By Michaela Gibson Morris
FAIRVIEW – Charlie Cleveland can still work on the old cars he loves because he got a jump start when his heart failed this fall.
The 69-year-old who lives in the Fairview community of Itawamba County went into sudden cardiac arrest two days after coming home from the hospital following a pair of heart attacks. Fortunately, his doctors had sent him home with a LifeVest wearable defibrillator. It sensed Cleveland’s heart was in a deadly rhythm and delivered a treatment shock.
“Without that vest, I would have been dead,” Cleveland said.
The heart is a pump that needs electrical signals to coordinate its work. In a healthy heart, that signal is like a smooth wave washing over the muscles, triggering them to contract in the right rhythm. Sudden cardiac arrest occurs when the heart has an electrical storm, said Tupelo cardiologist Dr. W.B. Calhoun.
“It swirls around instead of being a steady wave,” Calhoun said.
That leaves the heart quivering, unable to pump blood to the brain and other vital organs. The person passes out, and unless the heart is knocked back into rhythm, it can be deadly.
More than 300,000 Americans suffer sudden cardiac arrest outside the hospital every year, according to the American Heart Association. The survival rate is just over 10 percent. Fewer than 8 percent survive with good neurological function. Quick access to CPR and automated external defibrillators improves survival rates, but they depend on having a quick-thinking bystander who is ready and trained to act.
“Any time you have cardiac arrest outside the hospital is bad,” Calhoun said.
Sudden cardiac arrest is a separate event, from a heart attack. However, heart attacks and coronary artery disease are leading risk factors for sudden cardiac arrest.
“Heart attacks rarely kill people,” Calhoun said. It’s the disruption of the heart rhythm that is deadly.
Heart attacks, for good reason, get people’s attention. They occur when a clot blocks an artery supplying the heart muscle with blood. If the heart muscle is deprived of blood supply too long, it can die. Quick intervention minimizes the damage.
It’s the damaged heart muscle that can set people up for the electrical storm that triggers sudden cardiac arrest, Calhoun said.
People are at highest risk for sudden cardiac arrest in the two days following a heart attack, Calhoun said. Before heart attack patients leave the hospital, cardiologists look at how well the heart is working by measuring how much blood the heart is pushing out, which is called the ejection fraction.
A healthy heart has an ejection fraction of 60 to 65 percent, Calhoun said. The risk of sudden cardiac arrest rises for those who have an ejection fraction of 35 percent or less following a heart attack.
Previously, cardiologists implanted defibrillators much more quickly after patients received stents or went through open heart surgery if patients were at risk of sudden cardiac arrest, Calhoun said.
However, not every patient benefits from an implantable defibrillator, which is expensive and carries small, but real risks of complications.
“Now we wait to see if the heart improves,” watching for signs of heart rhythm problems, Calhoun said.
The wearable defibrillator provides a safety net for those at high risk.
“It’s a bridge to determine if you need further therapy,” Calhoun said.
The wearable defibrillator is built into a harness designed to be worn under clothes. It works by sensing the dangerous heart rhythms and delivering a treatment shock when needed. If the person is still conscious, they can delay the treatment.
A 2011 American Heart Association analysis found the incremental cost per life year gained was $26,238 for heart attack patients. Generally therapies are considered cost effective below $80,000 incremental cost per life year. Implantable defibrillators have an incremental cost per life year gained of between $55,000 and $65,000. Both are commonly covered by health insurance.
Cleveland didn’t have any history of heart trouble before his heart attack this fall. He missed the early signs of trouble, attributing the shoulder pain to the heavy work he had done with his son Reggie, putting in a bridge on their land. Two weeks later, when the pain intensified and came with shortness of breath, he asked his wife to call 911.
“I was just about to go,” Cleveland remembered. “That pain was so bad. I had no energy.”
He had a second heart attack in the hospital, but went home with two stents. Calhoun ordered the wearable defibrillator because Cleveland’s ejection fraction was less than 20 percent.
“I was feeling pretty good,” Cleveland said, but was following his doctors orders and taking it easy in the days after his heart attack.
He was watching a presidential debate when his heart went into sudden cardiac arrest. Cleveland passed out, and the LifeVest kicked in. Like an automated defibrillator it warns bystanders to step away so they don’t accidentally get part of the shock. It was a dramatic, scary moment, Bessie Cleveland remembered.
Cleveland regained consciousness quickly as his wife scrambled to call 911 and the rest of the family.
“The phone rang, and it was Zoll,” the company that makes LifeVest, Bessie Cleveland said. “It had sent them a message.”
After a stay in the hospital, which included a week in the intensive care unit because of reactions to medications, Cleveland was able to return home with an implanted defibrillator on board. He hasn’t had any rhythm problems so far.
“Now I’m back up to 25 percent,” ejection fraction, Cleveland said.
These days, he is getting back to doing what he loves, working on his cars and taking care of the family land. He enjoys time with his three children and six grandchildren ages 9 to 23. He got in some deer hunting and is looking forward to turkey season. He has learned he can get in a couple of hours of work on the bushhog if he stays out of third gear.
“If the Lord hadn’t had his hands on this, Charlie wouldn’t be here today,” Bessie Cleveland said. “It’s a blessing he’s still here.”