Protocol - Sudden Cardiac Arrest
Description:
This measure assesses if a patient died of sudden cardiac arrest by reviewing symptoms prior to death, timing of death, possible cardiac origin via autopsy evidence, and/or demonstration of a history of cardiac disease via physician questionnaire and medical records review.
Specific Instructions:
These protocols should be completed for cases where patients did not survive a sudden cardiac arrest. The physician's questionnaire from the Atherosclerosis Risk in Communities (ARIC) study is to be completed by the physician who signed the death certificate and/or the patient's physician. The second protocol, from the Multi-Ethnic Study of Atherosclerosis (MESA), provides items that should be abstracted from the patient's hospital records.
Protocol:
To be completed by physician who signed the death certificate and/or the patient's physician.
1. Are you familiar with the events surrounding the decedent's death?
[] Yes
[] No
2. Did you witness the death?
[] Yes
[] No
If you answered No to both 1 and 2, skip to end. Otherwise, continue with item 3.
3a. Was there any pain in the chest, left arm or shoulder or jaw within 72 hours of death?
[] Yes
[] No
[] Uncertain
If No or Uncertain, skip to item 4.
3b. Did the pain include the chest?
[] Yes
[] No
[] Uncertain
3c. Did you think this pain was of a cardiac origin?
[] Yes
[] No
[] Uncertain
If No, specify what you think was the cause:
4. Was cardiopulmonary resuscitation (CPR) and/or cardioversion performed within 24 hours of death?
[] Yes
[] No
[] Uncertain
5. Please give time between onset of acute symptoms to death. (We are defining death as the point where spontaneous breathing ceased and the patient never recovered.)
[] More than three days
[] Two - three days
[] One day
[] At least 12 hours, but less than 24 hours
[] At least 4 hours, but less than 12 hours
[] At least 1 hour, but less than 4 hours
[] Less than 1 hour
[] Death instantaneous, no symptoms
[] Unknown
6. Would you classify the decedent's cause of death as due to Coronary Heart Disease (CHD)?
[] Yes
[] No
[] Uncertain
To be abstracted from patient's hospital medical records.
7. Location of death:
[] Out-of-Hospital
[] Emergency Room (not dead on arrival—DOA)
[] In Hospital
[] Nursing Home, Skilled Nursing Facility (SNF), or Extended Care Facility (ECF)
[] Other, specify:
8. Was the death witnessed?
[] Yes
[] No
[] Unknown
9. Multi-Ethnic Study of Atherosclerosis (MESA) classification of underlying cause of death (choose one):
[] Atherosclerotic coronary heart disease (complete questions 10, 11 and 12 only)
[] Stroke (skip to end)
[] Atherosclerotic disease other than coronary disease or stroke (specify): _______________________________ (complete question 12 only)
[] Other cardiovascular disease, not defined above (specify):_______________________________ (complete question 12 only)
[] Non-cardiovascular disease (specify):_______________________________ (skip to end)
[] Unknown because death certificate unavailable (skip to end)
10. Type of fatal coronary heart disease:
[] Definite fatal myocardial infarction (MI) (no known non-atherosclerotic cause and definite myocardial infarction within 4 weeks of death)
[] Definite fatal coronary heart disease (CHD) (no known non-atherosclerotic cause, and one or both of the following: chest pain within 72 hours of death or a history of chronic ischemic heart disease)
[] Possible fatal coronary heart disease (CHD) (no known non-atherosclerotic cause, and death certificate underlying cause: I20-25, I46, I51.6, R96 or R98-99)
11. Estimated time between onset of acute cardiac symptoms and death:
[] Less than five minutes
[] five minutes to one hour
[] one hour to 24 hours
[] More than 24 hours
[] Unknown
12. Mechanism of death in patients dying of cardiovascular causes (check all that apply):
[] Primary arrhythmic death
[] Secondary arrhythmic/mechanical death
[] Congestive heart failure (CHF)
[] Cardiac procedure such as coronary artery bypass graft (CABG) or angioplasty
[] Hemorrhage from thrombolytic therapy
[] Other (specify):_______________________________
[] Unknown or Uncertain
Protocol Name from Source:
The Expert Review Panel has not reviewed this measure yet.
Availability:
Personnel and Training Required
A trained and certified Hospital Record Abstractor is required to complete the protocol from Multi-Ethnic Study of Atherosclerosis (MESA). This person should be trained on how to perform medical record and chart abstraction using various hospital records.
A physician who signed the death certificate and/or the patient's physician.
Equipment Needs
None
Requirements
| Requirement Category | Required |
|---|---|
| Major equipment | No |
| Specialized training | Yes |
| Specialized requirements for biospecimen collection | No |
| Average time of greater than 15 minutes in an unaffected individual | No |
Mode of Administration
Self-administered questionnaire and medical record abstraction
Life Stage:
Adult
Participants:
Atherosclerosis Risk in Communities (ARIC): ≥45 years old
Multi-Ethnic Study of Atherosclerosis (MESA): ages 45–85 years old
Selection Rationale
Two protocols were chosen to obtain sufficient data to assess whether a patient died of sudden cardiac arrest. Obtaining this information from a physician, in combination with medical records, will provide a high level of specificity and reliability.
Language
English, Spanish
Standards
| Standard | Name | ID | Source |
|---|---|---|---|
| Common Data Elements (CDE) | Death From Cardiac Arrest Indicator | 2935447 | CDE Browser |
| Logical Observation Identifiers Names and Codes (LOINC) | Sudden cardiac arrest proto | 62396-7 | LOINC |
Derived Variables
None
Process and Review
The Expert Review Panel has not reviewed this measure yet.
Source
U.S. Department of Health and Human Services. National Institutes of Health. National Heart, Lung and Blood Institute. Atherosclerosis Risk in Communities (ARIC). Physician Questionnaire Form. Questions 5–7 (source for questions 1–3 in Protocol Text), questions 10–12 (source for questions 4–6).
U.S. Department of Health and Human Services. National Institutes of Health. National Heart, Lung and Blood Institute. Multi-Ethnic Study of Atherosclerosis (MESA). Mortality Review Form. Questions 1–6 (source for questions 7–12).
General References
For the Multi-Ethnic Study of Atherosclerosis (MESA) hospital record abstraction diagnosis criteria, see MESA Clinical Events Manual of Procedures, Section 4.2: Criteria for Deaths.
http://www.mesa-nhlbi.org/PublicDocs/MesaMOO/Appendix11_MESA_ClinicalEvents_MOP.pdf
Protocol ID:
40701
Variables:
Export Variables| Variable Name | Variable ID | Variable Description | Version | dbGaP Mapping |
|---|---|---|---|---|
| PX040701_Cause | PX040701090000 | Multi-Ethnic Study of Atherosclerosis (MESA) classification of underlying cause of death (choose one) | 4 | N/A |
| PX040701_Cause_Noncardiovascular_Disease_Specify | PX040701090300 | Multi-Ethnic Study of Atherosclerosis (MESA) classification of underlying cause of death: Non-cardiovascular disease (specify) | 4 | Variable Mapping |
| PX040701_Cause_Other_Atherosclerotic_Disease_Specify | PX040701090100 | Multi-Ethnic Study of Atherosclerosis (MESA) classification of underlying cause of death: Atherosclerotic disease other than coronary disease or stroke (specify) | 4 | N/A |
| PX040701_Cause_Other_Cardiovascular_Disease_Specify | PX040701090200 | Multi-Ethnic Study of Atherosclerosis (MESA) classification of underlying cause of death: Other cardiovascular disease, not defined above (specify) | 4 | N/A |
| PX040701_CHD | PX040701060000 | Would you classify the decedent's cause of death as due to Coronary Heart Disease (CHD)? | 4 | N/A |
| PX040701_CPR | PX040701040000 | Was cardiopulmonary resuscitation (CPR) and/or cardioversion performed within 24 hours of death? | 4 | N/A |
| PX040701_Fatal_CHD_TYPE | PX040701100000 | Type of fatal coronary heart disease. | 4 | N/A |
| PX040701_Location | PX040701070000 | Location of death | 4 | N/A |
| PX040701_Location_Other_Specify | PX040701070100 | Location of death | 4 | N/A |
| PX040701_Mechanism | PX040701120000 | Mechanism of death in patients dying of cardiovascular causes (check all that apply). | 4 | N/A |
| PX040701_Mechanism_Other_Specify | PX040701120100 | Mechanism of death in patients dying of cardiovascular causes | 4 | N/A |
| PX040701_Pain | PX040701030100 | Was there any pain in the chest, left arm or shoulder or jaw within 72 hours of death? | 4 | N/A |
| PX040701_Pain_Cardiac_Origin | PX040701030300 | Did you think this pain was of a cardiac origin? | 4 | N/A |
| PX040701_Pain_Cardiac_Origin_Specify_Cause | PX040701030301 | Did you think this pain was of a cardiac origin? If no, specify what you think was the cause. | 4 | N/A |
| PX040701_Pain_Include_Chest | PX040701030200 | Did the pain include the chest? | 4 | N/A |
| PX040701_Physician_Familiar_With_Event | PX040701010000 | Are you familiar with the events surrounding the decedent's death? | 4 | N/A |
| PX040701_Physician_Witness_Death | PX040701020000 | Did you witness the death? | 4 | N/A |
| PX040701_Symptom_Time | PX040701050000 | Please give time between onset of acute symptoms to death. (We are defining death as the point where spontaneous breathing ceased and the patient never recovered). | 4 | N/A |
| PX040701_Symptom_Time_Estimated | PX040701110000 | Estimated time between onset of acute cardiac symptoms and death. | 4 | N/A |
| PX040701_Witness_Record | PX040701080000 | Was the death witnessed? | 4 | N/A |
Measure Name:
Sudden Cardiac Arrest
Release Date:
September 9, 2009
Definition
Measure to assess if patient died of sudden cardiac arrest.
Purpose
To determine if a patient died of sudden cardiac arrest through a physician's assessment of the patient's conditions and medical record abstraction to make a determination of the probability of coronary heart disease, peripheral vascular disease and cerebral vascular disease.
Keywords
cardiovascular, coronary heart disease, cerebral vascular disease, autopsy, Atherosclerosis Risk in Communities, ARIC, Multi-Ethnic Study of Atherosclerosis, MESA, heart attack, sudden cardiac arrest, SCA, sudden cardiac death, SCD, chest pain, coronary heart disease, CHD, near fatal arrhythmia, external cardiac defibrillation, implantable pacemaker, personal history