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ByLauranNeergaard The Associated Press WASHINGTON Suddencar- diac arrest may not always be so sudden: New research suggests a lot of people may ignorepotentiallylife-saving warning signs hours, days, even a few weeks before they collapse. Cardiac arrest claims about 350,000 U.S. lives a year. It's not a heart at- tack but worse: The heart abruptly stops beating, its electrical activity knocked out of rhythm. CPR can buy critical time, but so few pa- tients survive that it's hard been to tell if the longtime medical belief is correct that it's a strike with little or no advance warning. Anunusualstudythathas closely tracked sudden car- diac arrest in Portland, Or- egon, for over a decade got aroundthatroadblock,using interviews with witnesses, family and friends after pa- tients collapse and tracking down their medical records. Abouthalfofmiddle-aged patients for whom symptom information could be found had experienced warning signs, mostly chest pain or shortness of breath, in the monthbeforesufferingacar- diac arrest, researchers re- portedMonday.Theresearch offers the possibility of one daypreventingsomecardiac arrestsifdoctorscouldfigure out how to find and treat the people most at risk. "By the time the 911 call is made, it's much too late for atleast90percentofpeople," saidDr.SumeetChughofthe Cedars-Sinai Heart Institute in Los Angeles, who led the study reported in Annals of Internal Medicine. "There's this window of opportunity that we really didn't know existed." Importantly, a fraction of patients considered their symptoms bad enough to call911beforetheycollapsed, and they were most likely to survive. That's a reminder to the public not to ignore possi- ble signs of heart trouble in hopes they're just indiges- tion, said University of Pitts- burgh emergency medicine specialist Dr. Clifton Calla- way, who wasn't involved in Monday's study but praised it. "Chest pain, shortness of breath — those are things you should come in the mid- dle of the night to the emer- gency department and get checked out," said Calla- way, who chairs the Amer- ican Heart Association's emergency care committee. "We strongly recommend you don't try to ride it out at home." Previous heart attacks, coronary heart disease, and certain inherited disorders that affect heartbeat all can increase the risk of sudden cardiacarrest.Peopleknown tobeathighriskmayreceive an implanted defibrillator to shock the heart back into rhythm.Butcardiacarrestis suchapublichealthproblem thattheInstituteofMedicine lastsummerurgedanational campaign to teach CPR, so more bystanders know how to help. Monday's data from the Oregon Sudden Unexpected Death Study examined re- cords for nearly 1,100 people ages 35 to 65 who suffered a cardiac arrest between 2002 and 2012. For about a quarter of patients, researchers could find no information about whether they experienced symptoms — making it im- possibletosayjusthow com- mon warning signs really are. But of the remaining 839 patients,halfhadevidenceof at least one symptom in the previous month, the study found. For most, the symp- toms began within 24 hours of their collapse, although some came a week before and a few up to a month. Chest pain was most com- mon in men, while women were more likely to expe- rience shortness of breath. Other symptoms included fainting and heart palpita- tions. Chugh had no way to de- termine symptom severity. But only 19 percent of pa- tients called 911 about symp- toms, mostly people with al- ready diagnosed heart dis- ease or who were having recurrent symptoms. Their survival was 32 percent, compared with 6 percent for other patients. Partly that's because a fifth of those 911 callers had their cardiac ar- rest in the ambulance on the way to the hospital. Stay tuned: The study is just the start of more re- search to better predict who is at highest risk for cardiac arrest,anddeterminehowto target them without panick- ingpeoplewho'ddofinewith general heart disease treat- ment, Chugh cautioned. HEART HEALTH Study:Somecardiac arrest victims ignore warning symptoms By Lauran Neergaard The Associated Press WASHINGTON A shake- up of the nation's kidney transplant system means more organs are getting to patients once thought nearly impossible to match, according to early tracking of the new rules. It's been a year since the United Network for Organ Sharing changed rules for the transplant waiting list, aiming to decrease dispar- ities and squeeze the most benefit from a scarce re- source: kidneys from de- ceased donors. Now data from UNOS shows that the changes are helping certain patients, includ- ing giving those expected to live the longest a better shot at the fittest kidneys. The hope is to "really level the playing field," said Dr. Mark Aeder, a trans- plant surgeon at Univer- sity Hospitals Case Medical Center in Cleveland who is chairman of the UNOS' kidney committee. In Abingdon, Virginia, 8-year-old Marshall Jones was one of the lucky first recipients. A birth defect severely damaged his kid- neys and a failed trans- plant when he was younger left his immune system ab- normally primed to reject kidneys from 99 percent of donors. Then last January, after four years of searching, or- gan officials found a pos- sible match, hours away by plane but available un- der the new policy — and it worked. "We don't use the word lightly, but this was really a miracle kidney for him," said Dr. Victoria Norwood, Marshall's doctor and the pediatric nephrology chief at the University of Vir- ginia. There's a huge gap be- tween who needs a new kidney and who gets one. More than 101,000 people are on the national wait- ing list, while only about 17,000 kidney transplants are performed each year. Roughly 11,000 of them are with kidneys donated from someone who just died; the rest occur when a pa- tient is able to find a liv- ing donor. The wait for a deceased- donor kidney varies widely around the country, and in 2014, more than 4,500 peo- ple died before their turn. The new kidney alloca- tion system can't alleviate the overall organ shortage. "The only thing to shorten total wait time for every- body is more organ do- nors," Aeder said. Instead, the policy al- tered how deceased-do- nor kidneys are distrib- uted, shifting priorities so that how long you've been on the waiting list isn't the main factor. Among the changes: —fewer transplants are occurring in which the kid- ney is predicted to outlive the recipient. Now, the kid- neys expected to last the longest — as calculated by donor age and medical his- tory — are offered first to the patients expected to survive the longest. That's called longevity matching. Before the change, 14 per- cent of the longest-last- ing kidneys went to recip- ients age 65 or older. That dropped to 5 percent as the new policy kicked in, according to UNOS moni- toring. —the less time spent on dialysis, the better pa- tients fare after a trans- plant. Yet where you live still plays a big role in how quickly you're put on the transplant list, with minorities and those in rural and poorer areas spending more time on di- alysis first. The new pol- icy gives people credit for that dialysis time, moving them up the waiting list, and boosted transplants among long-time dialy- sis users, UNOS found. In turn, transplants inched up among African-Amer- icans, who spend dispro- portionately more time on dialysis. —then there are those hardest-to-match patients such as Marshall, about 8,000 of them now on the waiting list. The new pol- icy gives them special pri- ority for organs that can be shipped to a wider area of the country than other kidneys, broadening the search for a super-rare match. As a result, the percent- age of transplants among those patients has risen nearly fivefold, UNOS se- nior research scientist Darren Stewart said. UNOS is tracking the changes closely to look for unintended problems because more transplants for one group can mean fewer for another. For ex- ample, adults younger than age 50 are getting more kidneys since the rule change, but older patients still account for about half of transplants. Another question is how the new policy will work long term as a back- log of the special-case pa- tients starts to clear. "All of a sudden you got a floodgate that opens be- cause you gave these peo- ple a big advantage and you're shipping kidneys across the country to them," said Dr. John Rob- erts, transplant chief at the University of Califor- nia, San Francisco, one of the largest kidney pro- grams. He praised the rule change but said it may need some fine-tuning. DONORS Ne w ru le s br in gi ng k id ne ys t o hardest-to-transplant patients COESWEET—UNIVERSITYOFVIRGINIAHEALTHSYSTEM Marshall Jones and his mother, Tina, are seen in the Battle Building at the University of Virginia Children's Hospital in Charlottesville, Va. A shake-up of the nation's kidney transplant system is getting more organs to patients once thought nearly impossible to match, according to early tracking of the new rules. Marshall was one of the lucky first recipients. By Ricardo Alonso- Zaldivar The Associated Press WASHINGTON Republi- can foes of President Barack Obama'shealthcarelawmay be able to get more by chip- ping away at it than trying totakethewholethingdown at once. That's one lesson of the budget deal passed by Con- gressandsignedbythepres- ident last week. It delayed a widely crit- icized tax on high-cost em- ployer health insurance plansthathasn'ttakeneffect yet. And it temporarily sus- pended two taxes on indus- try already being collected, which are also part of the health law. In contrast to frontal at- tacks on "Obamacare" that have repeatedly failed, this tacticcouldwellsucceed.De- lays and suspensions have a wayofbecomingpermanent. Polls show that the public remains deeply divided over the Affordable Care Act, or ACA. Opponents are already looking for other provisions thatcouldbeseparatedfrom the law. Next could be the "em- ployer mandate," a require- ment that larger compa- nies offer coverage or risk fines. Part of the mandate is a controversial definition of a full-time worker as some- one who averages 30 hours aweek.Criticssayit discour- ages companies from hiring full-time employees. "Maybe Republicans have come to grips with the idea thatthebasicstructureofthe ACA has been in place long enough that simple repeal is notpossible,"saideconomist Joe Antos of the American Enterprise Institute, a busi- ness-oriented think tank. Perhaps the budget deal "is practice" for more changes, he added. Supporters of the health care law are trying to down- play the consequences of the budget deal as superficial dings. It did not touch cov- erage provisions that have reduced the nation's unin- sured rate to a historic low of 9 percent. Indeed, Obama himself announced that 6 million people have already signed up for 2016 coverage, with more than a month left in open-enrollment season. The tax is 40 percent of the value of employer- sponsored plans that ex- ceeds certain thresholds: $10,200 for individual cov- erage and $27,500 for fam- ily coverage. In its first year, 2018, it would have affected 26 percent of all employers and nearly half of larger companies, ac- cording to the nonparti- san Kaiser Family Foun- dation. Since the tax is in- dexed to general inflation, which rises more slowly than health insurance pre- miums, it would have af- fected a growing share of health plans over time. Proponents of the tax, in- cluding many economists, see it as a much-needed brake on health care spend- ing. But business and labor joined forces to oppose it. The budget deal delayed it two years, and its future is in doubt. The spirited defense of the tax came from Jason Furman, chairman of the White House Council of Economic Advisers. "Re- pealing the tax or delaying its scheduled implementa- tion ... would have serious negative consequences for our health care system," Furman warned in a speech Oct. 7. CHIPPING AWAY In budget deal, health law foes took a different path JACQUELYN MARTIN — THE ASSOCIATED PRESS FILE Students cheer as they hold up signs, outside of the Supreme Court in Washington, supporting the Affordable Care Act a er the Supreme Court decided that the ACA may provide nationwide tax subsidies. COE SWEET — UVA HEALTH SYSTEM Marshall Jones, right, laughs with Dr. John Barcia in the Battle Building at the University of Virginia Children's Hospital in Charlottesville, Va. 645AntelopeBlvd.Su#10 530-330-1096 We've Moved Reformer Pilates and Tabata Bootcamp to frontier village Limitedopeningsin 750DavidAvenue,RedBluff•527-9193• www.tehamaestatesretirement.com findusonFacebook Tehama Estates The areas #1 Senior Housing Provider SeniorRetirementApartments •3DeliciousHealthyMealsEachDay • Daily Housekeeping • 24 Hour Staffing, 365 Days of the Year • Utilities Included (except phone & cable) • Transportation • Fun Activities and Events Call For Rent Special TehamaEstatesProvides: Sponsoredby The Saturday Market Your community YEAR-ROUND Certified Farmers & Artisan Market 9-12:30, every Saturday Home Depot parking lot HappyHolidays to all SlowFood Shasta Cascade ® Themarketwillbe closed on 12/26 so that our vendors may enjoy the holiday too GiveTheGiftOf Hea lth And Fitness (530) 529-1220 100 Jackson St. Red Bluff Holiday Special $25.00 Come in for details Gift Certificates Available HEALTH » redbluffdailynews.com Tuesday, December 22, 2015 MORE AT FACEBOOK.COM/RBDAILYNEWS AND TWITTER.COM/REDBLUFFNEWS B3