Every year it is estimated that 400,000 people die of sudden cardiac arrest (SCA), the number one cause of death, in the USA. There are usually no warning signs or symptoms. This is different than a heart attack, a result of cholesterol buildup which then cracks and causes a clot formation, leading to a clogged artery and subsequent dead heart muscle portion. One might therefore characterize a heart attack as a ‘plumbing’ problem. Sudden cardiac arrest, in contrast, is an ‘electrical’ problem. It is sudden, as the name suggests, and is actually a very rapid chaotic electric rhythm, which, if not treated with a shock from a defibrillator, will result in death in a few short minutes.
Clinical studies have shown that people at highest risk of SCA may be identified by simple non-invasive tests done at the office of a cardiologist. Most patients who experience SCA have prior heart damage and a decrease pumping function, called the ejection fraction, or EF. Studies show that the best numerical indicator of an increased risk of SCA we have to date (though it does need to be taken in context of other issues) is an EF of less than or equal to 35% (normal being greater than 55%). The cause of a low EF is usually a prior heart attack or weakened heart muscle from a variety of causes, sometimes unknown. All patients with a history of a heart attack or congestive heart failure (CHF) should know what their EF is. A patient with a low EF should have a referral to a cardiac electrophysiologist (a cardiologist with specialty training in the evaluation and treatment of heart rhythm disorders) for consideration of implantation of an implantable cardioverter defibrillator (ICD).
So how does this relate to digital health technology and an EHR? The EF, once determined commonly by way of a sonogram of the heart (echocardiogram) or nuclear stress test should be recorded in the EHR. Therefore, with a diagnosis of CAD (coronary artery disease) or CHF cited in the primary or secondary diagnoses of the EHR’s ‘front page’, the EF should be either affixed next to the diagnosis or linked to it. Some EHRs can readily be mined for the information. A clinical decision support tool for patients with a low EF could be implemented, suggesting referral to a cardiologist or electrophysiologist for consideration of an ICD. With paper charts, the diagnostic tests to determine an EF might not be sought after or difficult to locate (especially if performed by a specialist, outside lab, or hospital). The EHR might be programmed to deliver a ‘tickler’ to obtain an EF measurement if a new pertinent diagnosis is entered. In this way, the EHR may act as both an informational organizer and decision support tool for either a primary care physician or cardiologist to not lose sight of the potential increased risk of SCA of a patient. Clinical decision support tools like this are reasons why Meaningful Use is extremely meaningful, especially if it is YOUR loved one’s life at stake. In addition, patient portals containing this information will be useful if public awareness campaigns about sudden cardiac arrest are combined with progress in portal access. A single click of a tablet screen may save a patient’s life! For more information, see http://www.hrsonline.org/PatientInfo/HeartRhythmDisorders/SCA/index.cfm).