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Oberdier MT, Neri L, Orro A, Carrick RT, Nobile MS, Jaipalli S, Khan M, Diciotti S, Borghi C, Halperin HR. Sudden cardiac arrest prediction via deep learning electrocardiogram analysis. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2025; 6:170-179. [PMID: 40110219 PMCID: PMC11914729 DOI: 10.1093/ehjdh/ztae088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 09/24/2024] [Accepted: 10/16/2024] [Indexed: 03/22/2025]
Abstract
Aims Sudden cardiac arrest (SCA) is a commonly fatal event that often occurs without prior indications. To improve outcomes and enable preventative strategies, the electrocardiogram (ECG) in conjunction with deep learning was explored as a potential screening tool. Methods and results A publicly available data set containing 10 s of 12-lead ECGs from individuals who did and did not have an SCA, information about time from ECG to arrest, and age and sex was utilized for analysis to individually predict SCA or not using deep convolution neural network models. The base model that included age and sex, ECGs within 1 day prior to arrest, and data sampled from windows of 720 ms around the R-waves from 221 individuals with SCA and 1046 controls had an area under the receiver operating characteristic curve of 0.77. With sensitivity set at 95%, base model specificity was 31%, which is not clinically applicable. Gradient-weighted class activation mapping showed that the model mostly relied on the QRS complex to make predictions. However, models with ECGs recorded between 1 day to 1 month and 1 month to 1 year prior to arrest demonstrated predictive capabilities. Conclusion Deep learning models processing ECG data are a promising means of screening for SCA, and this method explains differences in SCAs due to age and sex. Model performance improved when ECGs were nearer in time to SCAs, although ECG data up to a year prior had predictive value. Sudden cardiac arrest prediction was more dependent upon QRS complex data compared to other ECG segments.
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Affiliation(s)
- Matt T Oberdier
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Luca Neri
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD 21205, USA
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Alessandro Orro
- Institute of Biomedical Technologies, Department of Biomedical Sciences, National Research Council (ITB-CNR), 20054 Segrate, Italy
| | - Richard T Carrick
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Marco S Nobile
- Department of Environmental Sciences, Informatics and Statistics, Ca' Foscari University of Venice, 30172 Mestre (Venice), Italy
| | - Sujai Jaipalli
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Mariam Khan
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering 'Guglielmo Marconi', University of Bologna, 47521 Cesena, Italy
- Alma Mater Research Institute for Human-Centred Artificial Intelligence, University of Bologna, 40121 Bologna, Italy
| | - Claudio Borghi
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
- Cardiovascular Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Henry R Halperin
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD 21205, USA
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21205, USA
- Department of Radiology, Johns Hopkins University, Baltimore, MD 21205, USA
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Hookana I, Eskuri MAE, Holmström L, Vähätalo J, Kenttä T, Tikkanen JT, Pakanen L, Perkiömäki J, Huikuri HV, Junttila MJ. Age-related trends of ischemic sudden cardiac death in women. Int J Cardiol 2024; 410:132238. [PMID: 38838747 DOI: 10.1016/j.ijcard.2024.132238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 06/03/2024] [Indexed: 06/07/2024]
Affiliation(s)
- I Hookana
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland.
| | - M A E Eskuri
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | - L Holmström
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | - J Vähätalo
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | - T Kenttä
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | - J T Tikkanen
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | - L Pakanen
- Forensic Medicine Unit, Finnish Institute for Health and Welfare, Oulu, Finland; and Department of Forensic Medicine, Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - J Perkiömäki
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | - H V Huikuri
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | - M J Junttila
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
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Perry J, Brody JA, Fong C, Sunshine JE, O'Reilly-Shah VN, Sayre MR, Rea TD, Simon N, Shojaie A, Sotoodehnia N, Chatterjee NA. Predicting Out-of-Hospital Cardiac Arrest in the General Population Using Electronic Health Records. Circulation 2024; 150:102-110. [PMID: 38860364 DOI: 10.1161/circulationaha.124.069105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 05/03/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND The majority of out-of-hospital cardiac arrests (OHCAs) occur among individuals in the general population, for whom there is no established strategy to identify risk. In this study, we assess the use of electronic health record (EHR) data to identify OHCA in the general population and define salient factors contributing to OHCA risk. METHODS The analytical cohort included 2366 individuals with OHCA and 23 660 age- and sex-matched controls receiving health care at the University of Washington. Comorbidities, electrocardiographic measures, vital signs, and medication prescription were abstracted from the EHR. The primary outcome was OHCA. Secondary outcomes included shockable and nonshockable OHCA. Model performance including area under the receiver operating characteristic curve and positive predictive value were assessed and adjusted for observed rate of OHCA across the health system. RESULTS There were significant differences in demographic characteristics, vital signs, electrocardiographic measures, comorbidities, and medication distribution between individuals with OHCA and controls. In external validation, discrimination in machine learning models (area under the receiver operating characteristic curve 0.80-0.85) was superior to a baseline model with conventional cardiovascular risk factors (area under the receiver operating characteristic curve 0.66). At a specificity threshold of 99%, correcting for baseline OHCA incidence across the health system, positive predictive value was 2.5% to 3.1% in machine learning models compared with 0.8% for the baseline model. Longer corrected QT interval, substance abuse disorder, fluid and electrolyte disorder, alcohol abuse, and higher heart rate were identified as salient predictors of OHCA risk across all machine learning models. Established cardiovascular risk factors retained predictive importance for shockable OHCA, but demographic characteristics (minority race, single marital status) and noncardiovascular comorbidities (substance abuse disorder) also contributed to risk prediction. For nonshockable OHCA, a range of salient predictors, including comorbidities, habits, vital signs, demographic characteristics, and electrocardiographic measures, were identified. CONCLUSIONS In a population-based case-control study, machine learning models incorporating readily available EHR data showed reasonable discrimination and risk enrichment for OHCA in the general population. Salient factors associated with OCHA risk were myriad across the cardiovascular and noncardiovascular spectrum. Public health and tailored strategies for OHCA prediction and prevention will require incorporation of this complexity.
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Affiliation(s)
- Jessica Perry
- Department of Biostatistics (J.P., N.S., A.S.), University of Washington, Seattle
| | - Jennifer A Brody
- Cardiovascular Health Research Unit (J.A.B., N.S., T.D.R.), University of Washington, Seattle
| | - Christine Fong
- Department of Medicine, Department of Anesthesiology and Pain Medicine (C.F., J.E.S., V.N.O.), University of Washington, Seattle
| | - Jacob E Sunshine
- Department of Medicine, Department of Anesthesiology and Pain Medicine (C.F., J.E.S., V.N.O.), University of Washington, Seattle
| | - Vikas N O'Reilly-Shah
- Department of Medicine, Department of Anesthesiology and Pain Medicine (C.F., J.E.S., V.N.O.), University of Washington, Seattle
| | - Michael R Sayre
- Department of Emergency Medicine (M.R.S.), University of Washington, Seattle
- Seattle Fire Department (M.R.S.), WA
| | - Thomas D Rea
- Cardiovascular Health Research Unit (J.A.B., N.S., T.D.R.), University of Washington, Seattle
| | - Noah Simon
- Cardiovascular Health Research Unit (J.A.B., N.S., T.D.R.), University of Washington, Seattle
- King County Emergency Medical Services (T.D.R.), Seattle, WA
| | - Ali Shojaie
- Department of Biostatistics (J.P., N.S., A.S.), University of Washington, Seattle
| | - Nona Sotoodehnia
- Department of Biostatistics (J.P., N.S., A.S.), University of Washington, Seattle
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Miedel C, Jonsson M, Dragas M, Djärv T, Nordberg P, Rawshani A, Claesson A, Forsberg S, Nord A, Herlitz J, Riva G. Underlying reasons for sex difference in survival following out-of-hospital cardiac arrest: a mediation analysis. Europace 2024; 26:euae126. [PMID: 38743799 PMCID: PMC11110941 DOI: 10.1093/europace/euae126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/19/2024] [Indexed: 05/16/2024] Open
Abstract
AIMS Previous studies have indicated a poorer survival among women following out-of-hospital cardiac arrest (OHCA), but the mechanisms explaining this difference remain largely uncertain.This study aimed to assess the survival after OHCA among women and men and explore the role of potential mediators, such as resuscitation characteristics, prior comorbidity, and socioeconomic factors. METHODS AND RESULTS This was a population-based cohort study including emergency medical service-treated OHCA reported to the Swedish Registry for Cardiopulmonary Resuscitation in 2010-2020, linked to nationwide Swedish healthcare registries. The relative risks (RR) of 30-day survival were compared among women and men, and a mediation analysis was performed to investigate the importance of potential mediators. Total of 43 226 OHCAs were included, of which 14 249 (33.0%) were women. Women were older and had a lower proportion of shockable initial rhythm. The crude 30-day survival among women was 6.2% compared to 10.7% for men [RR 0.58, 95% confidence interval (CI) = 0.54-0.62]. Stepwise adjustment for shockable initial rhythm attenuated the association to RR 0.85 (95% CI = 0.79-0.91). Further adjustments for age and resuscitation factors attenuated the survival difference to null (RR 0.98; 95% CI = 0.92-1.05). Mediation analysis showed that shockable initial rhythm explained ∼50% of the negative association of female sex on survival. Older age and lower disposable income were the second and third most important variables, respectively. CONCLUSION Women have a lower crude 30-day survival following OHCA compared to men. The poor prognosis is largely explained by a lower proportion of shockable initial rhythm, older age at presentation, and lower income.
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Affiliation(s)
- Charlotte Miedel
- Department of Clinical Science and Education, Center for Resuscitation Science, Södersjukhuset, Karolinska Institutet, Sjukhusbacken 10, 118 83, Stockholm, Sweden
| | - Martin Jonsson
- Department of Clinical Science and Education, Center for Resuscitation Science, Södersjukhuset, Karolinska Institutet, Sjukhusbacken 10, 118 83, Stockholm, Sweden
| | - Mariana Dragas
- Department of Clinical Science and Education, Center for Resuscitation Science, Södersjukhuset, Karolinska Institutet, Sjukhusbacken 10, 118 83, Stockholm, Sweden
| | - Therese Djärv
- Department of Clinical Science and Education, Center for Resuscitation Science, Södersjukhuset, Karolinska Institutet, Sjukhusbacken 10, 118 83, Stockholm, Sweden
- Department of Medicine, Karolinska Institutet, Solna, Sweden
| | - Per Nordberg
- Department of Clinical Science and Education, Center for Resuscitation Science, Södersjukhuset, Karolinska Institutet, Sjukhusbacken 10, 118 83, Stockholm, Sweden
| | - Araz Rawshani
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | - Andreas Claesson
- Department of Clinical Science and Education, Center for Resuscitation Science, Södersjukhuset, Karolinska Institutet, Sjukhusbacken 10, 118 83, Stockholm, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | - Sune Forsberg
- Department of Clinical Science and Education, Center for Resuscitation Science, Södersjukhuset, Karolinska Institutet, Sjukhusbacken 10, 118 83, Stockholm, Sweden
| | - Anette Nord
- Department of Clinical Science and Education, Center for Resuscitation Science, Södersjukhuset, Karolinska Institutet, Sjukhusbacken 10, 118 83, Stockholm, Sweden
| | - Johan Herlitz
- Department of Clinical Science and Education, Center for Resuscitation Science, Södersjukhuset, Karolinska Institutet, Sjukhusbacken 10, 118 83, Stockholm, Sweden
- Prehospen-Centre for Prehospital Research, Faculty of Caring Science, Work-Life and Social Welfare, University of Borås, Borås, Sweden
| | - Gabriel Riva
- Department of Clinical Science and Education, Center for Resuscitation Science, Södersjukhuset, Karolinska Institutet, Sjukhusbacken 10, 118 83, Stockholm, Sweden
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5
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Kittnar O. Sex Related Differences in Electrocardiography. Physiol Res 2023; 72:S127-S135. [PMID: 37565417 PMCID: PMC10660582 DOI: 10.33549/physiolres.934952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/08/2022] [Indexed: 12/01/2023] Open
Abstract
Since its implementation into the clinical medicine by Willem Einthoven electrocardiography had become one of crucial diagnostic method in cardiology. In spite of this fact effects of gender differences on parameters of electrocardiographic recordings started to be studied only recently. Sex related differences in physiological ECG are only minimal in childhood but there are developing during adolescence reflecting rapidly evolving differences particularly in hormonal secretion and activity of an autonomic nervous system. The heart rate is approximately 7 % higher in women than in men, PQ and QRS intervals are longer in men while QT interval is longer in women. The ST segment in females is flatter but generally the sex-related differences in ST-T waveform patterns are relatively very small with higher level of ST segment and taller T wave in men. The effects of sex-related differences, including sex hormones, on cardiac cell injury and death and their influence in determining rhythmogenesis and action potential configuration and conduction play an important role in clinics. Women have a higher prevalence of sick sinus syndrome, inappropriate sinus tachycardia, atrioventricular nodal reentry tachycardia, idiopathic right ventricular tachycardia, and arrhythmic events in the long QT syndrome. In contrast, men have a higher prevalence of atrioventricular block, carotid sinus syndrome, atrial fibrillation, supraventricular tachycardia due to accessory pathways, Wolff-Parkinson-White syndrome, reentrant ventricular tachycardia, ventricular fibrillation and sudden death, and the Brugada syndrome.
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Affiliation(s)
- O Kittnar
- Institute of Physiology, 1st Medical Faculty, Charles University, Prague, Czech Republic.
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Schöffl I, Holler S, Dittrich S, Pickardt T, Opgen-Rhein B, Boehne M, Wannenmacher B, Reineke K, Wiegand G, Hecht T, Kaestner M, Messroghli D, Schubert S, Seidel F, Weigelt A. Myocarditis and sports in the young: data from a nationwide registry on myocarditis-"MYKKE-Sport". Front Sports Act Living 2023; 5:1197640. [PMID: 37435596 PMCID: PMC10331598 DOI: 10.3389/fspor.2023.1197640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/12/2023] [Indexed: 07/13/2023] Open
Abstract
Background Myocarditis represents one of the most common causes of Sudden Cardiac Death in children. Myocardial involvement during a viral infection is believed to be higher as a consequence of intensive exertion. Recommendations for return to sports are based on cohort and case studies only. This study aims to investigate the relationship between physical activity and myocarditis in the young. Patient Every patient in the MYKKE registry fulfilling criteria for suspicion of myocarditis was sent a questionnaire regarding the physical activity before, during and after the onset of myocarditis. Method This study is a subproject within the MYKKE registry, a multicenter registry for children and adolescents with suspected myocarditis. The observation period for this analysis was 93 months (September 2013-June 2021). Anamnestic, cardiac magnetic resonance images, echocardiography, biopsy and laboratory records from every patient were retrieved from the MYKKE registry database. Results 58 patients (mean age 14.6 years) were enrolled from 10 centers. Most patients participated in curricular physical activity and 36% in competitive sports before the onset of myocarditis. There was no significant difference of heart function at admission between the physically active and inactive subjects (ejection fraction of 51.8 ± 8.6% for the active group vs. 54.4 ± 7.7% for the inactive group). The recommendations regarding the return to sports varied widely and followed current guidelines in 45%. Most patients did not receive an exercise test before returning to sports. Conclusion Sports before the onset of myocarditis was not associated with a more severe outcome. There is still a discrepancy between current literature and actual recommendations given by health care providers. The fact that most participants did not receive an exercise test before being cleared for sports represents a serious omission.
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Affiliation(s)
- Isabelle Schöffl
- Department of Pediatric Cardiology, Friedrich-Alexander-Universität, Erlangen-Nürnberg, Germany
- School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, Great Britain
| | - Sophia Holler
- Department of Pediatric Cardiology, Friedrich-Alexander-Universität, Erlangen-Nürnberg, Germany
| | - Sven Dittrich
- Department of Pediatric Cardiology, Friedrich-Alexander-Universität, Erlangen-Nürnberg, Germany
| | - Thomas Pickardt
- Competence Network for Congenital Heart Defects, Berlin, Germany
| | - Bernd Opgen-Rhein
- Department of Pediatric Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Boehne
- Department of Paediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - Bardo Wannenmacher
- Clinic for Paediatric Cardiology, Heart Centre, University of Leipzig, Leipzig, Germany
| | - Katja Reineke
- Department for Paediatric Cardiology, University Heart Center Freiburg, Freiburg, Germany
| | - Gesa Wiegand
- Department for Paediatric Cardiology, University Hospital Tübingen, Tübingen, Germany
| | - Tobias Hecht
- Heart- and Diabetes Center North Rhine-Westphalia, Center of Pediatric Cardiology and Congenital Heart Disease, Ruhr University Bochum, Bad Oeynhausen, Germany
| | | | - Daniel Messroghli
- Department of Cardiology, German Heart Center Berlin, Berlin, Germany
- Department of Cardiology, Charité-Universitätsmedizin, Berlin, Germany
- German Centre for Cardiovascular Research, Berlin, Germany
| | - Stephan Schubert
- Heart- and Diabetes Center North Rhine-Westphalia, Center of Pediatric Cardiology and Congenital Heart Disease, Ruhr University Bochum, Bad Oeynhausen, Germany
- German Centre for Cardiovascular Research, Berlin, Germany
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Franziska Seidel
- Department of Pediatric Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- German Centre for Cardiovascular Research, Berlin, Germany
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Berlin, Berlin, Germany
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine,Charité-Universitätsmedizin Berlin, Berlin, Germany
- Experimental and Clinical Research Center, A Cooperation Between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and the Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Annika Weigelt
- Department of Pediatric Cardiology, Friedrich-Alexander-Universität, Erlangen-Nürnberg, Germany
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Babayiğit E, Dural M, Görenek B. Sudden cardiac death and atrial depolarization in coronary artery disease. Europace 2023; 25:euad115. [PMID: 37099676 PMCID: PMC10227759 DOI: 10.1093/europace/euad115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Affiliation(s)
- Erdi Babayiğit
- Department of Cardiology, Eskisehir Osmangazi University, Eskişehir, Turkey
| | - Muhammet Dural
- Department of Cardiology, Eskisehir Osmangazi University, Eskişehir, Turkey
| | - Bülent Görenek
- Department of Cardiology, Eskisehir Osmangazi University, Eskişehir, Turkey
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Haum M, Kellnar A, Thienel M, Lackermair K. Review: Sex-related differences in the treatment of cardiac arrhythmia. Pharmacol Ther 2023; 244:108388. [PMID: 36940792 DOI: 10.1016/j.pharmthera.2023.108388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/22/2023] [Accepted: 03/16/2023] [Indexed: 03/23/2023]
Abstract
Cardiac arrhythmias are a common and potentially serious cardiovascular disorders that affect both men and women. However, there is evidence to suggest that there may be sex-related differences in the prevalence, clinical presentation, and management of cardiac arrhythmias. Hormonal and cellular factors may play a role in these sex-specific differences. In addition, there are differences in the types of arrhythmias that men and women experience, with men more likely to experience ventricular arrhythmias and women more likely to experience supraventricular arrhythmias. The management of cardiac arrhythmias also differs between men and women. For example, some studies have found that women are less likely to receive appropriate treatment for arrhythmias and are more likely to have adverse outcomes following treatment. Despite these sex-related differences, the majority of research on cardiac arrhythmias has been conducted in men, and there is a need for more research to specifically examine the differences between men and women. This is especially important given that the prevalence of cardiac arrhythmia is increasing, and it is essential to understand how to effectively diagnose and treat these conditions in both men and women. In this review, we examine the current understanding of sex-related differences in cardiac arrhythmias. We also review the available data on sex-specific management strategies for cardiac arrhythmias and highlight areas of future research.
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Affiliation(s)
- Magda Haum
- Department of Medicine I, Munich University Hospital, Ludwig-Maximilian-University, Munich, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Germany
| | - Antonia Kellnar
- Department of Medicine I, Munich University Hospital, Ludwig-Maximilian-University, Munich, Germany
| | - Manuela Thienel
- Department of Medicine I, Munich University Hospital, Ludwig-Maximilian-University, Munich, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Germany.
| | - Korbinian Lackermair
- Department of Medicine I, Munich University Hospital, Ludwig-Maximilian-University, Munich, Germany
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9
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Belhadj A, Shimi M, Kort I, Zaara MA, Hamdoun M, Ben Khelil M. Risk factors of sudden cardiac death in women: A 10 years study in Tunisia. J Forensic Leg Med 2023; 96:102517. [PMID: 37004373 DOI: 10.1016/j.jflm.2023.102517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 02/17/2023] [Accepted: 03/25/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Sudden cardiac death (SCD) represents a frequent etiology of sudden death. It represents a major public health issue. Few data about SCD in women are available from the Arab world. Our work aimed to analyze the risk factors of sudden cardiac death in Tunisian women in comparison with men. METHODS A cross-sectional retrospective study including all sudden cardiac death cases, conducted in the Forensic Medicine Department of the main teaching hospital of Tunis, between January 2010 and December 2019. RESULTS We counted 417 cases of sudden cardiac death in women representing 17.5% of the total number of sudden cardiac deaths recorded during the study period. The average age was 60.03 ± 15.01 years with a predominance of urban married women. The most frequent cardiac risk factors were high blood pressure (50%), diabetes (36.2%), and cardiac disease history (34.2%). Predominately married women with a history of High blood pressure and diabetes, had a high predictive of sudden cardiac death. CONCLUSION Cardiac sudden death is no longer a male focused issue. As a matter of facts Rates of SCD in women are rising with a different pattern. We will highlight the importance of adopting specific preventive measures of SCD in female.
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10
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Tompkins CM, Zareba W, Greenberg H, Goldstein R, McNitt S, Polonsky B, Brown M, Kutyifa V. Differences in mode of death between men and women receiving implantable cardioverter-defibrillators or cardiac resynchronization therapy in the MADIT trials. Heart Rhythm 2023; 20:39-45. [PMID: 36007729 DOI: 10.1016/j.hrthm.2022.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/26/2022] [Accepted: 08/15/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Studies have reported sex differences in outcomes following implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy-defibrillator (CRT-D) implantation. However, little is known about sex differences with regard to mode of death or device efficacy following ICD or CRT-D implantation. OBJECTIVES The purpose of this study was to investigate whether sex influenced mode of death or device efficacy in ICD and CRT-D subjects enrolled in the MADIT (Multicenter Automatic Defibrillator Implantation Trial) studies (MADIT-II, MADIT-CRT, and MADIT-RIT). METHODS The combined MADIT cohort consisted of 3038 men and 1000 women with ischemic cardiomyopathy (ICM) or nonischemic cardiomyopathy (NICM), left ventricular ejection fraction ≤30%; New York Heart Association functional class I-III heart failure who received ICD or CRT-D. Mode of death was divided into cardiac and noncardiac causes, reviewed by independent adjudication committees. RESULTS A total of 295 men and 66 women died (9.7% vs 6.6%; P =.003) during 26 months. The most common cause of death was nonarrhythmic cardiac death in men (n = 121 [41%]) and noncardiac death in women (n = 22 [33%]). All-cause mortality and cardiac deaths were 1.5- to 2.0-fold higher in men vs women with ICM but similar for those with NICM after adjustment for covariates. ICD efficacy was similar in men and women, resulting in a 50% reduction in all-cause mortality. CRT-D was more effective at reducing all-cause and cardiac death in women than men. CONCLUSION Mode of death differs between sex and is dependent on the underlying cardiac substrate. Compared to women, cardiac death is higher in men with ICM but similar in those with NICM. ICDs are equally effective at reducing mortality in both men and women. However, CRT-D may be more effective at reducing mortality in women.
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Affiliation(s)
| | | | - Henry Greenberg
- Mailman School of Public Health, Columbia University, New York, New York
| | - Robert Goldstein
- Uniformed Services University of Health Sciences, Bethesda, Maryland
| | - Scott McNitt
- University of Rochester Medical Center, Rochester, New York
| | | | - Mary Brown
- University of Rochester Medical Center, Rochester, New York
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Helman TJ, Headrick JP, Stapelberg NJC, Braidy N. The sex-dependent response to psychosocial stress and ischaemic heart disease. Front Cardiovasc Med 2023; 10:1072042. [PMID: 37153459 PMCID: PMC10160413 DOI: 10.3389/fcvm.2023.1072042] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 04/03/2023] [Indexed: 05/09/2023] Open
Abstract
Stress is an important risk factor for modern chronic diseases, with distinct influences in males and females. The sex specificity of the mammalian stress response contributes to the sex-dependent development and impacts of coronary artery disease (CAD). Compared to men, women appear to have greater susceptibility to chronic forms of psychosocial stress, extending beyond an increased incidence of mood disorders to include a 2- to 4-fold higher risk of stress-dependent myocardial infarction in women, and up to 10-fold higher risk of Takotsubo syndrome-a stress-dependent coronary-myocardial disorder most prevalent in post-menopausal women. Sex differences arise at all levels of the stress response: from initial perception of stress to behavioural, cognitive, and affective responses and longer-term disease outcomes. These fundamental differences involve interactions between chromosomal and gonadal determinants, (mal)adaptive epigenetic modulation across the lifespan (particularly in early life), and the extrinsic influences of socio-cultural, economic, and environmental factors. Pre-clinical investigations of biological mechanisms support distinct early life programming and a heightened corticolimbic-noradrenaline-neuroinflammatory reactivity in females vs. males, among implicated determinants of the chronic stress response. Unravelling the intrinsic molecular, cellular and systems biological basis of these differences, and their interactions with external lifestyle/socio-cultural determinants, can guide preventative and therapeutic strategies to better target coronary heart disease in a tailored sex-specific manner.
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Affiliation(s)
- Tessa J. Helman
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, NSW, Sydney, Australia
- Correspondence: Tessa J. Helman
| | - John P. Headrick
- Schoolof Pharmacy and Medical Sciences, Griffith University, Southport, QLD, Australia
| | | | - Nady Braidy
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, NSW, Sydney, Australia
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Agusala V, Dale P, Khera R, Brown SP, Idris AH, Link MS, Mody P. Variation in coronary angiography use in Out-of-Hospital cardiac arrest. Resuscitation 2022; 181:79-85. [PMID: 36332772 DOI: 10.1016/j.resuscitation.2022.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Multiple studies have examined the association of early coronary angiography (CAG) among out-of-hospital cardiac arrest (OHCA) patients with conflicting results. However, patterns of use of CAG among OHCA patients in real-world settings are not well-described. METHODS Utilizing data from the Resuscitation Outcomes Consortium's Continuous Chest Compressions trial for our analysis, we stratified patients based on initial arrest rhythm and ST-elevation on initial post-resuscitation electrocardiogram (ECG) and examined the rates of CAG in resuscitated patients. We also examined the rates of CAG across different trial clusters in the overall study population as well as in pre-specified patient subgroups RESULTS: Of 26,148 patients in the CCC trial, 5,608 survived to hospital admission and were enrolled in the study. Among them, 26 % underwent CAG. Patients with ST-elevation underwent CAG at a significantly higher rate than patients presenting without ST-elevation (70 % vs 31 %, p < 0.001). Similarly, patients presenting with shockable rhythms underwent CAG more frequently compared with patients with non-shockable rhythms (28 % vs 5 %, p < 0.001). There was marked variation in CAG frequency across different trial clusters with the proportion of patients within a trial cluster receiving CAG ranging from 4 % - 41 %. The proportion varied more among patients with ST-elevation (16 % - 82 %) or initial shockable rhythm (11 % - 75 %) compared with no ST-elevation (2 % - 28 %) or initial non-shockable rhythm (0 % - 19 %). CONCLUSION Among a national cohort of OHCA patients, large variation in the use of CAG exists, highlighting the existing uncertainty regarding perceived benefit from early CAG in OHCA.
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Affiliation(s)
- Vijay Agusala
- University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Patrick Dale
- University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Rohan Khera
- Yale University School of Medicine, New Haven, CT, United States
| | - Siobhan P Brown
- University of Washington, Seattle, Washington, United States
| | - Ahamed H Idris
- University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Mark S Link
- University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Purav Mody
- University of Texas Southwestern Medical Center, Dallas, TX, United States.
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13
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Bergami M, Cenko E, Yoon J, Mendieta G, Kedev S, Zdravkovic M, Vasiljevic Z, Miličić D, Manfrini O, van der Schaar M, Gale CP, Badimon L, Bugiardini R. Statins for primary prevention among elderly men and women. Cardiovasc Res 2022; 118:3000-3009. [PMID: 34864917 PMCID: PMC9648819 DOI: 10.1093/cvr/cvab348] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 11/24/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS We undertook a propensity match-weighted cohort study to investigate whether statin treatment recommendations for statins translate into improved cardiovascular (CV) outcomes in the current routine clinical care of the elderly. METHODS AND RESULTS We included in our analysis (ISACS Archives -NCT04008173) a total of 5619 Caucasian patients with no known prior history of CV disease who presented to hospital with a first manifestation of CV disease with age of 65 years or older. The risk of ST-segment elevation myocardial infarction (STEMI) was much lower in statin users than in non-users in both patients aged 65-75 years [14.7% absolute risk reduction; relative risk (RR): 0.55, 95% CI 0.45-0.66] and those aged 76 years and older (13.3% absolute risk reduction; RR: 0.58, 95% CI 0.46-0.72). Estimates were similar in patients with and without history of hypercholesterolaemia (interaction test; P-values = 0.24 and 0.35). Proportional reductions in STEMI diminished with female sex in the old (P for interaction = 0.002), but not in the very old age (P for interaction = 0.26). We also observed a remarkable reduction in the risk of 30 day mortality from STEMI with statin therapy in both age groups (10.2% absolute risk reduction; RR: 0.39; 95% CI 0.23-0.68 for patients aged 76 or over and 3.8% absolute risk reduction; RR 0.37; 95% CI 0.17-0.82 for patients aged 65-75 years old; interaction test, P-value = 0.46). CONCLUSIONS Preventive statin therapy in the elderly reduces the risk of STEMI with benefits in mortality from STEMI, irrespective of the presence of a history of hypercholesterolaemia. This effect persists after the age of 76 years. Benefits are less pronounced in women. Randomized clinical trials may contribute to more definitively determine the role of statin therapy in the elderly.
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Affiliation(s)
- Maria Bergami
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico Sant’Orsola Malpighi, Padiglione 11, Via Massarenti 9, 40138 Bologna, Italy
| | - Edina Cenko
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico Sant’Orsola Malpighi, Padiglione 11, Via Massarenti 9, 40138 Bologna, Italy
| | | | - Guiomar Mendieta
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), C. de Melchor Fernández Almagro, 3, 28029, Madrid, Spain
| | - Sasko Kedev
- University Clinic of Cardiology, Medical Faculty, University ‘Ss. Cyril and Methodius’, Skopje 1000, Macedonia
| | - Marija Zdravkovic
- Department of Cardiology, University Clinical Hospital Center Bezanijska Kosa are two separate words, Belgrade 11080, Serbia
| | - Zorana Vasiljevic
- School of Medicine, University of Belgrade, Dr Subotica 8, 11000, Belgrade, Serbia
| | - Davor Miličić
- Department for Cardiovascular Diseases, University Hospital Center Zagreb, University of Zagreb, Kispaticeva 12, HR-10000, Zagreb, Croatia
| | - Olivia Manfrini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico Sant’Orsola Malpighi, Padiglione 11, Via Massarenti 9, 40138 Bologna, Italy
| | - Mihaela van der Schaar
- Department of Electrical and Computer Engineering, University of California 56-125B Engineering IV Building 420 Westwood Plaza, Los Angeles, CA 90095-1594USA
- Cambridge Centre for Artificial Intelligence in Medicine, Department of Applied Mathematics and Theoretical Physics and Department of Population Health, University of Cambridge, Trinity Ln, Cambridge CB2 1TN, UK
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Woodhouse, Leeds LS2 9JT, UK
| | - Lina Badimon
- Cardiovascular Program (ICCC), IR-IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, CiberCV-Institute Carlos III, C/ Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain
| | - Raffaele Bugiardini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico Sant’Orsola Malpighi, Padiglione 11, Via Massarenti 9, 40138 Bologna, Italy
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14
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Wittwer MR, Aldridge E, Hein C, Thorrowgood M, Zeitz C, Beltrame JF, Arstall MA. Sex Differences in Incidence and Outcome of Out-of-Hospital Cardiac Arrest Within a Local Health Network. Front Cardiovasc Med 2022; 9:870696. [PMID: 35463759 PMCID: PMC9024218 DOI: 10.3389/fcvm.2022.870696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/16/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Sex and gender differences in presentation and characteristics of out-of-hospital cardiac arrest (OHCA) are established in cohorts with presumed cardiac aetiology but not non-cardiac etiology. This study investigated the effect of sex on incidence and outcome of OHCA according to presumed and adjudicated aetiology within a local health network. Methods Population-based observational cohort study of emergency medical services (EMS) attended OHCAs within an Australian local health network. Cases identified from an EMS registry between 2012-2016 were linked to a hospital registry. Age-standardised incidence and baseline characteristics were stratified by sex for EMS-treated OHCA, non-EMS witnessed presumed cardiac and obvious non-cardiac sub-cohorts, and hospitalised cases. Logistic regression was used to explore the primary outcome of survival to hospital discharge. Results We identified 2,024 EMS-attended and 780 EMS-treated OHCAs. The non-EMS witnessed sub-cohorts comprised 504 presumed cardiac and 168 obvious non-cardiac OHCAs. Adjudicated aetiology was recorded in 123 hospitalised cases. Age-standardised incidence for women was almost half that of men across all groups. Across cohorts, women were generally older and arrested with a non-shockable initial rhythm in an area of low socioeconomic status. There was no sex difference in the primary outcome for the main EMS-treated cohort or in the non-cardiac sub-cohorts. The sex difference in outcome in the presumed cardiac sub-cohort was not present after multivariable adjustment. Conclusions There are sex differences in incidence and outcome of EMS-treated OHCA that appear to be driven by differences in susceptibility to cardiac arrhythmias and underlying etiology, rather than treatment delays or disparities.
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Affiliation(s)
- Melanie R. Wittwer
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
- Northern Adelaide Local Health Network, Adelaide, SA, Australia
- *Correspondence: Melanie R. Wittwer
| | - Emily Aldridge
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
- Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Cindy Hein
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | | | - Chris Zeitz
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
- Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - John F. Beltrame
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
- Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Margaret A. Arstall
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
- Northern Adelaide Local Health Network, Adelaide, SA, Australia
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15
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Skjelbred T, Rajan D, Svane J, Lynge TH, Tfelt-Hansen J. Sex differences in sudden cardiac death in a nationwide study of 54 028 deaths. BRITISH HEART JOURNAL 2022; 108:1012-1018. [DOI: 10.1136/heartjnl-2021-320300] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 02/09/2022] [Indexed: 12/21/2022]
Abstract
ObjectiveSudden cardiac death (SCD) is a leading cause of death and is more common among males than females. Epidemiological studies of sex differences in SCD cases of all ages are sparse. The aim of this study was to examine differences in incidence rates, clinical characteristics, comorbidities and autopsy findings between male and female SCD cases.MethodsAll deaths in Denmark in 2010 (54 028) were reviewed. Autopsy reports, death certificates, discharge summaries and nationwide health registries were reviewed to identify cases of SCD. Based on the available information, all deaths were subcategorised into definite, probable and possible SCD.ResultsA total of 6867 SCD cases were identified, of which 3859 (56%) were males and 3008 (44%) were females. Incidence rates increased with age and were higher for male population across all age groups in the adult population. Average age at time of SCD was 71 years among males compared with 79 among females (p<0.01). The greatest difference in SCD incidence between males and females was found among the 35–50 years group with an incidence rate ratio of 3.7 (95% CI: 2.8 to 4.8). Compared with female SCD victims, male SCD victims more often had cardiovascular diseases and diabetes mellitus (p<0.01).ConclusionThis is the first nationwide study of sex differences in SCD across all ages. Differences in incidence rates between males and females were greatest among young adults and the middle-aged. Incidence rates of SCD among older female population approached that of the male population, despite having significantly more cardiovascular disease and diabetes in male SCD cases.
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16
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Zeitler EP, Poole JE, Albert CM, Al-Khatib SM, Ali-Ahmed F, Birgersdotter-Green U, Cha YM, Chung MK, Curtis AB, Hurwitz JL, Lampert R, Sandhu RK, Shaik F, Sullivan E, Tamirisa KP, Santos Volgman A, Wright JM, Russo AM. Arrhythmias in Female Patients: Incidence, Presentation and Management. Circ Res 2022; 130:474-495. [PMID: 35175839 DOI: 10.1161/circresaha.121.319893] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
There is a growing appreciation for differences in epidemiology, treatment, and outcomes of cardiovascular conditions by sex. Historically, cardiovascular clinical trials have under-represented females, but findings have nonetheless been applied to clinical care in a sex-agnostic manner. Thus, much of the collective knowledge about sex-specific cardiovascular outcomes result from post hoc and secondary analyses. In some cases, these investigations have revealed important sex-based differences with implications for optimizing care for female patients with arrhythmias. This review explores the available evidence related to cardiac arrhythmia care among females, with emphasis on areas in which important sex differences are known or suggested. Considerations related to improving female enrollment in clinical trials as a way to establish more robust clinical evidence for the treatment of females are discussed. Areas of remaining evidence gaps are provided, and recommendations for areas of future research and specific action items are suggested. The overarching goal is to improve appreciation for sex-based differences in cardiac arrhythmia care as 1 component of a comprehensive plan to optimize arrhythmia care for all patients.
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Affiliation(s)
- Emily P Zeitler
- The Geisel School of Medicine at Dartmouth, Hanover, NH (E.P.Z.).,Division of Cardiology, Dartmouth-Hitchcock Medical Center, The Dartmouth Institute, Lebanon, NH (E.P.Z.)
| | - Jeanne E Poole
- University of Washington Medical Center, Seattle (J.E.P.)
| | - Christine M Albert
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Hospital, Los Angeles, CA (C.M.A., R.K.S.)
| | - Sana M Al-Khatib
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (S.M.A.-K.)
| | | | | | - Yong-Mei Cha
- Mayo Clinic, St Mary's Campus, Rochester, MN (F.A.-A., Y.-M.C.)
| | | | - Anne B Curtis
- Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo General Medical Center, NY (A.B.C.)
| | | | - Rachel Lampert
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (R.L.)
| | - Roopinder K Sandhu
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Hospital, Los Angeles, CA (C.M.A., R.K.S.)
| | - Fatima Shaik
- Division of Cardiology, Cooper Medical School of Rowan University, Camden, NJ (F.S., A.M.R.)
| | | | | | | | - Jennifer M Wright
- Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI (J.M.W.)
| | - Andrea M Russo
- Division of Cardiology, Cooper Medical School of Rowan University, Camden, NJ (F.S., A.M.R.)
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17
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Ha ACT, Doumouras BS, Wang CN, Tranmer J, Lee DS. Prediction of sudden cardiac arrest in the general population: Review of traditional and emerging risk factors. Can J Cardiol 2022; 38:465-478. [PMID: 35041932 DOI: 10.1016/j.cjca.2022.01.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/08/2022] [Accepted: 01/09/2022] [Indexed: 12/28/2022] Open
Abstract
Sudden cardiac death (SCD) is the most common and devastating outcome of sudden cardiac arrest (SCA), defined as an abrupt and unexpected cessation of cardiovascular function leading to circulatory collapse. The incidence of SCD is relatively infrequent for individuals in the general population, in the range of 0.03-0.10% per year. Yet, the absolute number of cases around the world is high due to the sheer size of the population at risk, making SCA/SCD a major global health issue. Based on conservative estimates, there are at least 2 million cases of SCA occurring worldwide on a yearly basis. As such, identification of risk factors associated with SCA in the general population is an important objective from a clinical and public health standpoint. This review will provide an in-depth discussion of established and emerging factors predictive of SCA/SCD in the general population beyond coronary artery disease and impaired left ventricular ejection fraction. Contemporary studies evaluating the association between age, sex, race, socioeconomic status and the emerging contribution of diabetes and obesity to SCD risk beyond their role as atherosclerotic risk factors will be reviewed. In addition, the role of biomarkers, particularly electrocardiographic ones, on SCA/SCD risk prediction in the general population will be discussed. Finally, the use of machine learning as a tool to facilitate SCA/SCD risk prediction will be examined.
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Affiliation(s)
- Andrew C T Ha
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
| | - Barbara S Doumouras
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Chang Nancy Wang
- Department of Medicine, Queen's University, Kingston, Ontario, Canada; ICES Central, Toronto, Ontario, Canada
| | - Joan Tranmer
- School of Nursing, Queen's University, Kingston, Ontario, Canada; ICES Queens, Queen's University, Kingston, Ontario, Canada
| | - Douglas S Lee
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; ICES Central, Toronto, Ontario, Canada; Ted Rogers Centre for Heart Research, Toronto, Ontario, Canada.
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18
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Quattrone A, Lie OH, Nestaas E, de Lange C, Try K, Lindberg HL, Skulstad H, Erikssen G, Edvardsen T, Haugaa K, Estensen ME. Long-term follow-up and sex differences in adults operated for tetralogy of Fallot. Open Heart 2021; 8:e001738. [PMID: 34663747 PMCID: PMC8524375 DOI: 10.1136/openhrt-2021-001738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 09/29/2021] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Adults operated for tetralogy of Fallot (TOF) have high risk of ventricular arrhythmias (VA). QRS duration >180 ms is an established risk factor for VA. We aimed to investigate heart function, prevalence of arrhythmias and sex differences in patients with TOF at long-term follow-up. METHODS We included TOF-operated patients≥18 years from our centre's registry. We reviewed medical records and the most recent echocardiographic exam. VA was recorded on ECGs, 24-hour Holter registrations and from implantable cardioverter defibrillator. RESULTS We included 148 patients (age 37±10 years). Left ventricular global longitudinal strain (LV GLS, -15.8±3.1% vs -18.8±3.2%, p=0.001) and right ventricular (RV) GLS (-15.8±3.9% vs -19.1±4.1%, p=0.001) were lower in men at all ages compared with women. Higher RV D1 (4.3±0.5 cm vs 4.6±0.6 cm, p=0.01), lower ejection fraction (55%±8% vs 50%±9%, p=0.02), lower RV GLS (-18.1±4.0 ms vs -16.1±4.8 ms, p=0.04) and N-terminal pro-brain natriuretic peptide (NT-proBNP) over reference range (n=27 (23%) vs n=8 (77%), p<0.001) were associated with higher incidence of VA. QRS duration was longer in men (151±30 ms vs 128±25 ms, p<0.001). No patients had QRS duration >180 ms. QRS duration did not differ in those with and without VA (143±32 ms vs 137±28 ms, p=0.06). CONCLUSIONS Our results confirmed reduced RV function in adults operated for TOF. Male patients had impaired LV and RV function expressed by lower LV and RV GLS values at all ages. Reduced cardiac function and elevated NT-proBNP were associated with higher incidence of VA and may be important in risk assessment.
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Affiliation(s)
- Alessia Quattrone
- Center for Cardiological Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Oyvind H Lie
- Center for Cardiological Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Eirik Nestaas
- Department of Paediatrics, Vestfold Hospital Trust, Tønsberg, Norway
| | - Charlotte de Lange
- Division of Radiology and Nuclear Medicine, Section of Pediatric Radiology, Oslo University Hospital, Oslo, Norway
- Department of Radiology and Clinical Physiology, Queen Silvia Childrens Hospital, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Kirsti Try
- Division of Radiology and Nuclear Medicine, Section of Pediatric Radiology, Oslo University Hospital, Oslo, Norway
| | - Harald L Lindberg
- Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway
| | - Helge Skulstad
- Center for Cardiological Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Gunnar Erikssen
- Center for Cardiological Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Thor Edvardsen
- Center for Cardiological Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kristina Haugaa
- Center for Cardiological Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Mette E Estensen
- Center for Cardiological Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
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Kim SK, Bennett R, Ingles J, Kumar S, Zaman S. Arrhythmia in Cardiomyopathy: Sex and Gender Differences. Curr Heart Fail Rep 2021; 18:274-283. [PMID: 34549379 DOI: 10.1007/s11897-021-00531-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/22/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW There is emerging evidence for important sex differences in cardiac arrhythmias. In this up-to-date review, we summarise the differences in incidence, aetiology, treatment and prevention of ventricular arrhythmias (VAs) and sudden cardiac death (SCD) in women versus men, in the context of ischaemic and nonischaemic cardiomyopathies. RECENT FINDINGS The incidence of ventricular tachyarrhythmia and SCD is significantly lower in women than in men with ischaemic cardiomyopathy, whereas sex differences in nonischaemic cardiomyopathy are less clear. Women who receive a primary prevention implantable cardioverter-defibrillator (ICD) are less likely to receive appropriate activations, compared to men; however, such findings are limited by under-representation of women. Women with ischaemic cardiomyopathy have significantly lower incidence of VA and SCD compared to men and may not derive the same benefit from a primary prevention ICD. However, further clinical ICD studies are needed that ensure adequate female participation, in order to examine sex differences in outcomes in both ischaemic and nonischaemic cardiomyopathies.
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Affiliation(s)
- Sul Ki Kim
- Department of Cardiology, Westmead Hospital, Sydney, Australia
| | - Richard Bennett
- Department of Cardiology, Westmead Hospital, Sydney, Australia.,Westmead Applied Research Centre, The University of Sydney, Sydney, Australia
| | - Jodie Ingles
- Cardio Genomics Program At Centenary Institute, The University of Sydney, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Sydney, Australia.,Westmead Applied Research Centre, The University of Sydney, Sydney, Australia
| | - Sarah Zaman
- Department of Cardiology, Westmead Hospital, Sydney, Australia. .,Westmead Applied Research Centre, The University of Sydney, Sydney, Australia.
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20
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van der Lingen ALCJ, Theuns DAMJ, Rijnierse MT, Becker MAJ, van de Ven PM, van Rossum AC, van Halm VP, Kemme MJB, Yap SC, Allaart CP. Sex-specific differences in outcome and risk stratification of ventricular arrhythmias in implantable cardioverter defibrillator patients. ESC Heart Fail 2021; 8:3726-3736. [PMID: 34184828 PMCID: PMC8497372 DOI: 10.1002/ehf2.13444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 05/10/2021] [Accepted: 05/16/2021] [Indexed: 11/10/2022] Open
Abstract
AIMS Risk stratification models of sudden cardiac death (SCD) are based on the assumption that risk factors of SCD affect risk to a similar extent in both sexes. The aim of the study is to evaluate differences in clinical outcomes between sexes and evaluate whether risk factors associated with appropriate device therapy (ADT) differ between men and women. METHODS AND RESULTS We performed a cohort study of implantable cardioverter defibrillator (ICD) patients referred for primary or secondary prevention of SCD between 2009 and 2018. Multivariable Cox regression models for prediction of ADT were constructed for men and women separately. Of 2300 included patients, 571 (25%) were women. Median follow-up was 4.6 (inter-quartile range: 4.4-4.9) years. Time to ADT was shorter for men compared with women [hazard ratio (HR) 1.71, P < 0.001], as was time to mortality (HR 1.37, P = 0.003). In women, only secondary prevention ICD therapy (HR 1.82, P < 0.01) was associated with ADT, whereas higher age (HR 1.20, P < 0.001), absence of left bundle branch block (HR 0.72, P = 0.01), and secondary prevention therapy (HR 1.80, P < 0.001) were independently associated with ADT in men. None of the observed parameters showed a distinctive sex-specific pattern in ADT. CONCLUSIONS Male ICD patients were at higher risk of ADT and death compared with female ICD patients, irrespective of an ischaemic or non-ischaemic underlying cardiomyopathy. Our study highlights the importance to stratify outcomes of ICD trials by sex, as study results differ between men and women. However, none of the available clinical parameters showed a clear sex-specific relation to ventricular arrhythmias. As a consequence, sex-specific risk stratification models of SCD using commonly available clinical parameters could not be derived.
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Affiliation(s)
- Anne-Lotte C J van der Lingen
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, 1081 HV, The Netherlands
| | - Dominic A M J Theuns
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Mischa T Rijnierse
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, 1081 HV, The Netherlands
| | - Marthe A J Becker
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, 1081 HV, The Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Albert C van Rossum
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, 1081 HV, The Netherlands
| | - Vokko P van Halm
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, 1081 HV, The Netherlands
| | - Michiel J B Kemme
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, 1081 HV, The Netherlands
| | - Sing C Yap
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Cornelis P Allaart
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, 1081 HV, The Netherlands
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21
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Chiamvimonvat N, Frazier-Mills C, Shen ST, Avari Silva JN, Wan EY. Sex and Race Disparities in Presumed Sudden Cardiac Death: One Size Does Not Fit All. Circ Arrhythm Electrophysiol 2021; 14:e010053. [PMID: 33993706 DOI: 10.1161/circep.121.010053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Nipavan Chiamvimonvat
- Department of Internal Medicine, University of California, Davis, Genome and Biomedical Science Facility (N.C.)
| | - Camille Frazier-Mills
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC (C.F.-M.)
| | - Sharon T Shen
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN (S.T.S.)
| | - Jennifer N Avari Silva
- Department of Pediatrics, Division of Cardiology, Washington University School of Medicine, St Louis, MO (J.N.A.S.)
| | - Elaine Y Wan
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York (E.Y.W.)
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22
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Kim YG, Oh SK, Choi HY, Choi JI. Inherited arrhythmia syndrome predisposing to sudden cardiac death. Korean J Intern Med 2021; 36:527-538. [PMID: 33092314 PMCID: PMC8137412 DOI: 10.3904/kjim.2020.481] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/27/2020] [Indexed: 12/03/2022] Open
Abstract
Inherited arrhythmia (IA) is one of the main causes of sudden cardiac death (SCD) in young people, and is reported to be a more prevalent cause of SCD in Asia than in Western countries. IAs are a group of genetic disorders caused by mutations in genes encoding cardiac ion channels, leading to electrophysiological characteristics that often occur in the absence of structural abnormalities. Channelopathies, such as long QT syndrome and Brugada syndrome, carry a potential risk of life-threatening ventricular tachyarrhythmias that predispose to SCD, although early prediction and prevention of the risk remain challenging. Recent advances in genetic testing have facilitated risk stratification as well as a precise diagnosis for IA, despite ongoing debates about the implications. Herein, we provide epidemiological data, a pathophysiological overview, and the current clinical approach to IAs related to SCD. In addition, we review the general issues arising from genetic testing for IAs.
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Affiliation(s)
- Yun Gi Kim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Suk-Kyu Oh
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Ha Young Choi
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jong-Il Choi
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
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23
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Feng D, Li C, Yang X, Wang L. Gender differences and survival after an out-of-hospital cardiac arrest: a systematic review and meta-analysis. Intern Emerg Med 2021; 16:765-775. [PMID: 33174152 DOI: 10.1007/s11739-020-02552-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 10/23/2020] [Indexed: 11/26/2022]
Abstract
Patients who experience out-of-hospital cardiac arrest (OHCA) have unacceptably high mortality rates. It remains unclear whether gender has an association with survival in this regard. Hence, we aimed to investigate the association between gender and survival by conducting a systematic review and meta-analysis. The databases of PubMed, Embase, and Cochrane Database of Systematic Reviews were searched from inception to 17 March, 2020. Studies assessing the association between gender and survival to discharge or 30-day survival after OHCA were included. Two reviewers independently assessed the eligibility of the identified studies. The random-effects model was used to pool data, and the outcome was reported as odds ratios (ORs) and 95% confidence intervals, as the relative measure of association. Twenty-three eligible studies enrolling 897,805 patients were included in this systematic review. Overall, women were older and less likely to experience arrest in public places. When arrest occurred, women had less initial shockable rhythm, were less likely to be witnessed by bystanders, and were less likely provided with CPR compared with men. After admission, women underwent less coronary angiography, percutaneous coronary angiography, and targeted temperature management therapy. Eleven studies with ORs were pooled, showing a significant survival benefit in women (OR = 1.08, p < 0.05, I2 = 52.3%). In the subgroup analysis, both premenopausal women (< 50 years) (OR = 1.42, p < 0.001, I2 = 0%) and postmenopausal women (≥ 50 years) (OR = 1.07, p < 0.05, I2 = 16.4%) had higher odds of survival compared with age-matched men. Despite the unfavorable factors, the pooled results showed a significant survival benefit in women after OHCA, especially in premenopausal women.
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Affiliation(s)
- Dejing Feng
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chao-Yang Hospital, Capital Medical University, 8# Gong-Ti South Road, Beijing, 10020, China
| | - Chuang Li
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chao-Yang Hospital, Capital Medical University, 8# Gong-Ti South Road, Beijing, 10020, China
| | - Xinchun Yang
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chao-Yang Hospital, Capital Medical University, 8# Gong-Ti South Road, Beijing, 10020, China
| | - Lefeng Wang
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chao-Yang Hospital, Capital Medical University, 8# Gong-Ti South Road, Beijing, 10020, China.
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24
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Hwang SS, Ahn KO, Shin SD, Ro YS, Lee SY, Park JO, Suh J. Temporal trends in out-of-hospital cardiac arrest outcomes in men and women from 2008 to 2015: A national observational study. Am J Emerg Med 2021; 41:174-178. [DOI: 10.1016/j.ajem.2020.01.055] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 01/07/2020] [Accepted: 01/28/2020] [Indexed: 01/05/2023] Open
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25
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Sports-Related Sudden Cardiac Arrest in Germany. Can J Cardiol 2021; 37:105-112. [DOI: 10.1016/j.cjca.2020.03.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/16/2020] [Accepted: 03/16/2020] [Indexed: 11/17/2022] Open
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26
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Mody P, Pandey A, Slutsky AS, Segar MW, Kiss A, Dorian P, Parsons J, Scales DC, Rac VE, Cheskes S, Bierman AS, Abramson BL, Gray S, Fowler RA, Dainty KN, Idris AH, Morrison L. Gender-Based Differences in Outcomes Among Resuscitated Patients With Out-of-Hospital Cardiac Arrest. Circulation 2020; 143:641-649. [PMID: 33317326 DOI: 10.1161/circulationaha.120.050427] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Studies examining gender-based differences in outcomes of patients experiencing out-of-hospital cardiac arrest have demonstrated that, despite a higher likelihood of return of spontaneous circulation, women do not have higher survival. METHODS Patients successfully resuscitated from out-of-hospital cardiac arrest enrolled in the CCC trial (Trial of Continuous or Interrupted Chest Compressions during CPR) were included. Hierarchical multivariable logistic regression models were constructed to evaluate the association between gender and survival after adjustment for age, gender, cardiac arrest rhythm, witnessed status, bystander cardiopulmonary resuscitation, episode location, epinephrine dose, emergency medical services response time, and duration of resuscitation. Do not resuscitate (DNR) and withdrawal of life-sustaining therapy (WLST) order status were used to assess whether differences in postresuscitation outcomes were modified by baseline prognosis. The analysis was replicated among ALPS trial (Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Cardiac Arrest) participants. RESULTS Among 4875 successfully resuscitated patients, 1825 (37.4%) were women and 3050 (62.6%) were men. Women were older (67.5 versus 65.3 years), received less bystander cardiopulmonary resuscitation (49.1% versus 54.9%), and had a lower proportion of cardiac arrests that were witnessed (55.1% versus 64.5%) or had shockable rhythm (24.3% versus 44.6%, P<0.001 for all). A significantly higher proportion of women received DNR orders (35.7% versus 32.1%, P=0.009) and had WLST (32.8% versus 29.8%, P=0.03). Discharge survival was significantly lower in women (22.5% versus 36.3%, P<0.001; adjusted odds ratio, 0.78 [95% CI, 0.66-0.93]; P=0.005). The association between gender and survival to discharge was modified by DNR and WLST order status such that women had significantly reduced survival to discharge among patients who were not designated DNR (31.3% versus 49.9%, P=0.005; adjusted odds ratio, 0.74 [95% CI, 0.60-0.91]) or did not have WLST (32.3% versus 50.7%, P=0.002; adjusted odds ratio, 0.73 [95% CI, 0.60-0.89]). In contrast, no gender difference in survival was noted among patients receiving a DNR order (6.7% versus 7.4%, P=0.90) or had WLST (2.8% versus 2.4%, P=0.93). Consistent patterns of association between gender and postresuscitation outcomes were observed in the secondary cohort. CONCLUSIONS Among patients resuscitated after experiencing out-of-hospital cardiac arrest, discharge survival was significantly lower in women than in men, especially among patients considered to have a favorable prognosis.
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Affiliation(s)
- Purav Mody
- Division of Cardiology, Department of Internal Medicine (P.M., A.P., M.W.S.), University of Texas Southwestern Medical Center, Dallas.,VA North Texas Health System, Dallas (P.M.)
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine (P.M., A.P., M.W.S.), University of Texas Southwestern Medical Center, Dallas
| | - Arthur S Slutsky
- Keenan Research Center for Biomedical Science at the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Departments of Medicine, Surgery, and Biomedical Engineering, Interdepartmental Division of Critical Care (A.S.S.), University of Toronto, Ontario, Canada
| | - Matthew W Segar
- Division of Cardiology, Department of Internal Medicine (P.M., A.P., M.W.S.), University of Texas Southwestern Medical Center, Dallas
| | - Alex Kiss
- Evaluative Clinical Sciences, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Institute for Health Policy and Management (A.K.), University of Toronto, Ontario, Canada
| | - Paul Dorian
- Division of Cardiology, St Michael's Hospital, Division of Cardiology, Department of Medicine, Faculty of Medicine, Institute of Medical Sciences (P.D.), University of Toronto, Ontario, Canada
| | - Janet Parsons
- Applied Health Research Centre at the Li Ka Shing Knowledge Institute, St Michael's Hospital, Department of Physical Therapy and the Rehabilitation Sciences Institute (J.P.), University of Toronto, Ontario, Canada
| | - Damon C Scales
- Sunnybrook Health Sciences Center, Interdepartmental Division of Critical Care Medicine, Faculty of Medicine, Institute for Health Policy and Management (D.C.S.), University of Toronto, Ontario, Canada
| | - Valeria E Rac
- Ted Rogers Centre for Heart Research and Peter Munk Cardiac Centre and Toronto General Hospital Research Institute, Toronto Health Economics and Technology Assessment (THETA) Collaborative, Institute of Health Policy, Management and Evaluation (V.E.R.), University of Toronto, Ontario, Canada
| | - Sheldon Cheskes
- Sunnybrook Centre for Prehospital Medicine, Division of Emergency Medicine, Department of Family and Community Medicine (S.C.), University of Toronto, Ontario, Canada
| | - Arlene S Bierman
- Centre for Practice Improvement, Agency for Healthcare Research and Quality, Rockville, MD (A.S.B.)
| | - Beth L Abramson
- Division of Cardiology, St Michael's Hospital, Division of Cardiology, Department of Medicine, Faculty of Medicine (B.L.A.), University of Toronto, Ontario, Canada
| | - Sara Gray
- Emergency Medicine and Critical Care, St Michael's Hospital, Division of Emergency Medicine, Department of Medicine, Interdepartmental Division of Critical Care, Faculty of Medicine (S.G.), University of Toronto, Ontario, Canada
| | - Rob A Fowler
- Sunnybrook Health Sciences Center, Interdepartmental Division of Critical Care Medicine, Faculty of Medicine, Institute for Health Policy and Management (R.A.F.), University of Toronto, Ontario, Canada
| | - Katie N Dainty
- North York General Hospital, Institute for Health Policy and Management (K.N.D.), University of Toronto, Ontario, Canada
| | - Ahamed H Idris
- Department of Emergency Medicine (A.H.I.), University of Texas Southwestern Medical Center, Dallas
| | - Laurie Morrison
- Rescu at the Li Ka Shing Knowledge Institute, Emergency Medicine, St. Michael's Hospital, Division of Emergency Medicine, Department of Medicine, Faculty of Medicine, Institute for Health Policy and Management (L.M.), University of Toronto, Ontario, Canada
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27
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Al-Dury N, Rawshani A, Karlsson T, Herlitz J, Ravn-Fischer A. The influence of age and gender on delay to treatment and its association with survival after out of hospital cardiac arrest. Am J Emerg Med 2020; 42:198-202. [PMID: 33234358 DOI: 10.1016/j.ajem.2020.11.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/08/2020] [Accepted: 11/15/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Nooraldeen Al-Dury
- University of Gothenburg, Institute of Medicine, Sahlgrenska Academy, Gothenburg, Sweden; Dept. of Radiology, Østfold Hospital Trust, Grålum, Norway.
| | - Araz Rawshani
- University of Gothenburg, Institute of Medicine, Sahlgrenska Academy, Gothenburg, Sweden
| | - Thomas Karlsson
- Health Metrics at the Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Johan Herlitz
- University of Gothenburg, Institute of Medicine, Sahlgrenska Academy, Gothenburg, Sweden; University of Borås, Borås, Sweden
| | - Annica Ravn-Fischer
- University of Gothenburg, Institute of Medicine, Sahlgrenska Academy, Gothenburg, Sweden; Sahlgrenska University Hospital, Dept. of Cardiology, Gothenburg, Sweden
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28
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Ben Ahmed H, Ben Khelil M, Bellali M, Shimi M, Belhaj A, Allouche M, Allouche E, Razghallah R, Banasr A, Benzarti A, Hamdoun M. [Sudden cardiac death in women, data from the northern Tunisian sudden cardiac-death registry]. Ann Cardiol Angeiol (Paris) 2020; 70:1-6. [PMID: 33109353 DOI: 10.1016/j.ancard.2020.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 10/04/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Sudden cardiac death is a major public health problem. Epidemiological and clinical differences according to gender have been described in sudden cardiac death. The aim of this study was to examine the gender differences between autopsy findings and circumstance of occurrence associated with sudden cardiac death. METHODS We prospectively collected epidemiological and autopsy data of victims of sudden cardiac death occurring in the northern governorates of Tunisia between January 2013 and December 2019. Symptoms preceding death, circadian, weekly and seasonal variations of sudden death were also analyzed. RESULTS The study population included 1834 men and 468 women with a mean age of 56.5±14.2 years. All cardiovascular risk factors except smoking were significantly more frequent among women but ischemic heart disease was the most common cause of death in men (51.3 %, versus 28 %, P<0.001). Women were more likely to have a negative macroscopic autopsy than men (34 % versus 23.6 %, P<0.001). Chest pain preceding sudden death was more frequent in male (24 % versus 13.2 %, P<0.001). In contrast, women were more likely to have dyspnea (8.1 % versus 15.6 %, P<0.001). Sudden death in women occurred indoors more often than in men (63.9 % versus 54.5 %, P<0.001) and also more often during night (midnight to 6 am). We also recorded an excess cardiac mortality in winter in both sexes. CONCLUSIONS Women had considerably more cardiovascular risk factors and more commonly negative macroscopic autopsy. Death occurred indoors and during night more often than in men.
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Affiliation(s)
- H Ben Ahmed
- Service de cardiologie, hôpital Charles-Nicolle, faculté de médecine, université Tunis-El-Manar, 2092 Tunis, Tunisie.
| | - M Ben Khelil
- Service de médecine légale, hôpital Charles-Nicolle, faculté de médecine, université Tunis-El-Manar, 2092 Tunis, Tunisie
| | - M Bellali
- Service de médecine légale, hôpital Charles-Nicolle, faculté de médecine, université Tunis-El-Manar, 2092 Tunis, Tunisie
| | - M Shimi
- Service de médecine légale, hôpital Charles-Nicolle, faculté de médecine, université Tunis-El-Manar, 2092 Tunis, Tunisie
| | - A Belhaj
- Service de médecine légale, hôpital Charles-Nicolle, faculté de médecine, université Tunis-El-Manar, 2092 Tunis, Tunisie
| | - M Allouche
- Service de médecine légale, hôpital Charles-Nicolle, faculté de médecine, université Tunis-El-Manar, 2092 Tunis, Tunisie
| | - E Allouche
- Service de cardiologie, hôpital Charles-Nicolle, faculté de médecine, université Tunis-El-Manar, 2092 Tunis, Tunisie
| | - R Razghallah
- Service de cardiologie, hôpital Charles-Nicolle, faculté de médecine, université Tunis-El-Manar, 2092 Tunis, Tunisie
| | - A Banasr
- Service de médecine légale, hôpital Charles-Nicolle, faculté de médecine, université Tunis-El-Manar, 2092 Tunis, Tunisie
| | - A Benzarti
- Service de médecine légale, hôpital Charles-Nicolle, faculté de médecine, université Tunis-El-Manar, 2092 Tunis, Tunisie
| | - M Hamdoun
- Service de médecine légale, hôpital Charles-Nicolle, faculté de médecine, université Tunis-El-Manar, 2092 Tunis, Tunisie
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29
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Zhao D, Post WS, Blasco-Colmenares E, Cheng A, Zhang Y, Deo R, Pastor-Barriuso R, Michos ED, Sotoodehnia N, Guallar E. Racial Differences in Sudden Cardiac Death. Circulation 2020; 139:1688-1697. [PMID: 30712378 DOI: 10.1161/circulationaha.118.036553] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Blacks have a higher incidence of out-of-hospital sudden cardiac death (SCD) in comparison with whites. However, the racial differences in the cumulative risk of SCD and the reasons for these differences have not been assessed in large-scale community-based cohorts. The objective of this study is to compare the lifetime cumulative risk of SCD among blacks and whites, and to evaluate the risk factors that may explain racial differences in SCD risk in the general population. METHODS This is a cohort study of 3832 blacks and 11 237 whites participating in the Atherosclerosis Risk in Communities Study (ARIC). Race was self-reported. SCD was defined as a sudden pulseless condition from a cardiac cause in a previously stable individual, and SCD cases were adjudicated by an expert committee. Cumulative incidence was computed using competing risk models. Potential mediators included demographic and socioeconomic factors, cardiovascular risk factors, presence of coronary heart disease, and electrocardiographic parameters as time-varying factors. RESULTS The mean (SD) age was 53.6 (5.8) years for blacks and 54.4 (5.7) years for whites. During 27.4 years of follow-up, 215 blacks and 332 whites experienced SCD. The lifetime cumulative incidence of SCD at age 85 years was 9.6, 6.6, 6.5, and 2.3% for black men, black women, white men, and white women, respectively. The sex-adjusted hazard ratio for SCD comparing blacks with whites was 2.12 (95% CI, 1.79-2.51). The association was attenuated but still statistically significant in fully adjusted models (hazard ratio, 1.38; 95% CI, 1.11-1.71). In mediation analysis, known factors explained 65.3% (95% CI 37.9-92.8%) of the excess risk of SCD in blacks in comparison with whites. The single most important factor explaining this difference was income (50.5%), followed by education (19.1%), hypertension (22.1%), and diabetes mellitus (19.6%). Racial differences were evident in both genders but stronger in women than in men. CONCLUSIONS Blacks had a much higher risk for SCD in comparison with whites, particularly among women. Income, education, and traditional risk factors explained ≈65% of the race difference in SCD. The high burden of SCD and the racial-gender disparities observed in our study represent a major public health and clinical problem.
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Affiliation(s)
- Di Zhao
- Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (D.Z., W.S.P., E.B.-C., E.D.M., E.G.)
| | - Wendy S Post
- Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (D.Z., W.S.P., E.B.-C., E.D.M., E.G.).,Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (W.S.P., A.C., E.D.M.)
| | - Elena Blasco-Colmenares
- Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (D.Z., W.S.P., E.B.-C., E.D.M., E.G.)
| | - Alan Cheng
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (W.S.P., A.C., E.D.M.).,Medtronic Inc, Minneapolis, MN (A.C.)
| | - Yiyi Zhang
- Division of General Medicine, Department of Medicine, Columbia University, New York, NY (Y.Z.)
| | - Rajat Deo
- Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania, Philadelphia (R.D.)
| | - Roberto Pastor-Barriuso
- National Center for Epidemiology, Carlos III Institute of Health and Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain (R.P.-B.)
| | - Erin D Michos
- Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (D.Z., W.S.P., E.B.-C., E.D.M., E.G.).,Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (W.S.P., A.C., E.D.M.)
| | - Nona Sotoodehnia
- Division of Cardiology, Cardiovascular Health Research Unit, University of Washington, Seattle (N.S.)
| | - Eliseo Guallar
- Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (D.Z., W.S.P., E.B.-C., E.D.M., E.G.)
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30
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Ajam T, Devaraj S, Fudim M, Ajam S, Soleimani T, Kamalesh M. Lower Post Myocardial Infarction Mortality Among Women Treated at Veterans Affairs Hospitals Compared to Men. Am J Med Sci 2020; 360:537-542. [PMID: 31982101 DOI: 10.1016/j.amjms.2019.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 12/02/2019] [Accepted: 12/05/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND There is conflicting evidence about whether mortality after myocardial infarction is higher among women than among men. This study aimed to compare sex differences in post myocardial infarction mortality in the Veterans Affairs system, a setting where the predominant subjects are men. MATERIALS AND METHODS The Veterans Affairs Corporate Data Warehouse inpatient and laboratory chemistry databases were used to identify patients diagnosed with acute myocardial infarction from inpatient records from January 1st, 2005 to April 25th, 2015. Mortality data was obtained through the Veterans Affairs death registry. RESULTS A total of 130,241 patients were identified; 127,711 men (98%) and 2,530 women (2%). Men typically had more comorbidities including congestive heart failure (54% vs. 46%, P value < 0.001), diabetes mellitus (54% vs. 48%, P value < 0.001), and chronic kidney disease (39% vs. 28%, P value < 0.001). The peak troponin-I was significantly higher among men (16.0 vs. 10.7 ng/mL, P value = 0.03). The mean follow-up time was 1490.67 ± 8 days. After adjusting for differences in demographics and comorbidities, women had a significantly lower risk of mortality (hazard ration [HR]: 0.747, P value < 0.0001) as compared to men. CONCLUSIONS In a health care system where the predominant subjects are men, women had better short- and long-term survival than men after an acute myocardial infarction. Further investigation is warranted to determine the reasons behind the improved outcomes in women post myocardial infarction in the veteran population.
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Affiliation(s)
- Tarek Ajam
- Department of Internal Medicine, Saint Louis University, Saint Louis, Missouri
| | - Srikant Devaraj
- Center of Business and Economics, Ball State University, Muncie, Indiana
| | - Marat Fudim
- Department of Cardiovascular Medicine, Duke University Medical Center, Durham, North Carolina
| | - Samer Ajam
- Department of Cardiovascular Medicine, Indiana University Krannert Institute of Cardiology, Indianapolis, Indiana
| | - Tahereh Soleimani
- Department of Cardiovascular Medicine, Indiana University Krannert Institute of Cardiology, Indianapolis, Indiana
| | - Masoor Kamalesh
- Department of Cardiovascular Medicine, Indiana University Krannert Institute of Cardiology, Indianapolis, Indiana; Department of Cardiovascular Medicine, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana.
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31
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Sex and Gender Differences in Heart Failure. ACTA ACUST UNITED AC 2020; 2:157-181. [PMID: 36262368 PMCID: PMC9536682 DOI: 10.36628/ijhf.2020.0004] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/26/2020] [Accepted: 03/26/2020] [Indexed: 01/04/2023]
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Mitchell RN, Ashar FN, Jarvelin M, Froguel P, Sotoodehnia N, Brody JA, Sebert S, Huikuri H, Rioux J, Goyette P, Newcomb CE, Junttila MJ, Arking DE. Effect of Sex and Underlying Disease on the Genetic Association of QT Interval and Sudden Cardiac Death. J Am Heart Assoc 2019; 8:e013751. [PMID: 31747862 PMCID: PMC6912973 DOI: 10.1161/jaha.119.013751] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 10/16/2019] [Indexed: 01/08/2023]
Abstract
Background Sudden cardiac death (SCD) accounts for ≈300 000 deaths annually in the United States. Men have a higher risk of SCD and are more likely to have underlying coronary artery disease, while women are more likely to have arrhythmic events in the setting of inherited or acquired QT prolongation. Moreover, there is evidence of sex differences in the genetics of QT interval duration. Using sex- and coronary artery disease-stratified analyses, we assess differences in genetic association between longer QT interval and SCD risk. Methods and Results We examined 2282 SCD subjects and 3561 Finnish controls. The SCD subjects were stratified by underlying disease (ischemic versus nonischemic) and by sex. We used logistic regression to test for association between the top QT interval-associated single-nucleotide polymorphism, rs12143842 (in the NOS1AP locus), and SCD risk. We also performed Mendelian randomization to test for causal association of QT interval in the various subgroups. No statistically significant differences were observed between the sexes for associations with rs12143842, despite the odds ratio being higher in females across all subgroup analyses. Consistent with our hypothesis, female non-ischemics had the highest odds ratio point estimate for association between rs12143842 and SCD risk and male ischemics the lowest odds ratio point estimate (P=0.036 for difference). Similar trends were observed for the Mendelian randomization analysis. Conclusions While individual subgroup comparisons did not achieve traditional criteria for statistical significance, this study is consistent with the hypothesis that the causal association of longer QT interval on SCD risk is stronger in women and nonischemic individuals.
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Affiliation(s)
- Rebecca N. Mitchell
- Department of Genetic MedicineMcKusick‐Nathans InstituteJohns HopkinsBaltimoreMD
| | - Foram N. Ashar
- Department of Genetic MedicineMcKusick‐Nathans InstituteJohns HopkinsBaltimoreMD
| | - Marjo‐Riitta Jarvelin
- Center for Life Course Health ResearchFaculty of MedicineUniversity of OuluFinland
- Biocenter OuluUniversity of OuluFinland
- Unit of Primary Health CareOulu University HospitalOuluFinland
- Department of Epidemiology and BiostatisticsMRC‐PHE Centre for Environment and HealthSchool of Public HealthImperial College LondonLondonUnited Kingdom
- Department of Life SciencesCollege of Health and Life SciencesBrunel University LondonLondonUnited Kingdom
| | - Philippe Froguel
- Department of Epidemiology and BiostatisticsMRC‐PHE Centre for Environment and HealthSchool of Public HealthImperial College LondonLondonUnited Kingdom
| | - Nona Sotoodehnia
- Cardiovascular Health Research UnitDivision of CardiologyDepartments of Medicine and EpidemiologyUniversity of WashingtonSeattleWA
| | - Jennifer A. Brody
- Cardiovascular Health Research UnitUniversity of WashingtonSeattleWA
| | - Sylvain Sebert
- Center for Life Course Health ResearchFaculty of MedicineUniversity of OuluFinland
- Biocenter OuluUniversity of OuluFinland
- Department of Epidemiology and BiostatisticsMRC‐PHE Centre for Environment and HealthSchool of Public HealthImperial College LondonLondonUnited Kingdom
| | - Heikki Huikuri
- Research Unit of Internal MedicineMedical Research Center OuluUniversity of Oulu and Oulu University HospitalOuluFinland
| | - John Rioux
- Montreal Heart InstituteUniversity of MontrealCanada
| | | | - Charles E. Newcomb
- Department of Genetic MedicineMcKusick‐Nathans InstituteJohns HopkinsBaltimoreMD
| | - M. Juhani Junttila
- Research Unit of Internal MedicineMedical Research Center OuluUniversity of Oulu and Oulu University HospitalOuluFinland
| | - Dan E. Arking
- Department of Genetic MedicineMcKusick‐Nathans InstituteJohns HopkinsBaltimoreMD
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Affiliation(s)
- Sumeet S Chugh
- SmidtHeart Institute, Cedars-Sinai Health System, Los Angeles, CA
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van den Berg ME, Kors JA, van Herpen G, Bots ML, Hillege H, Swenne CA, Stricker BH, Rijnbeek PR. Normal Values of QT Variability in 10-s Electrocardiograms for all Ages. Front Physiol 2019; 10:1272. [PMID: 31636572 PMCID: PMC6788348 DOI: 10.3389/fphys.2019.01272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 09/19/2019] [Indexed: 12/02/2022] Open
Abstract
Aims: QT variability is a promising electrocardiographic marker. It has been studied as a screening tool for coronary artery disease and left ventricular hypertrophy, and increased QT variability is a known risk factor for sudden cardiac death. Considering that comprehensive normal values for QT variability were lacking, we set out to establish these in standard 10-s electrocardiograms (ECGs) covering both sexes and all ages. Methods: Ten-second, 12-lead ECGs were provided by five Dutch population studies (Pediatric Normal ECG Study, Leiden University Einthoven Science Project, Prevention of Renal and Vascular End-stage Disease Study, Utrecht Health Project, Rotterdam Study). ECGs were recorded digitally and processed by well-validated analysis software. We selected cardiologically healthy participants, 46% being women. Ages ranged from 11 days to 91 years. After quality control, 13,828 ECGs were available. We assessed three markers: standard deviation of QT intervals (SDqt), short-term QT variability (STVqt), and QT variability index (QTVI). Results: For SDqt and STVqt, the median and the lower limit of normal remained stable with age. The upper limit of normal declined until around age 45, and increased strongly in the elderly, notably so in women. This implies that a subset of the population, small enough not to have appreciable effect on the median, shows a high degree of QT variability with a possible risk of arrhythmias or worse, especially in women. Otherwise, sex differences were negligible in all three measurements. For QTVI, median, and normal limits decreased until age 20, and steadily went up afterwards except for the lower limit of normal, which flattens off after age 65. Conclusion: We report the first set of normal values for QT variability based on 10-s ECGs, for all ages and both sexes.
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Affiliation(s)
- Marten E van den Berg
- Department of Medical Informatics, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Jan A Kors
- Department of Medical Informatics, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Gerard van Herpen
- Department of Medical Informatics, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Hans Hillege
- Department of Cardiology, University Medical Center Groningen, Groningen, Netherlands
| | - Cees A Swenne
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Bruno H Stricker
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Internal Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands.,Inspectorate of Health Care, Utrecht, Netherlands
| | - Peter R Rijnbeek
- Department of Medical Informatics, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands
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McLaughlin TJ, Jain SK, Voigt AH, Wang NC, Saba S. Comparison of Long-Term Survival Following Sudden Cardiac Arrest in Men Versus Women. Am J Cardiol 2019; 124:362-366. [PMID: 31103131 DOI: 10.1016/j.amjcard.2019.04.051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 04/16/2019] [Accepted: 04/25/2019] [Indexed: 02/04/2023]
Abstract
Sudden cardiac death (SCA) is a major cause of mortality with estimates of 450,000 deaths annually in the United States. The incidence of SCA differs between the sexes. Data regarding survival of women compared with men after SCA are, however, conflicting. We, therefore, examined the long-term survival of women versus men after SCA. A total of 1,433 (41% women; 44% out-of-hospital) survivors of SCA at our institution between 2002 and 2012 were followed to the primary end point of death through February 20, 2017. Women in our cohort were older (p = 0.02), were less likely to be white (p = 0.01), or to have suffered an acute myocardial infarction at the time of SCA (p < 0.001). They also had significantly shorter PR (p < 0.001) and QRS (p < 0.001) durations on their surface electrocardiogram, were more likely to present with an initial ventricular rhythm other than ventricular tachycardia or ventricular fibrillation (29% vs 22%, p = 0.001) and less likely to receive an implantable cardioverter defibrillator (22% vs 31%, p < 0.001). Over a median follow-up of 3.6 years, 674 (45%) patients died (53% women vs 43% men, p < 0.001). After adjusting for unbalanced baseline covariates, the sex difference in survival disappeared (hazard ratio 1.05; 95% confidence interval 0.85 to 1.29, p = 0.66). In conclusion, our results demonstrate comparable long-term mortality after SCA for men and women. Differences in unadjusted mortality are mainly due to older age, different risk profiles at the time of index event, and differential treatment with implantable cardioverter defibrillator.
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Weidner K, Behnes M, Rusnak J, Schupp T, Hoppner J, Taton G, Reiser L, Bollow A, Reichelt T, Ellguth D, Engelke N, Kuche P, Ansari U, El‐Battrawy I, Lang S, Nienaber CA, Akin M, Mashayekhi K, Ferdinand D, Weiß C, Borggrefe M, Akin I. Male sex increases mortality in ventricular tachyarrhythmias. Intern Med J 2019; 49:711-721. [DOI: 10.1111/imj.14170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 11/13/2018] [Accepted: 11/14/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Kathrin Weidner
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine MannheimUniversity of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim Mannheim Germany
| | - Michael Behnes
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine MannheimUniversity of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim Mannheim Germany
| | - Jonas Rusnak
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine MannheimUniversity of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim Mannheim Germany
| | - Tobias Schupp
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine MannheimUniversity of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim Mannheim Germany
| | - Jorge Hoppner
- Clinic for Diagnostic and Interventional Radiology HeidelbergUniversity of Heidelberg Heidelberg Germany
| | - Gabriel Taton
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine MannheimUniversity of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim Mannheim Germany
| | - Linda Reiser
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine MannheimUniversity of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim Mannheim Germany
| | - Armin Bollow
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine MannheimUniversity of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim Mannheim Germany
| | - Thomas Reichelt
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine MannheimUniversity of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim Mannheim Germany
| | - Dominik Ellguth
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine MannheimUniversity of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim Mannheim Germany
| | - Niko Engelke
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine MannheimUniversity of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim Mannheim Germany
| | - Philipp Kuche
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine MannheimUniversity of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim Mannheim Germany
| | - Uzair Ansari
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine MannheimUniversity of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim Mannheim Germany
| | - Ibrahim El‐Battrawy
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine MannheimUniversity of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim Mannheim Germany
| | - Siegfried Lang
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine MannheimUniversity of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim Mannheim Germany
| | | | - Muharrem Akin
- Department of Cardiology and AngiologyHannover Medical School Hannover Germany
| | - Kambis Mashayekhi
- Department of Cardiology and Angiology IIUniversity Heart Center Freiburg Bad Krozingen Germany
| | - Dennis Ferdinand
- Institute of Biomathematics and Medical Statistics, Faculty of Medicine MannheimUniversity Medical Center Mannheim Germany
| | | | - Martin Borggrefe
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine MannheimUniversity of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim Mannheim Germany
| | - Ibrahim Akin
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine MannheimUniversity of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim Mannheim Germany
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Ashar FN, Mitchell RN, Albert CM, Newton-Cheh C, Brody JA, Müller-Nurasyid M, Moes A, Meitinger T, Mak A, Huikuri H, Junttila MJ, Goyette P, Pulit SL, Pazoki R, Tanck MW, Blom MT, Zhao X, Havulinna AS, Jabbari R, Glinge C, Tragante V, Escher SA, Chakravarti A, Ehret G, Coresh J, Li M, Prineas RJ, Franco OH, Kwok PY, Lumley T, Dumas F, McKnight B, Rotter JI, Lemaitre RN, Heckbert SR, O’Donnell CJ, Hwang SJ, Tardif JC, VanDenburgh M, Uitterlinden AG, Hofman A, Stricker BHC, de Bakker PIW, Franks PW, Jansson JH, Asselbergs FW, Halushka MK, Maleszewski JJ, Tfelt-Hansen J, Engstrøm T, Salomaa V, Virmani R, Kolodgie F, Wilde AAM, Tan HL, Bezzina CR, Eijgelsheim M, Rioux JD, Jouven X, Kääb S, Psaty BM, Siscovick DS, Arking DE, Sotoodehnia N. A comprehensive evaluation of the genetic architecture of sudden cardiac arrest. Eur Heart J 2018; 39:3961-3969. [PMID: 30169657 PMCID: PMC6247663 DOI: 10.1093/eurheartj/ehy474] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 04/17/2018] [Accepted: 07/20/2018] [Indexed: 12/25/2022] Open
Abstract
Aims Sudden cardiac arrest (SCA) accounts for 10% of adult mortality in Western populations. We aim to identify potential loci associated with SCA and to identify risk factors causally associated with SCA. Methods and results We carried out a large genome-wide association study (GWAS) for SCA (n = 3939 cases, 25 989 non-cases) to examine common variation genome-wide and in candidate arrhythmia genes. We also exploited Mendelian randomization (MR) methods using cross-trait multi-variant genetic risk score associations (GRSA) to assess causal relationships of 18 risk factors with SCA. No variants were associated with SCA at genome-wide significance, nor were common variants in candidate arrhythmia genes associated with SCA at nominal significance. Using cross-trait GRSA, we established genetic correlation between SCA and (i) coronary artery disease (CAD) and traditional CAD risk factors (blood pressure, lipids, and diabetes), (ii) height and BMI, and (iii) electrical instability traits (QT and atrial fibrillation), suggesting aetiologic roles for these traits in SCA risk. Conclusions Our findings show that a comprehensive approach to the genetic architecture of SCA can shed light on the determinants of a complex life-threatening condition with multiple influencing factors in the general population. The results of this genetic analysis, both positive and negative findings, have implications for evaluating the genetic architecture of patients with a family history of SCA, and for efforts to prevent SCA in high-risk populations and the general community.
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Affiliation(s)
- Foram N Ashar
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins, 733 N Broadway, Baltimore, MD, USA
| | - Rebecca N Mitchell
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins, 733 N Broadway, Baltimore, MD, USA
| | - Christine M Albert
- Divisions of Preventive Medicine and Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 900 Commonwealth Ave East, 3rd Floor, Boston, MA, USA
| | - Christopher Newton-Cheh
- Center for Human Genetic Research & Cardiovascular Research Center, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, USA
| | - Jennifer A Brody
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, 1730 Minor Ave, Seattle, WA, USA
| | - Martina Müller-Nurasyid
- Institute of Genetic Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Ingolstädter Landstraße 1, Neuherberg, Germany
- Chair of Genetic Epidemiology, Institute for Medical Informatics, Biometry and Epidemiology, Faculty of Medicine, Ludwig-Maximilians University, Marchioninistr. 15, Munich, Germany
- Department of Internal Medicine I (Cardiology), Hospital of the Ludwig-Maximilians-University, Marchioninistr. 15, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Biedersteiner Strasse 29, Munich, Germany
| | - Anna Moes
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins, 733 N Broadway, Baltimore, MD, USA
| | - Thomas Meitinger
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Biedersteiner Strasse 29, Munich, Germany
- Institute of Human Genetics, Helmholtz Zentrum München - German Research Center for Environmental Health, Ingolstaedter Landstrasse 1, Neuherberg, Germany
- Institute of Human Genetics, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, Munich, Germany
| | - Angel Mak
- Cardiovascular Research Institute and Institute for Human Genetics, University of California, San Francisco, 1550 4th Street, San Francisco, CA, USA
| | - Heikki Huikuri
- Research Unit of Internal Medicine, University Hospital and University of Oulu, Kajaaninkatu 50, Oulu, Finland
| | - M Juhani Junttila
- Research Unit of Internal Medicine, University Hospital and University of Oulu, Kajaaninkatu 50, Oulu, Finland
| | - Philippe Goyette
- Montreal Heart Institute, Université de Montréal, 5000 rue Bélanger, Montréal, Quebec, Canada
| | - Sara L Pulit
- Department of Genetics, Center for Molecular Medicine, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht, The Netherlands
| | - Raha Pazoki
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Hospital, Praed St, Paddington, London, UK
| | - Michael W Tanck
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Meibergdreef 9, AZ Amsterdam, The Netherlands
| | - Marieke T Blom
- Department of Clinical and Experimental Cardiology, Heart Center, Academic Medical Center, Meibergdreef 9, AZ Amsterdam, The Netherlands
| | - XiaoQing Zhao
- CVPath Institute, 19 Firstfield Road, Gaithersburg, MD, USA
| | - Aki S Havulinna
- National Institute for Health and Welfare, Mannerheimintie 166, Helsinki, Finland
| | - Reza Jabbari
- Department of Cardiology, Rigshospitalet, Inge Lehmanns Vej 7, Copenhagen, Denmark
| | - Charlotte Glinge
- Department of Cardiology, Rigshospitalet, Inge Lehmanns Vej 7, Copenhagen, Denmark
| | - Vinicius Tragante
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, Utrecht, The Netherlands
| | - Stefan A Escher
- Lund University Diabetes Centre, Department of Clinical Sciences, Lund University, Barngatan 4, Skånes universitetssjukhus, Malmo, Sweden
| | - Aravinda Chakravarti
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins, 733 N Broadway, Baltimore, MD, USA
| | - Georg Ehret
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins, 733 N Broadway, Baltimore, MD, USA
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins University, 615 N Wolfe Street, Baltimore, MD, USA
| | - Man Li
- Department of Epidemiology, Johns Hopkins University, 615 N Wolfe Street, Baltimore, MD, USA
| | - Ronald J Prineas
- Public Health Sciences, Wake Forest University, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Oscar H Franco
- Institute of Social and Preventative Medicine, University of Bern, Mittelstrasse 43, Bern, Switzerland
- Department of Epidemiology, Erasmus MC, Dr. Molewaterplein 50, GE Rotterdam, The Netherlands
| | - Pui-Yan Kwok
- Cardiovascular Research Institute and Institute for Human Genetics, University of California, San Francisco, 1550 4th Street, San Francisco, CA, USA
| | - Thomas Lumley
- Department of Statistics, University of Auckland, Private Bag 92014, Auckland, New Zealand
| | - Florence Dumas
- Paris Sudden Death Expertise Center, University Paris Descartes, Sorbonne Paris Cité, INSERM U970, 56 rue Leblanc, Paris, France
| | - Barbara McKnight
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, 1730 Minor Ave, Seattle, WA, USA
- Department of Biostatistics, University of Washington, F-600, Health Sciences Building 1705 NE Pacific Street, Seattle, WA, USA
| | - Jerome I Rotter
- The Institute for Translational Genomics and Population Sciences, Departments of Pediatrics and Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, 1124 W. Carson Street, Torrance, CA, USA
| | - Rozenn N Lemaitre
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, 1730 Minor Ave, Seattle, WA, USA
| | - Susan R Heckbert
- Cardiovascular Health Research Unit, Department of Epidemiology, University of Washington, 1959 NE Pacific St, Seattle, WA, USA
| | - Christopher J O’Donnell
- NHLBI Framingham Heart Study, 73 Mount Wayte Avenue, Suite #2, Framingham, MA, USA
- Cardiology Section, Department of Medicine, Boston VA Healthcare System, 1400 VFW Parkway, Boston, MA, USA
| | - Shih-Jen Hwang
- Cardiology Section, Department of Medicine, Boston VA Healthcare System, 1400 VFW Parkway, Boston, MA, USA
| | - Jean-Claude Tardif
- Montreal Heart Institute, Université de Montréal, 5000 rue Bélanger, Montréal, Quebec, Canada
| | - Martin VanDenburgh
- Divisions of Preventive Medicine and Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 900 Commonwealth Ave East, 3rd Floor, Boston, MA, USA
| | - André G Uitterlinden
- Erasmus MC University Medical Center, Department of Internal Medicine, Dr. Molewaterplein 40, CD Rotterdam, The Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus MC, Dr. Molewaterplein 50, GE Rotterdam, The Netherlands
| | - Bruno H C Stricker
- Department of Epidemiology, Erasmus MC, Dr. Molewaterplein 50, GE Rotterdam, The Netherlands
| | - Paul I W de Bakker
- Department of Genetics, Center for Molecular Medicine, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, The Netherlands
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, The Netherlands
| | - Paul W Franks
- Lund University Diabetes Centre, Department of Clinical Sciences, Lund University, Barngatan 4, Skånes universitetssjukhus, Malmo, Sweden
| | - Jan-Hakan Jansson
- Department of Public Health and Clinical Medicine, Research Unit Skelleftea, Umea University, University Hospital, Building 1A, 4st, Umea, Sweden
| | - Folkert W Asselbergs
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, Utrecht, The Netherlands
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, 69-75 Chenies Mews, London, UK
- Institute of Health Informatics, University College London, 222 Euston Road London, UK
| | - Marc K Halushka
- Department of Pathology, Division of Cardiovascular Pathology, Johns Hopkins University School of Medicine, 720 Rutland Avenue, Ross Rm 632B, Baltimore, MD, USA
| | - Joseph J Maleszewski
- Department of Laboratory Medicine & Pathology, Mayo Clinic, 3050 Superior Drive, Rochester, MN, USA
| | - Jacob Tfelt-Hansen
- Department of Cardiology, Rigshospitalet, Inge Lehmanns Vej 7, Copenhagen, Denmark
- Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Inge Lehmanns Vej 7, Copenhagen, Denmark
| | - Thomas Engstrøm
- Department of Cardiology, Rigshospitalet, Inge Lehmanns Vej 7, Copenhagen, Denmark
- Department of Cardiology, University of Lund, Getingevägen 4, Lund, Sweden
| | - Veikko Salomaa
- National Institute for Health and Welfare, Mannerheimintie 166, Helsinki, Finland
| | - Renu Virmani
- CVPath Institute, 19 Firstfield Road, Gaithersburg, MD, USA
| | - Frank Kolodgie
- CVPath Institute, 19 Firstfield Road, Gaithersburg, MD, USA
| | - Arthur A M Wilde
- Amsterdam UMC, University of Amsterdam, Heart Center; Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Meibergdreef 9, AZ, Amsterdam, The Netherlands
| | - Hanno L Tan
- Amsterdam UMC, University of Amsterdam, Heart Center; Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Meibergdreef 9, AZ, Amsterdam, The Netherlands
| | - Connie R Bezzina
- Amsterdam UMC, University of Amsterdam, Heart Center; Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Meibergdreef 9, AZ, Amsterdam, The Netherlands
| | - Mark Eijgelsheim
- Department of Nephrology, University Medical Center Groningen, Hanzeplein 1, GZ, Groningen, The Netherlands
| | - John D Rioux
- Montreal Heart Institute, Université de Montréal, 5000 rue Bélanger, Montréal, Quebec, Canada
| | - Xavier Jouven
- Paris Sudden Death Expertise Center, University Paris Descartes, Sorbonne Paris Cité, INSERM U970, 56 rue Leblanc, Paris, France
| | - Stefan Kääb
- Department of Internal Medicine I (Cardiology), Hospital of the Ludwig-Maximilians-University, Marchioninistr. 15, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Biedersteiner Strasse 29, Munich, Germany
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, 1730 Minor Ave, suite #1360, Seattle, WA, USA
| | - David S Siscovick
- The New York Academy of Medicine, 1216 5th Ave, New York, New York, USA
| | - Dan E Arking
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins, 733 N Broadway, Baltimore, MD, USA
| | - Nona Sotoodehnia
- Cardiovascular Health Research Unit, Division of Cardiology, Departments of Medicine and Epidemiology, University of Washington, 1730 Minor Ave, Seattle, WA, USA
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Deo R, Safford MM, Khodneva YA, Jannat-Khah DP, Brown TM, Judd SE, McClellan WM, Rhodes JD, Shlipak MG, Soliman EZ, Albert CM. Differences in Risk of Sudden Cardiac Death Between Blacks and Whites. J Am Coll Cardiol 2018; 72:2431-2439. [PMID: 30442286 PMCID: PMC9704756 DOI: 10.1016/j.jacc.2018.08.2173] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 08/13/2018] [Accepted: 08/14/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Prior studies have consistently demonstrated that blacks have an approximate 2-fold higher incidence of sudden cardiac death (SCD) than whites; however, these analyses have lacked individual-level sociodemographic, medical comorbidity, and behavioral health data. OBJECTIVES The purpose of this study was to evaluate whether racial differences in SCD incidence are attributable to differences in the prevalence of risk factors or rather to underlying susceptibility to fatal arrhythmias. METHODS The Reasons for Geographic and Racial Differences in Stroke study is a prospective, population-based cohort of adults from across the United States. Associations between race and SCD defined per National Heart, Lung, and Blood Institute criteria were assessed. RESULTS Among 22,507 participants (9,416 blacks and 13,091 whites) without a history of clinical cardiovascular disease, there were 174 SCD events (67 whites and 107 blacks) over a median follow-up of 6.1 years (interquartile range: 4.6 to 7.3 years). The age-adjusted SCD incidence rate (per 1,000 person-years) was higher in blacks (1.8; 95% confidence interval [CI]: 1.4 to 2.2) compared with whites (0.7; 95% CI: 0.6 to 0.9), with an unadjusted hazard ratio of 2.35; 95% CI: 1.74 to 3.20. The association of black race with SCD risk remained significant after adjustment for sociodemographics, comorbidities, behavioral measures of health, intervening cardiovascular events, and competing risks of non-SCD mortality (hazard ratio: 1.97; 95% CI: 1.39 to 2.77). CONCLUSIONS In a large biracial population of adults without a history of cardiovascular disease, SCD rates were significantly higher in blacks as compared with whites. These racial differences were not fully explained by demographics, adverse socioeconomic measures, cardiovascular risk factors, and behavioral measures of health.
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Affiliation(s)
- Rajat Deo
- Electrophysiology Section, Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Monika M Safford
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Yulia A Khodneva
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Deanna P Jannat-Khah
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Todd M Brown
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Suzanne E Judd
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama; Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - William M McClellan
- Departments of Medicine and Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - J David Rhodes
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Michael G Shlipak
- Department of Epidemiology, Biostatistics, and Medicine, University of California San Francisco, San Francisco, California; Department of General Internal Medicine, San Francisco VA Medical Center, San Francisco, California
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, and Department of Internal Medicine, Cardiology Section, Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - Christine M Albert
- Center for Arrhythmia Prevention, Division of Preventive Medicine, and Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Heart Rhythm 2018; 15:e73-e189. [DOI: 10.1016/j.hrthm.2017.10.036] [Citation(s) in RCA: 177] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Indexed: 02/07/2023]
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Linde C, Bongiorni MG, Birgersdotter-Green U, Curtis AB, Deisenhofer I, Furokawa T, Gillis AM, Haugaa KH, Lip GYH, Van Gelder I, Malik M, Poole J, Potpara T, Savelieva I, Sarkozy A. Sex differences in cardiac arrhythmia: a consensus document of the European Heart Rhythm Association, endorsed by the Heart Rhythm Society and Asia Pacific Heart Rhythm Society. Europace 2018; 20:1565-1565ao. [PMID: 29961863 DOI: 10.1093/europace/euy067] [Citation(s) in RCA: 172] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Cecilia Linde
- Heart and Vascular Theme, Karolinska University Hospital, S-17176 Stockholm, Sweden
| | | | | | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | | | - Anne M Gillis
- Department of Cardiac Sciences, University of Calgary, Libin Cardiovascular Institute of Alberta, Alberta, Canada
| | - Kristina H Haugaa
- Department of Cardiology, Center for Cardiological Innovation and Institute for Surgical Research, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, UK
- Thrombosis Research Unit, Aalborg University, Denmark
| | - Isabelle Van Gelder
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marek Malik
- National Heart and Lung Institute, Imperial College, London
| | - Jeannie Poole
- University of Washington Medical center, Seattle, Washington, USA
| | - Tatjana Potpara
- School of Medicine, Belgrade University, Belgrade, Serbia
- Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
| | - Irina Savelieva
- St. George's, University of London, Cranmer Terrace, London, UK
| | - Andrea Sarkozy
- Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium
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Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, Deal BJ, Dickfeld T, Field ME, Fonarow GC, Gillis AM, Granger CB, Hammill SC, Hlatky MA, Joglar JA, Kay GN, Matlock DD, Myerburg RJ, Page RL. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2018; 72:e91-e220. [PMID: 29097296 DOI: 10.1016/j.jacc.2017.10.054] [Citation(s) in RCA: 784] [Impact Index Per Article: 112.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Transcriptomic and neurochemical analysis of the stellate ganglia in mice highlights sex differences. Sci Rep 2018; 8:8963. [PMID: 29895973 PMCID: PMC5997635 DOI: 10.1038/s41598-018-27306-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 05/31/2018] [Indexed: 12/22/2022] Open
Abstract
The stellate ganglia are the predominant source of sympathetic innervation to the heart. Remodeling of the nerves projecting to the heart has been observed in several cardiovascular diseases, however studies of adult stellate ganglia are limited. A profile of the baseline transcriptomic and neurochemical characteristics of the stellate ganglia in adult C57Bl6j mice, a common model for the study of cardiovascular diseases, may aid future investigations. We have generated a dataset of baseline measurements of mouse stellate ganglia using RNAseq, HPLC and mass spectrometry. Expression differences between male and female mice were identified. These differences included physiologically important genes for growth factors, receptors and ion channels. While the neurochemical profiles of male and female stellate ganglia were not different, minor differences in neurotransmitter content were identified in heart tissue.
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Boriani G, Lorenzetti S, Cerbai E, Oreto G, Bronzetti G, Malavasi VL, Biffi A, Padeletti L, Botto G, Diemberger I. The effects of gender on electrical therapies for the heart: physiology, epidemiology, and access to therapies. Europace 2018; 19:1418-1426. [PMID: 28525585 DOI: 10.1093/europace/eux068] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 02/18/2017] [Indexed: 12/19/2022] Open
Abstract
The difference between men and women is clear even just by looking at an electrocardiogram: females present higher resting heart rate, a shorter QRS complex length and greater corrected QT interval. The development of these differences from pubertal age onward suggests that sexual hormones play a key role, although their effect is far from being completely understood. Different incidences between sexes have been reported for many arrhythmias, both ventricular and supraventricular, and also for sudden cardiac death. Moreover, arrhythmias are an important issue during pregnancy, both for diagnosis and treatment. Interestingly, cardiovascular structural and electrophysiological remodelling promoted by exercise training enhances this 'gender effect'. Despite all these relevant issues, we lack gender specific recommendations in the current guidelines for electrical therapies for heart rhythm disorders and heart failure. Even more, we continue to see that fewer women are included in clinical trials and are less referred than men for these treatments.
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Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Policlinico di Modena, via del Pozzo, 41124 Modena, Italy
| | - Stefano Lorenzetti
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, Institute of Cardiology, University of Bologna, Policlinico S.Orsola-Malpighi, via Massarenti, 40138 Bologna, Italy
| | - Elisabetta Cerbai
- Department of NeuroFarBa, C.I.M.M.B.A., University of Florence, Largo Brambilla, 50134 Florence, Italy
| | - Giuseppe Oreto
- Department of Clinical and Experimental Medicine, University of Messina, via Consolare Valeria, 98125 Messina, Italy
| | - Gabriele Bronzetti
- Pediatric Cardiology, Cardio-Thoracic-Vascular Department, University Hospital Policlinico S.Orsola-Malpighi, via Massarenti, 40138 Bologna, Italy
| | - Vincenzo Livio Malavasi
- Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Policlinico di Modena, via del Pozzo, 41124 Modena, Italy
| | - Alessandro Biffi
- Institute of Sports Medicine and Science, Italian Olympic Committee, Largo Piero Gabrielli, 00197 Rome, Italy
| | - Luigi Padeletti
- University of Florence, Florence, Italy and IRCCS MultiMedica, 20099 Sesto San Giovanni, Italy
| | - Gianluca Botto
- Unit of Electrophysiology, S. Anna Hospital, via Ravona, San Fermo della Battaglia, 22020 Como, Italy
| | - Igor Diemberger
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, Institute of Cardiology, University of Bologna, Policlinico S.Orsola-Malpighi, via Massarenti, 40138 Bologna, Italy
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Mathieu S, El Khoury N, Rivard K, Paradis P, Nemer M, Fiset C. Angiotensin II Overstimulation Leads to an Increased Susceptibility to Dilated Cardiomyopathy and Higher Mortality in Female Mice. Sci Rep 2018; 8:952. [PMID: 29343862 PMCID: PMC5772611 DOI: 10.1038/s41598-018-19436-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 11/15/2017] [Indexed: 11/09/2022] Open
Abstract
Heart failure (HF) is associated with high mortality and affects men and women differently. The underlying mechanisms for these sex-related differences remain largely unexplored. Accordingly, using mice with cardiac-specific overexpression of the angiotensin II (ANGII) type 1 receptor (AT1R), we explored male-female differences in the manifestations of hypertrophy and HF. AT1R mice of both sexes feature electrical and Ca2+ handling alterations, systolic dysfunction, hypertrophy and develop HF. However, females had much higher mortality (21.0%) rate than males (5.5%). In females, AT1R stimulation leads to more pronounced eccentric hypertrophy (larger increase in LV mass/body weight ratio [+31%], in cell length [+27%], in LV internal end-diastolic [LVIDd, +34%] and systolic [LVIDs, +67%] diameter) and dilation (larger decrease in LV posterior wall thickness, +17%) than males. In addition, in female AT1R mice the cytosolic Ca2+ extrusion mechanisms were more severely compromised and were associated with a specific increased in Ca2+ sparks (by 187%) and evidence of SR Ca2+ leak. Altogether, these results suggest that female AT1R mice have more severe eccentric hypertrophy, dysfunction and compromised Ca2+ dynamics. These findings indicate that females are more susceptible to the adverse effects of AT1R stimulation than males favouring the development of HF and increased mortality.
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Affiliation(s)
- Sophie Mathieu
- Research Center, Montreal Heart Institute, 5000 Bélanger, Montréal, Québec, Canada.,Faculty of Pharmacy, Université de Montréal, Montréal, Québec, Canada
| | - Nabil El Khoury
- Research Center, Montreal Heart Institute, 5000 Bélanger, Montréal, Québec, Canada.,Department of Pharmacology and Physiology, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Katy Rivard
- Research Center, Montreal Heart Institute, 5000 Bélanger, Montréal, Québec, Canada.,Faculty of Pharmacy, Université de Montréal, Montréal, Québec, Canada
| | - Pierre Paradis
- Lady Davis Institute, McGill University, Montreal, Québec, Canada
| | - Mona Nemer
- Ottawa University, Ottawa, Ontario, Canada
| | - Céline Fiset
- Research Center, Montreal Heart Institute, 5000 Bélanger, Montréal, Québec, Canada. .,Faculty of Pharmacy, Université de Montréal, Montréal, Québec, Canada.
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Al-Dury N, Rawshani A, Israelsson J, Strömsöe A, Aune S, Agerström J, Karlsson T, Ravn-Fischer A, Herlitz J. Characteristics and outcome among 14,933 adult cases of in-hospital cardiac arrest: A nationwide study with the emphasis on gender and age. Am J Emerg Med 2017. [DOI: 10.1016/j.ajem.2017.06.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Styles K, Sapp J, Gardner M, Gray C, Abdelwahab A, MacIntyre C, Gao D, Al-Harbi M, Doucette S, Theriault C, Parkash R. The influence of sex and age on ventricular arrhythmia in a population-based registry. Int J Cardiol 2017. [DOI: 10.1016/j.ijcard.2017.06.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bougouin W, Dumas F, Marijon E, Geri G, Champigneulle B, Chiche JD, Varenne O, Spaulding C, Mira JP, Jouven X, Cariou A. Gender differences in early invasive strategy after cardiac arrest: Insights from the PROCAT registry. Resuscitation 2017; 114:7-13. [DOI: 10.1016/j.resuscitation.2017.02.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 02/07/2017] [Accepted: 02/07/2017] [Indexed: 10/20/2022]
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Regitz-Zagrosek V, Kararigas G. Mechanistic Pathways of Sex Differences in Cardiovascular Disease. Physiol Rev 2017; 97:1-37. [PMID: 27807199 DOI: 10.1152/physrev.00021.2015] [Citation(s) in RCA: 458] [Impact Index Per Article: 57.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Major differences between men and women exist in epidemiology, manifestation, pathophysiology, treatment, and outcome of cardiovascular diseases (CVD), such as coronary artery disease, pressure overload, hypertension, cardiomyopathy, and heart failure. Corresponding sex differences have been studied in a number of animal models, and mechanistic investigations have been undertaken to analyze the observed sex differences. We summarize the biological mechanisms of sex differences in CVD focusing on three main areas, i.e., genetic mechanisms, epigenetic mechanisms, as well as sex hormones and their receptors. We discuss relevant subtypes of sex hormone receptors, as well as genomic and nongenomic, activational and organizational effects of sex hormones. We describe the interaction of sex hormones with intracellular signaling relevant for cardiovascular cells and the cardiovascular system. Sex, sex hormones, and their receptors may affect a number of cellular processes by their synergistic action on multiple targets. We discuss in detail sex differences in organelle function and in biological processes. We conclude that there is a need for a more detailed understanding of sex differences and their underlying mechanisms, which holds the potential to design new drugs that target sex-specific cardiovascular mechanisms and affect phenotypes. The comparison of both sexes may lead to the identification of protective or maladaptive mechanisms in one sex that could serve as a novel therapeutic target in one sex or in both.
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Affiliation(s)
- Vera Regitz-Zagrosek
- Institute of Gender in Medicine & Center for Cardiovascular Research, Charite University Hospital, and DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Georgios Kararigas
- Institute of Gender in Medicine & Center for Cardiovascular Research, Charite University Hospital, and DZHK (German Centre for Cardiovascular Research), Berlin, Germany
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Winkel BG, Risgaard B, Bjune T, Jabbari R, Lynge TH, Glinge C, Bundgaard H, Haunsø S, Tfelt-Hansen J. Gender differences in sudden cardiac death in the young-a nationwide study. BMC Cardiovasc Disord 2017; 17:19. [PMID: 28061807 PMCID: PMC5219679 DOI: 10.1186/s12872-016-0446-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 12/16/2016] [Indexed: 11/28/2022] Open
Abstract
Background Hitherto, sudden cardiac death (SCD) in the young has been described with no distinction between genders. SCD occurs more often in men (SCDm) than women (SCDw), but this disparity is not understood and has not been investigated systematically in a nationwide setting. Our objective was to report gender differences in SCD in the young in a nationwide (Denmark) setting. Methods All deaths in persons aged 1–35 years nationwide in Denmark between 2000 and 2009 were included. Death certificates and autopsy reports were obtained. The extensive health care registries in Denmark were used to investigate any known disease prior to death. SCDw were compared to SCDm. Results During the 10-year study period there were a total of 8756 deaths in 23.7 million person-years. In total, 635 deaths were SCD. SCDw constituted 205 deaths (32%). Women had a higher proportion of witnessed deaths (51 vs. 41%, p = 0.02) and died less often in a public place (16 vs. 26%, p = 0.01). Age at death, ratios of autopsies and sudden unexplained deaths, and comorbidities, did not differ. Causes of SCD were largely comparable between genders. The incidence rate of SCDw was half of that of SCDm (1.8 vs. 3.6 per 100,000 person-years, incidence rate ratio 2.0 (95% CI 1.7–2.4), p < 0.01). Conclusions Incidence rate ratio of SCDm vs SCDw is 2. Young SCDw and SCDm are equally investigated, have comparable comorbidity, and causes of SCD. SCD due to potentially inherited cardiac diseases is less often in young women and could reflect a protection of female gender.
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Affiliation(s)
- Bo Gregers Winkel
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, 2142, Blegdamsvej 9, 2100, Copenhagen O, Denmark.
| | - Bjarke Risgaard
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, 2142, Blegdamsvej 9, 2100, Copenhagen O, Denmark
| | - Thea Bjune
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, 2142, Blegdamsvej 9, 2100, Copenhagen O, Denmark
| | - Reza Jabbari
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, 2142, Blegdamsvej 9, 2100, Copenhagen O, Denmark
| | - Thomas Hadberg Lynge
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, 2142, Blegdamsvej 9, 2100, Copenhagen O, Denmark
| | - Charlotte Glinge
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, 2142, Blegdamsvej 9, 2100, Copenhagen O, Denmark
| | - Henning Bundgaard
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, 2142, Blegdamsvej 9, 2100, Copenhagen O, Denmark
| | - Stig Haunsø
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, 2142, Blegdamsvej 9, 2100, Copenhagen O, Denmark
| | - Jacob Tfelt-Hansen
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, 2142, Blegdamsvej 9, 2100, Copenhagen O, Denmark
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Kaki AM, Alghalayini KW, Alama MN, Almazroaa AA, Khathlan NAA, Sembawa H, Ouseph BM. An audit of in-hospital cardiopulmonary resuscitation in a teaching hospital in Saudi Arabia: A retrospective study. Saudi J Anaesth 2017; 11:415-420. [PMID: 29033721 PMCID: PMC5637417 DOI: 10.4103/sja.sja_255_17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Data reflecting cardiopulmonary resuscitation (CPR) efforts in Saudi Arabia are limited. In this study, we analyzed the characteristics, and estimated the outcome, of in-hospital CPR in a teaching hospital in Saudi Arabia over 4 years. METHODS A retrospective, observational study was conducted between January 2009 and December 2012 and included 4361 patients with sudden cardiopulmonary arrest. Resuscitation forms were reviewed. Demographic data, resuscitation characteristics, and survival outcomes were recorded. RESULTS The mean ± standard deviation age of arrested patient was 40 ± 31 years. The immediate survival rate was 64%, 43% at 24 h, and 30% at discharge. The death rate was 70%. Respiratory type of arrest, time and place of arrest, short duration of arrest, witnessed arrest, the use of epinephrine and atropine boluses, and shockable arrhythmias were associated with higher 24-h survival rates. A low survival rate was found among patients with cardiac types of arrest, and those with a longer duration of arrest, pulseless electrical activity, and asystole. Comorbidities were present in 3786 patients with cardiac arrest and contributed to a poor survival rate (P < 0.001). CONCLUSIONS The study confirms the findings of previously published studies in highly developed countries and provides some reflection on the practice of resuscitation in Saudi Arabia.
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Affiliation(s)
- Abdullah Mohammed Kaki
- Department of Anesthesia and Critical Care, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Mohamed Nabil Alama
- Department of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Adnan Abdullah Almazroaa
- Department of Anesthesia and Critical Care, Faculty of Medicine, Taibah University, Madinah Al Munawarah, Saudi Arabia
| | | | - Hassan Sembawa
- Department of Emergency Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Beena M Ouseph
- Department of Nursing, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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