Two Cost Comparison’s for Cardiac Arrest Prevention Programs

 

Brock Reuther died as a result of a sudden cardiac arrest experienced while playing volleyball at his Alberta High School in May of 2012. Since that day Brock’s mom Kim has been advocating for programs to prevent other families from experiencing the pain the Reuther’s have gone through and it has been, to say the least, an uphill battle.     http://projectbrock.com/

I was speaking with Kim this week and shared with her two comparators that I often use when speaking about preventing sudden cardiac arrest in youth. She asked if I could send them to her in writing so here they are.

The HPV (Gardasil™) Vaccine vs. ECG Screening for Heart Arrhythmia

In August of 2007 the Government of Ontario announced it would spend $39 million to provide every Grade 8 girl in the province with the vaccine for Human Papillomavirus (HPV) which is known to be a cause of many cervical cancers. That works out to a little over $400.00 per child. Cervical cancer claims the lives of 150 women of all ages in Ontario each year and is the second most common type of cancer in women between ages 22 and 44.  This is an expensive but worthwhile prevention program that will assuredly save young lives.

For many years patient advocate groups in Canada have been seeking funding and support for a pilot study into ECG screening of young teens. Many advocates would like to see the screening process include Echocardiogram as well. Published studies show that ECG alone can be over 80% effective at identifying children at-risk for sudden cardiac arrest and when Echo is added screening will identify over 90% of those at-risk.  The tests are non or minimally invasive and very inexpensive. The Ontario Health Insurance Plan billing code for an ECG to be acquired and read by a physician is $11.05. A targeted Echo is a little more expensive at $33.50.  For 10% of the cost of an HPV vaccine we could protect all young people from a far more prevalent and preventable cause of death – Sudden Cardiac Arrest.

A $250,000 grant would easily fund a pilot study that could gather, study, analyze, weigh the values and publish the results of screening tests for over 5,000 youngsters. Every year 700 young people die suddenly of cardiac causes in Canada - 200 in Ontario, 65 in British Columbia, 60 in Alberta, etcetera.   An ECG/ECHO screening program for teenagers is relatively inexpensive and assuredly would save hundreds of young Canadians from sudden death.

Note: ECG screening of elite athletes in northern Italy has reduced sudden cardiac arrest deaths in that population by 89%.

Anaphylaxis Awareness vs. Sudden Cardiac Arrest Awareness

In the spring of 2012 I gave a talk on Recognizing and Managing Cardiovascular Emergencies to 250 Human Resources professionals from across Ontario. A portion of the talk included a discussion of cardiac arrest in youth.

·        I asked for a show of hands to the question “How many of you know that you cannot send a child to school with peanut products in their lunch?”

o   Virtually every hand in the room went up.

·        I then asked “How many of you know that “fainting” is a common warning sign of a potentially lethal heart rhythm disorder?”

o   Perhaps 10 hands went up.

·        I then asked “How many kids in Ontario will die this year from peanut allergies?”

o   The answer is probably none, perhaps one and if it is a very bad year two.  Note : 2 deaths in ON since 2010

·        Finally I asked “How many young people will die in Ontario this year as a result of Sudden Cardiac Arrest?”

o   The answer is 200 – a palpable buzz went through the room.

It is fantastic that the Provincial Government and the School Boards that it funds have invested so much money, time and effort into creating universal awareness and compliance for strategies for preventing two or three peanut allergy deaths each decade. It is frustrating and nonsensical that the same Government and the same School Boards have invested virtually nothing into awareness and prevention strategies for the most common cause of death on school properties and the most common medical cause of death amongst Ontario children.

Every patient advocate probably believes that research and programming for their disease is underfunded. Those of us working to protect the lives of children at-risk for Sudden Cardiac Arrest can look around and see tens of millions of dollars being spent on prevention strategies for diseases that cause less than 1% of the suffering brought on by Heart Arrhythmia Diseases. We would never want or ask Governments to cut back that spending, we are simply asking them to listen to our story and act on our requests for similar consideration. Again this year 700 young Canadians will die suddenly of cardiac causes, many of those deaths should be prevented.

A Five Point Cardiac Arrest Prevention Strategy for Canadian Schools

Here is an excerpt from an article written on research presented by Dr. Andrew Krahn at the 2012 Canadian Cardiovascular Congress.

“Our research gives us an idea of the scope of the problem – there are almost 200 young people who die suddenly every year in Ontario. A good proportion of them have unrecognized heart disease. So the question is: How can we catch this before it happens,” says Krahn.

He suggests that more attention be paid to possible warning signs such as fainting. He believes that teachers, coaches and an aware public may be key to detecting risk, ensuring prevention and formal medical evaluation and therapy.

“I would advocate for careful screening of people who faint, using questionnaires and education of healthcare professionals so that when warning signs present themselves, they recognize them and this information gets passed on to the right people,” he says.

http://news.bioscholar.com/2012/10/hidden-disease-sports-sudden-cardiac-arrest.html

With virtually no hard cost every School Board could implement Dr. Krahn’s recommendations for preventing sudden death in children. The five key elements of a Cardiac Arrest Prevention Strategy are: 

A 20 Minute Arrhythmia Awareness Training Program that provides some background on Inherited Heart Rhythm Disorders (IHRD) and explains the warning signs and how to respond appropriately to those warnings. It should be available on-line to all staff and families but should be mandatory for all staff taking AED/CPR certification training and for all Physical Education Teachers and Coaches

A Pre-Participation Screening Questionnaire that would be completed by all parents/guardians at the time of enrolment at a new school. When there are positive answers in both the patient history and family history sections of the questionnaire the family should consult a physician immediately.
http://leadingcause.blogspot.ca/2013/05/inherited-heart-rhythm-disorder-pre.html

Mandatory 9-1-1 Calling  for Loss-of-Consciousness Fainting (syncope) It may be mandatory 9-1-1 for all syncope or at the very least mandatory 9-1-1 for all syncope occurring during or shortly after physical activity. In most communities ambulance are equipped with ECG monitoring equipment and paramedics are trained in heart rhythm recognition. Our tax dollars paid for this equipment and training it only makes sense to use it. 

Mandatory Notification of Parents/Guardians of all Syncope including providing them with information about IHRD’s. Parent's must be informed on the day of the event and must be provided with information that will help them understand the significance of fainting and other warning signs and the importance of physician follow-up. 

Mandatory Medical Clearance for Return to Play Post Syncope Perhaps the most tragic teen deaths are those where there is one or more fainting episodes in the weeks or months prior and the child is allowed to continue to participate in physical activity and dies because of it.

Pennsylvania has passed a law that includes several of these elements. Many other states including Maryland, Ohio and Indiana have pending Sudden Cardiac Arrest Prevention Legislation. Ontario allowed a bill to die on the order paper and it has yet to be revived despite having unanimous support at first and second reading.

If provincial or state legislation is not pending in your jurisdiction go ahead and implement these policies and best practices in your School Board. Work together with local paediatric cardiologists/electrophysiologists to develop the messaging around warning signs. Work with local EMS and ER Physicians to develop policies and practices around 9-1-1 calling for syncope. Trust that mandatory 9-1-1 calling for syncope (especially a child's first faint) occurring on school property will not create an avalanche of unnecessary "nuisance" calls, it won't. Remember that Automated External Defibrillators don't always work, it is better to prevent cardiac arrest than to try and reverse it with an AED.

One in twenty paediatric faints are sinister (the good news is that 19 in 20 are benign) but that number goes up if physical activity was the obvious trigger.  From a risk management standpoint it makes sense to be proactive on fainting and for the well being of our children it is imperative that all fainting be investigated.