection by constantly monitoring the patient’s heart with adhesive electrodes, automatically detecting life-threatening arrhythmias and providing immediate treatment.
This can improve the survival rate to as high as 91%.
“If the patient develops a fast or abnormal heart rhythm, this device picks it up and lets out an alarm so everyone around is aware there is an abnormal rhythm going on.
“It gives a gap of 30 seconds before delivering a shock to reset the heart and improve the survival rate.
“It’s life-saving,” he says.
“It also helps us in monitoring so that we know when to move the patient to the ICU,” he adds.
If the arrhythmia continues after the first treatment shock, the sequence repeats and multiple shocks may be given.
He adds: “These HWDs are easy to use as it’s just a pouch and pad; it keeps the patient mobile and he can walk around with it.
“If anything happens, the siren will go off and give ample time for the patient to sit down.
“It’s beneficial to the patient and cardiologist as it gives us real-time data and peace of mind that the patient is being effectively treated.”
Saved by the device
“We did a study in post-heart attack patients from January to June in 2020 and found that there was a 1.9% increase in deaths compared to the corresponding period the previous year (2019).
“We postulated that the reasons could be due to less close monitoring as we moved them to general wards, less CCU and ICU beds, and fewer staff to monitor these patients.
“In September (2021), we had three patients detected to have a fast heart rate and this HWD saved their lives.
“The device fills the gaps and provides a lot of advantages.
“It also gives us the opportunity to free up more beds in the ICU,” says Dr Sidhu.
As the hospital currently only has three HWDs, the cardiologists will decide who gets to wear it.
He explains: “We choose patients who are at high risk of developing these arrhythmias and patients who are stable, but we have high suspicion that they might develop an unstable rhythm.
“True enough, it worked.”
He added: “Interestingly, we had one or two patients we suspected were stable, even during pre-pandemic times, and transferred them to the general ward.
“One of them had a sudden cardiac arrest and was successfully resuscitated by this HWD.
“So, there is definitely a wide use for this device.”
First in the region
While there is no data on the number of sudden cardiac arrests in Malaysian hospitals, heart disease is still the number one cause of death here.
According to the Department of Statistics, ischaemic heart disease remains the principal cause of death nationwide, making up 15% of the 109,164 medically-certified deaths in 2019.
This was followed by pneumonia (12.2%), cerebrovascular diseases (8%), transport accidents (3.8%) and malignant neoplasm (cancer) of the trachea, bronchus and lung (2.4%).
“I believe 25% of this number (the 15% of deaths from ischaemic heart disease) probably occurred immediately after a heart attack and this group could have been saved if they were resuscitated earlier,” says Dr Sidhu.
“The numbers are huge and we are definitely getting additional help with the HWDs.
“In our hospital, we are coming up with one year’s worth of data and trying to create more awareness on the usage of this device, even among medical professionals.”
As Klang Valley’s referral centre for cardiology and heart-related illnesses, Hospital Serdang is the first public hospital in the region to use HWDs – Thailand and Singapore have just started using them.
“We treat many high-risk patients and they come from all over the country, so we decided to bring in this HWD, especially since our data showed the mortality rate (from sudden cardiac arrest) was increasing during Covid-19 and this device could save lives, so it justifies purchasing it,” he explains.
The pandemic has accelerated the use of wearable devices in many areas, and heart patients can also do their own monitoring at home.
“In Hospital Serdang, we use Kardia, a small device shaped like a slide that patients can slip into their pockets and carry around.
“If they feel any palpitations, they just insert two fingers into the sensors, which are connected to Bluetooth, and it will generate an electrocardiogram (ECG).
“They will then email this ECG to the cardio team for further action.“
So, the home-monitoring scenario is also expanding,” he says.