Only 25 percent of patients who suffer cardiac arrest while hospitalized survive to hospital discharge. It’s a daunting statistic, but Mina Attin, Ph.D., R.N., an assistant professor at the University of Rochester School of Nursing, has been honored by the American Heart Association (AHA) for her work to improve those odds in patients with pacemakers and implantable defibrillators.
Attin recently received the Young Investigator Award from the AHA’s Resuscitation Science Symposium for her top-scoring abstract, “Paced electrocardiogram prior to in-hospital cardiac arrest.” The honor recognizes abstracts submitted by early career investigators in cardiac and trauma resuscitation science. Attin presented the abstract at the Resuscitation Science Symposium in Anaheim, California earlier this month.
“I hope to ultimately make a difference in patient care and clinical practice,” said Attin. “The novelty of this study is that I found specific biomarkers in the electrocardiogram that should be monitored before the cardiac arrest; however a larger study should be conducted to validate the findings.”
An electrocardiogram (ECG) records the electrical activity of the heart and is used for diagnosis and prediction of adverse events including cardiac arrhythmias and cardiac arrest. Recognizing bradycardia—a dangerously low heart rate—is a critical red flag for identifying patients at risk of cardiac arrest at hospitals. But for patients with pacemakers and other implantable defibrillators that prevent bradycardia, detecting adverse events is more difficult, especially when telemetry is not equipped with advanced technology that alerts clinicians of impending cardiac arrest, Attin said.
“The pacemaker is the backup system, so when the patient’s heart rate is 60, clinicians do not assess patients for complications unless there is a highly detectable abnormal sign (e.g., high blood pressure) or when patients complain of specific symptoms such as pain,” said Attin. “But my findings have shown that clinicians should look for diagnostic biomarkers other than heart rate using telemetry—specifically in patients with implanted medical devices.”
Attin’s research on in-hospital cardiac arrest began over seven years ago while she was on the faculty at San Diego State University (SDSU). Since joining the School of Nursing in 2015, Attin has expanded this research, engaging in collaborations with faculty from the University of Rochester’s School of Medicine and Dentistry as well as the Hajim School of Engineering.
The study has also provided opportunities for University of Rochester students to gain first-hand experience in a real-world lab environment. Students from the School of Nursing, the Hajim School of Engineering, and the Goergen Institute for Data Science all have participated in a variety of technical tasks to prepare data for analysis. One of their specific tasks was converting information gleaned from ECG paper traces into digital data which was then analyzed by the Research Facilitation Group at the School of Nursing.
Attin credits the success of her abstract to a combination of factors: an exceptionally supportive environment at the School of Nursing, dedicated students, and productive collaboration with School of Medicine, in particular with the cardiac electrophysiology team at the University of Rochester Medical Center (URMC).
“It's not just the individual,” said Attin. “The individual is usually praised for the result, but the work is the product of many factors such as the visionary leaders at the School of Nursing—including Dr. [Kathy] Rideout, Dr. [Harriet] Kitzman, and Dr. [Kimberly] Arcoleo, —and the school’s supportive work environment.
“At the School of Nursing, we have top-notch mentors. Senior Associate Dean for Research Harriet Kitzman has been mentoring me since I came here in 2015. I also have mentors and collaborators at the School of Medicine and School of Engineering who have been generously spending time with me and guiding me through my research studies.”
The full study is slated for publication in an upcoming edition of Pacing and Clinical Electrophysiology. Attin plans to continue her research by collecting and analyzing new data at URMC and applying for NIH grants.
“The ultimate goal is to understand the mechanism(s) of cardiac arrest and improve patient care, especially when we have such a high mortality rate after in-hospital cardiac arrest,” Attin said.