Responsibilities of General Practitioners in the Prevention and Treatment of Sudden Cardiac Death in China

doi:10.12114/j.issn.1007-9572.2019.00.652

Abstract

Abstract: Sudden cardiac death （SCD） is one of the most common causes of death with the rapid onset and extremely dangerous conditions.The incidence of SCD in China is on the rise and the number of deaths ranks first in the world.The general practitioner，as a gatekeeper，plays an increasingly important role in the healthcare system of China.This study focuses on the responsibilities of general practitioners may have in the SCD control system from the aspects of preventing risk factors，managing first aid treatment，referral，health education and patient management.

Key words: Sudden cardiac death, General practitioners, Risk factors, Health education, Community management

摘要： 心脏性猝死是最常见的死亡原因之一，发病迅速、病情凶险。我国心脏性猝死的发病率呈上升趋势，死亡人数居世界首位。全科医生作为居民健康的“守门人”，在我国医疗卫生服务体系中承担着越来越重要的作用。本文从危险因素预防、急诊处置、转诊、健康教育以及患者管理等方面探讨全科医生在整个心脏性猝死防治体系中可能发挥的作用。

关键词: 心脏性猝死, 全科医生, 危险因素, 健康教育, 社区管理

LIU Xiaoyu,ZHAO Jingyu,LI Bing, et al. Responsibilities of General Practitioners in the Prevention and Treatment of Sudden Cardiac Death in China　[J]. Chinese General Practice, 2020, 23(2): 194-197. DOI: 10.12114/j.issn.1007-9572.2019.00.652.
刘晓宇,赵婧宇,李兵等. 我国全科医生在心脏性猝死防治体系中的作用探讨[J]. 中国全科医学, 2020, 23(2): 194-197. DOI: 10.12114/j.issn.1007-9572.2019.00.652.

References

［1］ZIPES D P，CAMM A J，BORGGREFE M，et al．ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death——executive summary：a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines （Writing Committee to Develop Guidelines for Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death） developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society［J］．Eur Heart J，2006，27（17）：2099-2140．DOI：10.1093/eurheartj/ehl199.
［2］BENJAMIN E J，BLAHA M J，CHIUVE S E，et al．Heart disease and stroke statistics——2017 update：a report from the American Heart Association［J］．Circulation，2017，135（10）：e146-603．DOI：10.1161/CIR.0000000000000485.
［3］AL-KHATIB S M，STEVENSON W G，ACKERMAN M J，et al．
2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death：executive summary：a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society［J］．Heart Rhythm，2018，15（10）：e190-252．DOI：10.1016/j.hrthm.2017.10.035.
［4］MATHERS C D，LONCAR D.Projections of global mortality and burden of disease from 2002 to 2030［J］．PLoS Med，2006，3（11）：e442．DOI：10.1371/journal.pmed.0030442.
［5］HUA W，ZHANG L F，WU Y F，et al．Incidence of sudden cardiac death in China：analysis of 4 regional populations［J］．J Am Coll Cardiol，2009，54（12）：1110-1118．DOI：10.1016/j.jacc.2009.06.016.
［6］陈伟伟，高润霖，刘力生，等．中国心血管病报告2013概要［J］．中国循环杂志，2014，29（7）：487-491．DOI：10.3969/j.issn.1000-3614.2014.07.003.
［7］胡大一，丁荣晶.推动自动体外除颤器应用提高院外心脏骤停患者生存率［J］．中华内科杂志，2008，47（7）：533-534．DOI：10.3321/j.issn:0578-1426.2008.07.003.
HU D Y，DING R J.Promoting the application of automated external defibrillator to improve survival after cardiac arrest outside hospital［J］．Chinese Journal of Internal Medicine，2008，47（7）：533-534．DOI：10.3321/j.issn:0578-1426.2008.07.003.
［8］ROTH G A，DWYER-LINDGREN L，BERTOZZI-VILLA A，et al．Trends and patterns of geographic variation in cardiovascular mortality among US counties，1980—2014［J］．JAMA，2017，317（19）：1976-1992．DOI：10.1001/jama.2017.4150.
［9］BENJAMIN E J，MUNTNER P，ALONSO A，et al．Heart disease and stroke statistics——2019 update：a report from the American Heart Association［J］．Circulation，2019，139（10）：e56-528．DOI：10.1161/CIR.0000000000000659.
［10］胡盛寿，高润霖，刘力生，等．《中国心血管病报告2018》概要［J］．中国循环杂志，2019，34（3）：209-220．DOI：10.3969/j.issn.1000-3614.2019.03.001.
［11］吴杰.亚洲和中国心脏性猝死［J］．中国心脏起搏与心电生理杂志，2017，31（3）：189-191．DOI：10.13333/j.cnki.cjcpe.2017.03.001.
WU J.Asia and sudden cardiac death in China［J］．Chinese Journal of Cardiac Pacing and Electrophysiology，2017，31（3）：189-191．DOI：10.13333/j.cnki.cjcpe.2017.03.001.
［12］吴小亚，罗汀，李秋红，等．我国社区全科医生团队签约服务下的慢性病防治与实践模式分析［J］．中国慢性病预防与控制，2018，26（11）：877-880．DOI：10.16386/j.cjpccd.issn.1004-6194.2018.11.021.
［13］黄子通，杨正飞.心脏性猝死的预警与综合防治［J］．实用医院临床杂志，2012，9（1）：11-15．DOI：10.3969/j.issn.1672-6170.2012.01.003.
HUANG Z T，YANG Z F.Early warning and comprehensive treatment in sudden cardiac death［J］．Practical Journal of Clinical Medicine，2012，9（1）：11-15．DOI：10.3969/j.issn.1672-6170.2012.01.003.
［14］张恩浩，钟国强.心脏性猝死预防新进展［J］．实用心电学杂志，2018，27（2）：138-142．DOI：10.13308/j.issn.2095-9354.2018.02.016.
ZHANG E H，ZHONG G Q.New progress in the prevention of sudden cardiac death［J］．Journal of Practical Electrocardiology，2018，27（2）：138-142．DOI：10.13308/j.issn.2095-9354.2018.02.016.
［15］ADABAG A S，LUEPKER R V，ROGER V L，et al．Sudden cardiac death：epidemiology and risk factors［J］．Nat Rev Cardiol，2010，7（4）：216-225．DOI：10.1038/nrcardio.2010.3.
［16］AL-KHATIB S M，YANCY C W，SOLIS P，et al．2016 AHA/ACC clinical performance and quality measures for prevention of sudden cardiac death：a report of the American College of Cardiology/American Heart Association task force on performance measures［J］．J Am Coll Cardiol，2017，69（6）：712-744．DOI：10.1016/j.jacc.2016.09.933.
［17］ESTES N A 3rd.Predicting and preventing sudden cardiac death［J］．Circulation，2011，124（5）：651-656．DOI：10.1161/CIRCULATIONAHA.110.974170.
［18］EIDELMAN R S，VIGNOLA P，HENNEKENS C H.Alcohol consumption and coronary heart disease：a causal and protective factor［J］．Semin Vasc Med，2002，2（3）：253-256．DOI：10.1055/s-2002-35393.
［19］KUBOTA Y，EVENSON K R，MACLEHOSE R F，et al．Physical activity and lifetime risk of cardiovascular disease and cancer［J］．Med Sci Sports Exerc，2017，49（8）：1599-1605．DOI：10.1249/MSS.0000000000001274.
［20］WHANG W，MANSON J E，HU F B，et al．Physical exertion，exercise，and sudden cardiac death in women［J］．JAMA，2006，295（12）：1399-1403．DOI：10.1001/jama.295.12.1399.
［21］MULLER D，AGRAWAL R，ARNTZ H R.How sudden is sudden cardiac death?［J］．Circulation，2006，114（11）：1146-1150．DOI：10.1161/circulationaha.106.616318.
［22］ARNTZ H R，WILLICH S N，SCHREIBER C，et al．Diurnal，weekly and seasonal variation of sudden death.Population-based analysis of 24，061 consecutive cases［J］．Eur Heart J，2000，21（4）：315-320．DOI：10.1053/euhj.1999.1739.
［23］MORIN D P，HOMOUD M K，ESTES N A M 3rd.Prediction and prevention of sudden cardiac death［J］．Card Electrophysiol Clin，2017，9（4）：631-638．DOI：10.1016/j.ccep.2017.07.012.
［24］ESTES N A 3rd.The challenge of predicting and preventing sudden cardiac death immediately after myocardial infarction［J］．Circulation，2009，120（3）：185-187．DOI：10.1161/CIRCULATIONAHA.109.879924.
［25］郭继鸿.中国心脏性猝死现状与防治［J］．中国循环杂志，2013，28（5）：323-326．DOI：10.3969/j.issn.1000-3614.2013.05.002.
［26］PRIORI S G，ALIOT E，BLOMSTROM-LUNDQVIST C，et al．
Task force on sudden cardiac death of the European Society of Cardiology［J］．Eur Heart J，2001，22（16）：1374-1450．DOI：10.1053/euhj.2001.2824.
［27］MARIJON E，UY-EVANADO A，DUMAS F，et al．Warning symptoms are associated with survival from sudden cardiac arrest［J］．Ann Intern Med，2016，164（1）：23-29．DOI：10.7326/M14-2342.
［28］张堃.心脏性猝死与危险因素的防治［J］．临床急诊杂志，2018，19（11）：729-732．DOI：10.13201/j.issn.1009-5918.2018.11.002.
ZHANG K.Prevention of sudden cardiac death and its risk factors［J］．Journal of Clinical Emergency，2018，19（11）：729-732．DOI：10.13201/j.issn.1009-5918.2018.11.002.
［29］BOGLE B M，NING H Y，GOLDBERGER J J，et al．A simple community-based risk-prediction score for sudden cardiac death［J］．Am J Med，2018，131（5）：532-539.e5．DOI：10.1016/j.amjmed.2017.12.002.
［30］DEO R，NORBY F L，KATZ R，et al．Development and validation of a sudden cardiac death prediction model for the general population［J］．Circulation，2016，134（11）：806-816．DOI：10.1161/CIRCULATIONAHA.116.023042.
［31］MARIJON E，UY-EVANADO A，DUMAS F，et al．Warning symptoms are associated with survival from sudden cardiac arrest［J］．Ann Intern Med，2016，164（1）：23-29．DOI：10.7326/M14-2342.
［32］KAGAWA E，INOUE I，KAWAGOE T，et al．Assessment of outcomes and differences between in- and out-of-hospital cardiac arrest patients treated with cardiopulmonary resuscitation using extracorporeal life support［J］．Resuscitation，2010，81（8）：968-973．DOI：10.1016/j.resuscitation.2010.03.037.
［33］RITTER G，WOLFE R A，GOLDSTEIN S，et al．The effect of bystander CPR on survival of out-of-hospital cardiac arrest victims［J］．Am Heart J，1985，110（5）：932-937．DOI：10.1016/0002-8703（85）90187-5.
［34］KANDALA J，OOMMEN C，KERN K B.Sudden cardiac death［J］．Br Med Bull，2017，122（1）：5-15．DOI：10.1093/bmb/ldx011.
［35］SRINIVASAN N T，SCHILLING R J.Sudden cardiac death and arrhythmias［J］．Arrhythm Electrophysiol Rev，2018，7（2）：111-117．DOI：10.15420/aer.2018:15:2.
［36］BURY G，HEADON M，DIXON M，et al．Cardiac arrest in Irish general practice：an observational study from 426 general practices［J］．Resuscitation，2009，80（11）：1244-1247．DOI：10.1016/j.resuscitation.2009.07.010.
［37］HAUGAA K H，TILZ R，BOVEDA S，et al．Implantable cardioverter defibrillator use for primary prevention in ischaemic and non-ischaemic heart disease-indications in the post-DANISH trial era：results of the European Heart Rhythm Association survey［J］．Europace，2017，19（4）：660-664．DOI：10.1093/europace/eux089.
［38］NAKSUK N，DESIMONE C V，KAPA S，et al．Prevention of sudden cardiac death beyond the ICD：have we reached the boundary or are we just burning the surface?［J］．Indian Heart J，2014，66（Suppl 1）：S120-128．DOI：10.1016/j.ihj.2013.12.046.
［39］宿燕岗.心血管植入型电子器械的国内外现状及展望［J］．中华心律失常学杂志，2019，23（1）：8-11．DOI：10.3760/cma.j.issn.1007-6638.2019.01.003.

[1]	XU Baichuan, WANG Yan, ZHANG Peng, LI Yiting, LIU Feilai, XIE Yang. Research and Analysis of Screening Tools for Chronic Obstructive Pulmonary Disease Comorbidity Lung Cancer [J]. Chinese General Practice, 2025, 28(30): 3847-3852.
[2]	SHAO Xiaoying, SHAO Jie, ZHU Yan, SHAO Jinling, SHANG Ling, WU Zhenlian, ZHAO Yu, ZHANG Jiacai. Analysis of the Current Status of Iron Deficiency and Factors Affecting Iron Deficiency Anemia among Children Aged 6-36 Months in Guizhou Province [J]. Chinese General Practice, 2025, 28(27): 3368-3374.
[3]	ZHOU Qian, WU Xiaomin, WANG Baohua, YAN Ruohan, YU Miao, WU Jing. Study on Nomogram Prediction Model for Risk of Gastric Cancer [J]. Chinese General Practice, 2025, 28(23): 2870-2877.
[4]	CUI Longyan, DAI Gaolanxin, TAO Hongbing. Training Models for General Practitioners with Special Interests: Foreign Experiences and Chinese Insights [J]. Chinese General Practice, 2025, 28(22): 2720-2725.
[5]	ZHAO Can, SHEN Ying, CHEN Peimeng, PENG Houxuan, XI Qian, GU Jinmei, QIN Li, LIANG Ruiying, ZUO Yanli. An Assessment Research on Consultation Competence of RTME Graduates Trained Via the "5+3" Pathway in Township Health Centers in Guangxi Zhuang Autonomous Region [J]. Chinese General Practice, 2025, 28(22): 2731-2739.
[6]	GUO Shengteng, ZHANG Fenfen, WAN Di, YU Dongmei, WANG Qinghua. Risk Factors for Severe Acute Pancreatitis Complicated with Acute Lung Injury: a Meta-analysis [J]. Chinese General Practice, 2025, 28(20): 2546-2554.
[7]	LIU Zhiyang, LI Hongyan, YANG Chuanghao. Distribution Characteristics and Equilibrium of General Practitioners among Provinces in China [J]. Chinese General Practice, 2025, 28(16): 1992-2000.
[8]	YE Qing, CHEN Mingmin, REN Jingjing. The Necessity and Path Exploration of Developing Psychosis Subspecialty among General Practitioners in Primary Care Settings [J]. Chinese General Practice, 2025, 28(16): 1950-1954.
[9]	GU Jie, HUANG Yanyan. Diagnosis and Comprehensive Management of Rare Diseases: the Indispensable Role of General Practitioners [J]. Chinese General Practice, 2025, 28(16): 1955-1960.
[10]	SHI Muran, WU Ning, SONG Lijuan. Present Situation of TCM General Practitioners in China and Suggestions on Statistical Optimization [J]. Chinese General Practice, 2025, 28(13): 1560-1566.
[11]	WANG Xiaoyu, FENG Zhenzhen, WANG Jun, GUO Xiaochuan, LI Jiansheng. Risk Factors for Acute Kidney Injury in Acute Respiratory Distress Syndrome: a Systematic Review [J]. Chinese General Practice, 2025, 28(12): 1527-1537.
[12]	LI Xiaoze, SUN Guoqiang, SHEN Qiang, SONG Yan, WANG Hufeng. Effectiveness of Individualized Health Education Interventions on Middle-aged and Elderly Patients with Chronic Diseases in the Community: a Cluster Randomized Controlled Trial [J]. Chinese General Practice, 2025, 28(11): 1320-1328.
[13]	HE Runxian, LU Wenjie, JIANG Haotian, HU Yan, LIU Qing, GAO Ye, LIU Xu. Exploration and Research on Innovative Models for Alleviating Health Poverty in Western China's Child: a Case Study Based on the "Guguding" Medical Science Popularization and Training Program [J]. Chinese General Practice, 2025, 28(11): 1417-1420.
[14]	HUANG Jing, MIAO Yiting, HE Xuemei, JIANG Dongyang, LIANG Ying. The Job Satisfaction of General Practitioners in China and Its Influencing Factors: a Systematic Review [J]. Chinese General Practice, 2025, 28(10): 1220-1227.
[15]	LIAO Xingyu, TIAN Siyu, CHEN Min. The Disease Burden, Risk Factors and Predictive Analysis of Early-onset Colorectal Cancer of Different Genders between China and the World from 1990 to 2021 [J]. Chinese General Practice, 2025, 28(08): 1004-1011.