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1
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Fiorina L, Carbonati T, Narayanan K, Li J, Henry C, Singh JP, Marijon E. Near-term prediction of sustained ventricular arrhythmias applying artificial intelligence to single-lead ambulatory electrocardiogram. Eur Heart J 2025:ehaf073. [PMID: 40157386 DOI: 10.1093/eurheartj/ehaf073] [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: 06/03/2024] [Revised: 10/11/2024] [Accepted: 01/29/2025] [Indexed: 04/01/2025] Open
Abstract
BACKGROUND AND AIMS Accurate near-term prediction of life-threatening ventricular arrhythmias would enable pre-emptive actions to prevent sudden cardiac arrest/death. A deep learning-enabled single-lead ambulatory electrocardiogram (ECG) may identify an ECG profile of individuals at imminent risk of sustained ventricular tachycardia (VT). METHODS This retrospective study included 247 254, 14 day ambulatory ECG recordings from six countries. The first 24 h were used to identify patients likely to experience sustained VT occurrence (primary outcome) in the subsequent 13 days using a deep learning-based model. The development set consisted of 183 177 recordings. Performance was evaluated using internal (n = 43 580) and external (n = 20 497) validation data sets. Saliency mapping visualized features influencing the model's risk predictions. RESULTS Among all recordings, 1104 (.5%) had sustained ventricular arrhythmias. In both the internal and external validation sets, the model achieved an area under the receiver operating characteristic curve of .957 [95% confidence interval (CI) .943-.971] and .948 (95% CI .926-.967). For a specificity fixed at 97.0%, the sensitivity reached 70.6% and 66.1% in the internal and external validation sets, respectively. The model accurately predicted future VT occurrence of recordings with rapid sustained VT (≥180 b.p.m.) in 80.7% and 81.1%, respectively, and 90.0% of VT that degenerated into ventricular fibrillation. Saliency maps suggested the role of premature ventricular complex burden and early depolarization time as predictors for VT. CONCLUSIONS A novel deep learning model utilizing dynamic single-lead ambulatory ECGs accurately identifies patients at near-term risk of ventricular arrhythmias. It also uncovers an early depolarization pattern as a potential determinant of ventricular arrhythmias events.
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Affiliation(s)
- Laurent Fiorina
- Ramsay Santé, Institut Cardiovasculaire Paris Sud, Hôpital privé Jacques Cartier, Massy 91300, France
- Université Paris Cité, PARCC, INSERM U970, 56 Rue Leblanc, Paris 75015, France
| | | | - Kumar Narayanan
- Université Paris Cité, PARCC, INSERM U970, 56 Rue Leblanc, Paris 75015, France
- Department of Cardiology, Medicover Hospitals, Hyderabad, India
| | - Jia Li
- Cardiologs, 136 rue Saint Denis, Paris 75002, France
| | | | - Jagmeet P Singh
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Eloi Marijon
- Université Paris Cité, PARCC, INSERM U970, 56 Rue Leblanc, Paris 75015, France
- Division of Cardiology, European Georges Pompidou Hospital, 20-40 Rue Leblanc, Paris 75908, France
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2
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Empana JP, Perier MC, Warming PE, Marijon E, van Valkengoed I, Ågesen FN, Prescott E, Jabbari R, Climie RE, Elders P, Blom MT, Schwartz PJ, Tan HL, Tfelt-Hansen J, Jouven X. Baseline and 10-year change in the number of ideal cardiovascular health metrics and sudden cardiac death in the community. Europace 2025; 27:euaf046. [PMID: 40085819 PMCID: PMC11953004 DOI: 10.1093/europace/euaf046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2024] [Revised: 12/17/2024] [Accepted: 02/16/2025] [Indexed: 03/16/2025] Open
Abstract
AIMS Adherence to an ideal cardiovascular health (CVH) might contribute to lower the burden of sudden cardiac death (SCD) in the community. We aimed to examine the association between the number of ideal CVH metrics at baseline and of its change over 10 years with the risk of SCD. METHODS AND RESULTS The Copenhagen City Heart Study is a community-based prospective cohort study. The number of ideal CVH metrics (range 0-6; non-smoking and ideal level of body mass index, physical activity, untreated glucose, untreated systolic blood pressure, and untreated total cholesterol levels) at baseline in 1991-94 and its 10-year change thereof between 1981-83 and 1991-94 were evaluated. Definite SCD was defined as a death occurring within 1 h (eye-witnessed case) or within 24 h (non-eye-witnessed) of symptoms onset, with the presence of confirmed ventricular tachycardia and the exclusion of non-cardiac cause at autopsy. Fine and Gray sub-distribution HRs (sHRs) were calculated to account for competing risk. The study population includes 8837 participants (57% women; mean age 57 years, ±15 years) in 1991-94. After a median follow-up of 22.6 years from 1 January 1993 up to 31 December 2016, 56 definite SCD occurred. The risk of definite SCD decreased gradually with the number of ideal metrics in 1991-94 [sHR = 0.58; 95% confidence interval (CI): 0.44-0.75 per additional ideal metric] and with the change (i.e. improvement) in the number of ideal metrics between 1981-83 and 1991-94 (sHR = 0.68; 0.50-0.93 per change in the number of ideal metrics). Effect size was lower for coronary death, all-cause mortality, and coronary heart disease events. CONCLUSION Adherence to a higher number of ideal cardiovascular health was related to a substantial lower risk of definite SCD.
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Affiliation(s)
- Jean-Philippe Empana
- Universite Paris Cité, Paris Cardiovascular Research Centre, Integrative Epidemiology of Cardiovascular Diseases, Paris, 56 rue Leblanc, 75015 Paris, France
- Paris Sudden Death Expertise Centre (SDEC), 56 rue Leblanc, 75015 Paris, France
| | - Marie-Cecile Perier
- Universite Paris Cité, Paris Cardiovascular Research Centre, Integrative Epidemiology of Cardiovascular Diseases, Paris, 56 rue Leblanc, 75015 Paris, France
- Paris Sudden Death Expertise Centre (SDEC), 56 rue Leblanc, 75015 Paris, France
| | - Peder Emile Warming
- Department of Cardiology, Copenhagen University Hospital—Rigshospitalet, Copenhagen, Denmark
| | - Eloi Marijon
- Universite Paris Cité, Paris Cardiovascular Research Centre, Integrative Epidemiology of Cardiovascular Diseases, Paris, 56 rue Leblanc, 75015 Paris, France
- Paris Sudden Death Expertise Centre (SDEC), 56 rue Leblanc, 75015 Paris, France
| | - Irene van Valkengoed
- Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Frederik N Ågesen
- Department of Cardiology, Copenhagen University Hospital—Rigshospitalet, Copenhagen, Denmark
| | - Eva Prescott
- Department of Cardiology, Copenhagen University Hospital—Bispebjerg and Frederiksberg, Copenhagen, Denmark
- The Copenhagen City Heart Study, Copenhagen University Hospital—Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Rezza Jabbari
- Department of Cardiology, Copenhagen University Hospital—Rigshospitalet, Copenhagen, Denmark
| | - Rachel E Climie
- Universite Paris Cité, Paris Cardiovascular Research Centre, Integrative Epidemiology of Cardiovascular Diseases, Paris, 56 rue Leblanc, 75015 Paris, France
- Menzies Institute for Medical Research, University of Tasmanian, Hobart, Australia
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Petra Elders
- Department of General Practice, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam University Medical Center location Academic Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Marieke T Blom
- Department of General Practice, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam University Medical Center location Academic Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Peter J Schwartz
- Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics, Istituto Auxologico Italiano IRCCS, Via Pier Lombardo 22, Milan 20135, Italy
| | - Hanno L Tan
- Department of Clinical and Experimental Cardiology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Paris Cardiovascular Research Center, Integrative Epidemiology of cardiovascular diseases, Netherlands Heart Institute, Utrecht, The Netherlands
| | - J Tfelt-Hansen
- Department of Cardiology, Copenhagen University Hospital—Rigshospitalet, Copenhagen, Denmark
- Section of Forensic Genetics, Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Xavier Jouven
- Universite Paris Cité, Paris Cardiovascular Research Centre, Integrative Epidemiology of Cardiovascular Diseases, Paris, 56 rue Leblanc, 75015 Paris, France
- Paris Sudden Death Expertise Centre (SDEC), 56 rue Leblanc, 75015 Paris, France
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3
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Chityala RSR, Bishwakarma S, Shah KM, Pandey A, Saad M. Can artificial intelligence lower the global sudden cardiac death rate? A narrative review. J Electrocardiol 2025; 89:153882. [PMID: 39862597 DOI: 10.1016/j.jelectrocard.2025.153882] [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: 10/04/2024] [Revised: 01/10/2025] [Accepted: 01/13/2025] [Indexed: 01/27/2025]
Abstract
PURPOSE OF REVIEW WHO defines SCD as sudden unexpected death either within 1 h of symptom onset (witnessed) or within 24 h of having been observed alive and symptom-free (unwitnessed). Sudden cardiac arrest is a major cause of mortality worldwide, with survival to hospital discharge for hospital cardiac arrest and in-hospital cardiac arrest being only 9.3 % and 21.2 %, respectively, despite treatment highlighting the importance of effectively predicting and preventing cardiac arrest. This literature review aims to explore the role and application of AI (Artificial Intelligence) in predicting and preventing sudden cardiac arrest. MATERIAL AND METHODS Eligible studies were searched from PubMed and Web of Science. The inclusion criteria were fulfilled if sudden cardiac death prediction and prevention, artificial intelligence, machine learning, and deep learning were included. CONCLUSIONS Artificial intelligence, machine learning, and deep learning have shown remarkable prospects in SCA risk stratification, which can improve the survival rate from SCA. Nonetheless, they have not been adequately trained and tested, necessitating further studies with explainable techniques, larger sample sizes, external validation, more diverse patient samples, multimodal tools, ethics, and bias mitigation to unlock their full potential.
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Affiliation(s)
| | | | - Kaival Malav Shah
- Smt.B.K.Shah Medical Institute and Research Centre, Vadodara, Gujarat, India
| | | | - Muhammad Saad
- Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan.
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4
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Visanji M, Allan KS, Charette M, Grunau B, Roy C, Goldstein J, Choisi T, de Montigny L, Lin S, Brissaw J, Cameron-Dermann L, Donoghue M, Haines M, Hutton J, Nowroozpoor A, Olszynski P, Quinn R, Vaillancourt C, Carter A, Abawajy K, Lanteigne PR, Dorian P. Sports-Related Sudden Cardiac Arrest in Canada: Incidence and Survival. Can J Cardiol 2025; 41:522-530. [PMID: 39918517 DOI: 10.1016/j.cjca.2024.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Revised: 11/05/2024] [Accepted: 11/09/2024] [Indexed: 03/14/2025] Open
Abstract
BACKGROUND Sports-related (Sr-) sudden cardiac arrest (SCA) is widely recognized in young competitive athletes, yet occurs more frequently in middle-aged, recreational athletes. Our objective was to describe the epidemiology and characteristics of Sr-SCA in 5 Canadian Provinces (population: 10.9 million). METHODS We conducted a retrospective cohort study using emergency medical services records from consecutive out of hospital SCAs, for patients aged 18-85 years, who were treated, and whose SCA was from a presumed cardiac cause, during or ≤ 1 hour after sports activity. RESULTS A total of 18,769 SCAs occurred between January 1, 2016 and December 31, 2020, of which 339 (1.8%) were sport-related. Most patients were male (93.8%; 318/339), with an average age of 58.1 ± 14.3 years old. The incidence of Sr-SCA was 1.2 per 100,000 person-years (95% confidence interval [CI], 1.1-1.4). Men had an almost 16-fold greater incidence than women (2.3 [95% CI, 2.1-2.6] vs 0.2 [95% CI, 0.1-0.2] per 100,000 person-years). Sr-SCAs occurred during 52 unique sports. Almost two-thirds occurred in recreational facilities (60.2%; 204/339), with high rates of bystander witnessed (75.6%; 256/339) and bystander cardiopulmonary resuscitation (73.6%; 248/337). Bystanders delivered automated external defibrillator shocks in 121 of 335 (36.1%) cases. Median emergency medical services response time was 6.2 (interquartile range, 4.8-8.9) minutes, with an initial shockable rhythm reported in 76.9% (249/324). More than half of those with known final vital status (52.0%; 167/321) survived to hospital discharge, which varied on the basis of sport. CONCLUSIONS Sr-SCA occurs infrequently, attracts high rates of bystander intervention, and has high survivability.
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Affiliation(s)
- Mika'il Visanji
- McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Katherine S Allan
- Division of Cardiology and Li Ka Shing Knowledge Institute (LKSKI), Unity Health Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Manya Charette
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Brian Grunau
- British Columbia Emergency Health Services, Vancouver, British Columbia, Canada; Departments of Emergency Medicine, St Paul's Hospital and the University of British Columbia, Vancouver, British Columbia, Canada
| | - Carla Roy
- Medavie Health Services West, Saskatoon, Saskatchewan, Canada
| | - Judah Goldstein
- Dalhousie University Division of Emergency Medical Services, Halifax, Nova Scotia, Canada
| | | | - Luc de Montigny
- Urgences-santé, Montreal, Quebec, Canada; Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Steve Lin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Emergency Medicine and Li Ka Shing Knowledge Institute (LKSKI), Unity Health Toronto, Toronto, Ontario, Canada
| | - Jessyca Brissaw
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | | | - Morgan Haines
- Departments of Emergency Medicine, St Paul's Hospital and the University of British Columbia, Vancouver, British Columbia, Canada
| | - Jacob Hutton
- British Columbia Emergency Health Services, Vancouver, British Columbia, Canada; Departments of Emergency Medicine, St Paul's Hospital and the University of British Columbia, Vancouver, British Columbia, Canada
| | - Armin Nowroozpoor
- Department of Emergency Medicine, Duke University Medical Center, Durham, North Carolina, USA; Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Paul Olszynski
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Ryan Quinn
- McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Christian Vaillancourt
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Emergency Medicine, University of Ottawa, Ontario, Canada
| | - Alix Carter
- Dalhousie University Division of Emergency Medical Services, Halifax, Nova Scotia, Canada; London Health Sciences Centre, Schulich School of Medicine, London, Ontario, Canada
| | - Khadija Abawajy
- Dalhousie University Division of Emergency Medical Services, Halifax, Nova Scotia, Canada; Dalhousie Medical School, Halifax, Nova Scotia, Canada
| | | | - Paul Dorian
- Division of Cardiology and Li Ka Shing Knowledge Institute (LKSKI), Unity Health Toronto, Toronto, Ontario, Canada.
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Nishiyama C, Yoshimura S, Taniguchi T, Amano T, Ando H, Homma Y, Imamura T, Itoh T, Kiguchi T, Kiyohara K, Konno S, Makimoto H, Manabe T, Matsuzawa Y, Mitamura H, Niwamae N, Sakuma M, Sato K, Satoh Y, Tahara Y, Tsujita K, Tsukada YT, Uchida M, Ueda Y, Iwami T. Strategies for Reducing Sudden Cardiac Death by Raising Public Awareness - A Statement From the Education and Implementation for Cardiac Emergency Committee of the Japanese Circulation Society. Circ J 2025; 89:394-418. [PMID: 39721709 DOI: 10.1253/circj.cj-24-0599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2024]
Affiliation(s)
- Chika Nishiyama
- Department of Critical Care Nursing, Graduate School of Human Health Sciences, Kyoto University
| | - Satoshi Yoshimura
- Department of Preventive Services, Graduate School of Medicine, Kyoto University
| | | | | | | | - Yosuke Homma
- Department of Emergency Medicine, Chiba Kaihin Municipal Hospital
| | - Tomohiko Imamura
- Department of Preventive Services, Graduate School of Medicine, Kyoto University
| | - Tomonori Itoh
- Division of Cardiology, Department of Internal Medicine, Division of Community Medicine, Department of Medical Education, Iwate Medical University
| | - Takeyuki Kiguchi
- Department of Preventive Services, Graduate School of Medicine, Kyoto University
- Department of Emergency and Critical Care, Osaka General Medical Center
| | - Kosuke Kiyohara
- Department of Food Science, Faculty of Home Economics, Otsuma Women's University
| | | | - Hisaki Makimoto
- Data Science Center/Cardiovascular Center, Jichi Medical University
| | | | - Yasushi Matsuzawa
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | | | - Nogiku Niwamae
- Department of Cardiovascular Medicine, Japanese Red Cross Maebashi Hospital
| | - Masashi Sakuma
- Department of Cardiovascular Medicine, Dokkyo Medical University
| | - Kayoko Sato
- Department of Cardiology, Tokyo Women's Medical University
- Clinical Pathology Laboratory, Department of Food Science and Nutrition, Faculty of Nutrition, Tokyo Kasei University
| | | | - Yoshio Tahara
- Department of Cardiovascular Emergency, National Cerebral and Cardiovascular Center
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | | | | | - Yasunori Ueda
- Cardiovascular Division, National Hospital Organization Osaka National Hospital
| | - Taku Iwami
- Department of Preventive Services, Graduate School of Medicine, Kyoto University
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6
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Yoo KH, Oh J, Lim TH, Kang H, Ko BS, Cho Y, Lee J. Bystander interventions and clinical outcomes among adult out-of-hospital cardiac arrest victims in South Korea over a decade: Sex-based disparities. Public Health 2025; 242:7-13. [PMID: 39999508 DOI: 10.1016/j.puhe.2025.02.017] [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: 07/11/2024] [Revised: 12/27/2024] [Accepted: 02/17/2025] [Indexed: 02/27/2025]
Abstract
OBJECTIVE Delivering bystander interventions is key to improving out-of-hospital cardiac arrest (OHCA) outcomes. Despite reports on sex disparities in bystander interventions and clinical outcomes, comprehensive national-scale assessments in South Korea remain insufficient. Therefore, this study aimed to evaluate nationwide trends over a decade and examine sex disparities in bystander interventions among adult victims of OHCA in South Korea. STUDY DESIGN Population-based cohort study. METHODS We analysed bystander interventions and clinical outcomes among adult OHCA using data from the government's Out-of-Hospital Cardiac Arrest Surveillance between January 2009 and December 2019. We further assessed sex-based differences according to the arrest location, bystander type, and age group. RESULTS This study included a total of 209,901 victims of OHCA. The rate of bystander cardiopulmonary resuscitation (BCPR) improved from 3 % in 2009 to 25 % in 2019. Over the past decade, the usage rate of automated external defibrillators (AEDs) has consistently remained below 1 %. Compared to males, females received BCPR at an odds ratio (OR) of 1·05. However, in public locations, when the bystander was a non-family member, and for those over the age of 65 years, the ORs were 0·80, 0·88, and 0·96, respectively. A gap in sex disparity was observed annually when cardiac arrests occurred in public locations and the bystander was not a family member. CONCLUSIONS Sex disparities in BCPR are pronounced based on arrest location and bystander type. BCPR education programmes should be designed to address OHCA cases across sexes, and improvements in AED usage should be made.
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Affiliation(s)
- Kyung Hun Yoo
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea; Department of Emergency Medicine, Hanyang University Hospital, Seoul, Republic of Korea
| | - Jaehoon Oh
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea; Department of Emergency Medicine, Hanyang University Hospital, Seoul, Republic of Korea.
| | - Tae Ho Lim
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea; Department of Emergency Medicine, Hanyang University Hospital, Seoul, Republic of Korea
| | - Hyunggoo Kang
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea; Department of Emergency Medicine, Hanyang University Hospital, Seoul, Republic of Korea
| | - Byuk Sung Ko
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea; Department of Emergency Medicine, Hanyang University Hospital, Seoul, Republic of Korea
| | - Yongil Cho
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea; Department of Emergency Medicine, Hanyang University Hospital, Seoul, Republic of Korea
| | - Juncheol Lee
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea; Department of Emergency Medicine, Hanyang University Hospital, Seoul, Republic of Korea
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7
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Kransdorf EP, Mathias M, Nakamura K, Tyrer J, Pharaoh PD, Chugh H, Reinier K, Akdemir Z, Boerwinkle E, Yu B, Chugh SS. Genetic Causes of Sudden Cardiac Arrest in the Community. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.12.08.24318665. [PMID: 39936145 PMCID: PMC11812600 DOI: 10.1101/2024.12.08.24318665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2025]
Abstract
Background Annually 300,000 Americans experience sudden cardiac arrest (SCA). Studies in referral SCA cohorts have observed rare variants in genes associated with arrhythmia and cardiomyopathy. We sought to: (1) establish the population prevalence of rare disease-causing variants in a set of candidate genes and (2) confirm the association of disease-causing variants in these genes with SCA in two prospective population-based studies. Methods SCA patients (n=3264) were accrued from the Oregon Sudden Unexpected Death Study and the PREdiction of Sudden death in mulTi-ethnic cOmmunities (PRESTO) study and compared to control patients (n=13713) from the Atherosclerosis Risk in Communities (ARIC) study. Whole genome sequencing was performed. Disease-causing (likely pathogenic or pathogenic) variants in candidate genes associated with arrhythmia/cardiomyopathy were identified using updated American College of Medical Genetics and Genomics criteria. Gene- collapsing case-control analysis was performed using the conditional logistic regression-sequence kernel association test. Results We identified 300 disease-causing variants, the majority of which were in cardiomyopathy genes (71%). There were 136 patients (4.2%) in the SCA group and 351 patients (2.6%) in the control group with one or more disease-causing variants (OR 1.66, 95% confidence interval 1.33-2.07, p<0.001). We identified 13 genes associated with an increased risk of SCA, nine associated with cardiomyopathy ( BAG3, DSC2, DSG2, FLNC, LMNA, MYBPC3, TNNI3, TNNT2, TTN ) and four with arrhythmia ( CACNA1C, CASQ2, KCNH2, KCNQ1 ). Conclusions Disease-causing variants in cardiomyopathy genes were the predominant genetic cause of SCA. These findings inform which genes to include in genetic screening for SCA.
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8
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Gabet A, Lailler G, Fauchier L, Deharo JC, Tuppin P, Leclercq C, Amara W, Grave C, Blacher J, Olié V. Epidemiology of major heart rhythm and conduction disorders. Arch Cardiovasc Dis 2024; 117:693-704. [PMID: 39521645 DOI: 10.1016/j.acvd.2024.10.003] [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: 07/04/2024] [Revised: 09/09/2024] [Accepted: 10/07/2024] [Indexed: 11/16/2024]
Abstract
BACKGROUND Heart rhythm and conduction disorders cover a variety of pathologies, ranging from the benign to the immediately life threatening. AIMS To describe the epidemiology of patients hospitalized for arrhythmias in France, and to estimate the prevalence and mortality associated with these disorders, divided into three separate groups: atrial fibrillation and flutter; conduction disorders; and ventricular tachycardia/cardiac arrest. METHODS We looked in the National Health Data System and selected patients who had been hospitalized at least once in 2022 for these diseases and patients who died as a result of these diseases in 2021. The prevalence of these disorders among people alive on 1st January 2023 was estimated by combining previous hospitalizations and people in receipt of 100% coverage for a registered long-term disease. RESULTS At 1st January 2023, the prevalence of patients who had been hospitalized with major rhythm and conduction disorders was 2,740,141: 2,027,900 with atrial fibrillation/flutter; 999,692 with conduction disorders; and 214,989 with ventricular tachycardia/cardiac arrest. In 2022, respectively 90,502, 48,268 and 16,930 were hospitalized for these conditions, which equate to rates of 169.5, 68.3, and 31.7 per 100,000 inhabitants, respectively. Several departments in the Hauts-de-France and Grand-Est regions had rates>20% above the national rate. The rate of ventricular tachycardia/cardiac arrest was 40% higher among residents of the most deprived municipalities than among residents of the least deprived municipalities. Mortality at the end of hospitalization reached 44% for patients hospitalized for ventricular tachycardia/cardiac arrest. CONCLUSIONS Arrhythmias and conduction disorders affect a significant proportion of the population, leading to a large number of hospitalizations and procedures, particularly ablation techniques and pacemaker/defibrillator implantation. Given the extent of regional disparities and the impact of the socioeconomic status of the municipality of residence, targeted prevention and screening strategies should be implemented.
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MESH Headings
- Humans
- Prevalence
- France/epidemiology
- Hospitalization
- Female
- Male
- Aged
- Middle Aged
- Risk Factors
- Time Factors
- Atrial Fibrillation/epidemiology
- Atrial Fibrillation/diagnosis
- Atrial Fibrillation/physiopathology
- Atrial Fibrillation/mortality
- Atrial Fibrillation/therapy
- Atrial Flutter/epidemiology
- Atrial Flutter/diagnosis
- Atrial Flutter/therapy
- Atrial Flutter/physiopathology
- Atrial Flutter/mortality
- Tachycardia, Ventricular/epidemiology
- Tachycardia, Ventricular/diagnosis
- Tachycardia, Ventricular/physiopathology
- Tachycardia, Ventricular/mortality
- Tachycardia, Ventricular/therapy
- Aged, 80 and over
- Databases, Factual
- Adult
- Heart Rate
- Heart Arrest/epidemiology
- Heart Arrest/diagnosis
- Heart Arrest/mortality
- Heart Arrest/physiopathology
- Heart Arrest/therapy
- Arrhythmias, Cardiac/epidemiology
- Arrhythmias, Cardiac/diagnosis
- Arrhythmias, Cardiac/mortality
- Arrhythmias, Cardiac/therapy
- Arrhythmias, Cardiac/physiopathology
- Young Adult
- Heart Conduction System/physiopathology
- Adolescent
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Affiliation(s)
- Amélie Gabet
- Cardiovascular and Neurovascular Disease Surveillance Unit, Santé Publique France, 94410 Saint-Maurice, France.
| | - Grégory Lailler
- Cardiovascular and Neurovascular Disease Surveillance Unit, Santé Publique France, 94410 Saint-Maurice, France
| | - Laurent Fauchier
- Department of Cardiology, Trousseau University Hospital and Tours University, 37004 Tours, France
| | - Jean-Claude Deharo
- Department of Cardiology, La Timone Adult Hospital, Aix-Marseille University, 13005 Marseille, France
| | - Philippe Tuppin
- French National Health Insurance (CNAM), 75020 Paris, France
| | - Christophe Leclercq
- Rennes University Hospital, 35000 Rennes, France; Rennes 1 University, 35000 Rennes, France; Inserm U642, Signal and Image Processing Laboratory, Clinical Investigation and Technological Innovation Centre 804, 35042 Rennes, France
| | - Walid Amara
- Cardiology Department, Raincy-Montfermeil Hospital Group, 93370 Montfermeil, France
| | - Clémence Grave
- Cardiovascular and Neurovascular Disease Surveillance Unit, Santé Publique France, 94410 Saint-Maurice, France
| | - Jacques Blacher
- Hôtel-Dieu Hospital, Paris-Cité University, AP-HP, 75004 Paris, France
| | - Valérie Olié
- Cardiovascular and Neurovascular Disease Surveillance Unit, Santé Publique France, 94410 Saint-Maurice, France
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Aro AL, Karvonen J. Sudden cardiac death in psychiatric patients: for whom the bell tolls? Heart 2024; 110:1345-1346. [PMID: 39438153 DOI: 10.1136/heartjnl-2024-324808] [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: 10/25/2024] Open
Affiliation(s)
- Aapo L Aro
- Helsinki University Hospital Heart and Lung Center, Helsinki, Finland
| | - Jarkko Karvonen
- Helsinki University Hospital Heart and Lung Center, Helsinki, Finland
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10
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Gao Y, Li X, Yang J, Zhang Z, Chen Z, Wu S, Cui X, Ma X, Guo X, Chen R, Sun Q, Dai Y, Zhang S, Chen K. Nonalcoholic fatty liver disease is associated with ventricular arrhythmias and major cardiovascular events in patients with implantable cardioverter-defibrillators. Heart Rhythm 2024:S1547-5271(24)03511-2. [PMID: 39490951 DOI: 10.1016/j.hrthm.2024.10.050] [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: 09/12/2024] [Revised: 10/19/2024] [Accepted: 10/22/2024] [Indexed: 11/05/2024]
Abstract
BACKGROUND Patients with nonalcoholic fatty liver disease (NAFLD) are at risk for cardiovascular diseases. Less is known about the relationship between NAFLD, ventricular arrhythmias (VAs), and cardiovascular events. OBJECTIVE We sought to evaluate the association between NAFLD and VAs and major cardiovascular events in patients with implantable cardioverter-defibrillators (ICDs). METHODS A total of 921 patients at high risk of sudden cardiac death who received ICDs were retrospectively analyzed. NAFLD is diagnosed by the presence of hepatic steatosis and lack of secondary causes of hepatic fat accumulation. The primary end points were VAs, defined as sustained ventricular tachycardia and ventricular fibrillation documented by the device. The secondary end points were cardiac mortality, heart transplantation, and rehospitalization for heart failure. RESULTS The prevalence of NAFLD in patients with ICDs was 24.2% (223/921). The mean age was 58.5 ± 12.7 years, and 25.7% were female. During the mean follow-up of 34.8 months, 272 (29.5%) patients achieved primary end points and 171 (18.6%) achieved secondary end points. Kaplan-Meier analysis revealed that NAFLD was associated with an increased risk of VAs (hazard ratio [HR], 3.90; 95% confidence interval [CI], 2.87-5.29; log-rank P < .0001) and secondary end points (HR, 2.04; 95% CI, 1.72-2.94; log-rank P < .0001). In adjusted Cox regression models, NAFLD was an independent risk factor for VAs (HR, 3.84; CI, 2.87-5.12; P < .001) and secondary end points (HR, 2.26; CI, 1.55-3.28; P < .001). CONCLUSION In our retrospective cohort, NAFLD is significantly associated with VAs and major cardiovascular events in patients with ICDs.
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Affiliation(s)
- Yuan Gao
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoyao Li
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiandu Yang
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhuxin Zhang
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhongli Chen
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sijin Wu
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiang Cui
- Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuan Ma
- Department of Magnetic Resonance Imaging, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaogang Guo
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ruohan Chen
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qi Sun
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Dai
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu Zhang
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Keping Chen
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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11
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Juntunen S, Holmström L, Vähätalo J, Mäntyniemi L, Tikkanen J, Pakanen L, Kaikkonen K, Perkiömäki J, Huikuri H, Junttila J. The burden of sudden cardiac arrest in the setting of acute coronary syndrome. Resuscitation 2024; 202:110297. [PMID: 38942268 DOI: 10.1016/j.resuscitation.2024.110297] [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: 03/01/2024] [Revised: 06/05/2024] [Accepted: 06/24/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND The incidence of sudden cardiac arrest (SCA) during acute coronary syndrome is somewhat unclear, since often subjects dying before the first healthcare contact are not included in the estimates. We aimed to investigate the complete incidence of SCA during ACS. METHODS The study population consists of two cohorts. The first cohort includes 472 ACS patients from Northern Ostrobothnia, Finland from year 2016 and the second cohort 162 autopsy-verified SCD subjects (extrapolated) from the same region and year, whose death was attributable to coronary artery disease (CAD) and ACS. An extrapolation of SCA incidence during ACS was done by utilizing autopsy data and data from prior autopsy study on this sample. RESULTS The overall incidence of SCA in the setting of ACS was 17.5%. The incidence of SCA was 20.6% in all ACS subjects without prior CAD diagnosis, and 25.4% in STEMI subjects without prior CAD diagnosis. In subjects with previously diagnosed CAD, the incidence of SCA was 10.9% in all ACS subjects and 16.1% in STEMI subjects. There was a statistically significant difference in the incidence of SCA between subjects with and without prior CAD diagnosis (p = 0.0052). CONCLUSION The inclusion of ACS-SCA subjects dying before the first emergency medical service (EMS) contact results in a higher and likely more accurate estimation of SCA during ACS. The incidence of SCA was higher among subjects without prior CAD diagnosis. The high mortality rate highlights the importance of early ACS detection to reduce the burden of CAD-related premature deaths.
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Affiliation(s)
- Samuli Juntunen
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu, Oulu University Hospital, Oulu, Finland.
| | - Lauri Holmström
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu, Oulu University Hospital, Oulu, Finland
| | - Juha Vähätalo
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu, Oulu University Hospital, Oulu, Finland
| | - Lassi Mäntyniemi
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu, Oulu University Hospital, Oulu, Finland
| | - Jani Tikkanen
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu, Oulu University Hospital, Oulu, Finland
| | - Lasse Pakanen
- Forensic Medicine Unit, Finnish Institute for Health and Welfare, Oulu, Finland; Department of Forensic Medicine, Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Kari Kaikkonen
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu, Oulu University Hospital, Oulu, Finland
| | - Juha Perkiömäki
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu, Oulu University Hospital, Oulu, Finland
| | - Heikki Huikuri
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu, Oulu University Hospital, Oulu, Finland
| | - Juhani Junttila
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu, Oulu University Hospital, Oulu, Finland
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12
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van den Beuken WMF, van Schuppen H, Demirtas D, van Halm VP, van der Geest P, Loer SA, Schwarte LA, Schober P. Investigating Users' Attitudes Toward Automated Smartwatch Cardiac Arrest Detection: Cross-Sectional Survey Study. JMIR Hum Factors 2024; 11:e57574. [PMID: 39056309 PMCID: PMC11292589 DOI: 10.2196/57574] [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: 02/20/2024] [Revised: 05/19/2024] [Accepted: 06/02/2024] [Indexed: 07/28/2024] Open
Abstract
Background Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality in the developed world. Timely detection of cardiac arrest and prompt activation of emergency medical services (EMS) are essential, yet challenging. Automated cardiac arrest detection using sensor signals from smartwatches has the potential to shorten the interval between cardiac arrest and activation of EMS, thereby increasing the likelihood of survival. Objective This cross-sectional survey study aims to investigate users' perspectives on aspects of continuous monitoring such as privacy and data protection, as well as other implications, and to collect insights into their attitudes toward the technology. Methods We conducted a cross-sectional web-based survey in the Netherlands among 2 groups of potential users of automated cardiac arrest technology: consumers who already own a smartwatch and patients at risk of cardiac arrest. Surveys primarily consisted of closed-ended questions with some additional open-ended questions to provide supplementary insight. The quantitative data were analyzed descriptively, and a content analysis of the open-ended questions was conducted. Results In the consumer group (n=1005), 90.2% (n=906; 95% CI 88.1%-91.9%) of participants expressed an interest in the technology, and 89% (n=1196; 95% CI 87.3%-90.7%) of the patient group (n=1344) showed interest. More than 75% (consumer group: n= 756; patient group: n=1004) of the participants in both groups indicated they were willing to use the technology. The main concerns raised by participants regarding the technology included privacy, data protection, reliability, and accessibility. Conclusions The vast majority of potential users expressed a strong interest in and positive attitude toward automated cardiac arrest detection using smartwatch technology. However, a number of concerns were identified, which should be addressed in the development and implementation process to optimize acceptance and effectiveness of the technology.
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Affiliation(s)
| | - Hans van Schuppen
- Department of Anesthesiology, Amsterdam UMC, Amsterdam, Netherlands
- Helicopter Emergency Medical Service Lifeliner 1, Amsterdam, Netherlands
| | - Derya Demirtas
- Center for Healthcare Operations Improvement and Research, University of Twente, Enschede, Netherlands
- Industrial Engineering and Business Information Systems, University of Twente, Enschede, Netherlands
| | | | - Patrick van der Geest
- Ambulance Rotterdam-Rijnmond, Barendrecht, Netherlands
- Department of Intensive Care Medicine, Spaarne Gasthuis, Haarlem, Netherlands
| | - Stephan A Loer
- Department of Anesthesiology, Amsterdam UMC, Amsterdam, Netherlands
| | - Lothar A Schwarte
- Department of Anesthesiology, Amsterdam UMC, Amsterdam, Netherlands
- Helicopter Emergency Medical Service Lifeliner 1, Amsterdam, Netherlands
| | - Patrick Schober
- Department of Anesthesiology, Amsterdam UMC, Amsterdam, Netherlands
- Helicopter Emergency Medical Service Lifeliner 1, Amsterdam, Netherlands
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13
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Tello Montoliu A, Olea González A, Pujante Escudero Á, Martínez Del Villar M, de la Guía Galipienso F, Díaz González L, Fernández Olmo R, Freixa-Pamias R, Vivas Balcones D. Cardiovascular considerations on recreational scuba diving. SEC-Clinical Cardiology Association/SEC-Working Group on Sports Cardiology consensus document. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:566-573. [PMID: 38580141 DOI: 10.1016/j.rec.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/11/2024] [Indexed: 04/07/2024]
Abstract
The practice of recreational scuba diving has increased worldwide, with millions of people taking part each year. The aquatic environment is a hostile setting that requires human physiology to adapt by undergoing a series of changes that stress the body. Therefore, physical fitness and control of cardiovascular risk factors are essential for practicing this sport. Medical assessment is not mandatory before participating in this sport and is only required when recommended by a health questionnaire designed for this purpose. However, due to the significance of cardiovascular disease, cardiology consultations are becoming more frequent. The aim of the present consensus document is to describe the cardiovascular physiological changes that occur during diving, focusing on related cardiovascular diseases, their management, and follow-up recommendations. The assessment and follow-up of individuals who practice diving with previous cardiovascular disease are also discussed. This document, endorsed by the Clinical Cardiology Association of the Spanish Society of Cardiology (SEC) and the SEC Working Group on Sports Cardiology of the Association of Preventive Cardiology, aims to assist both cardiologists in evaluating patients, as well as other specialists responsible for assessing individuals' fitness for diving practice.
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Affiliation(s)
- Antonio Tello Montoliu
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain; Cuerpo de Sanidad, Centro de Buceo de la Armada, Armada Española, Cartagena, Murcia, Spain.
| | - Agustín Olea González
- Cuerpo de Sanidad, Centro de Buceo de la Armada, Armada Española, Cartagena, Murcia, Spain; Jefatura de Apoyo Sanitario de Cartagena, Armada Española, Cartagena, Murcia, Spain
| | - Ángel Pujante Escudero
- Cuerpo de Sanidad, Centro de Buceo de la Armada, Armada Española, Cartagena, Murcia, Spain
| | | | - Fernando de la Guía Galipienso
- Servicio de Cardiología, Policlínica Glorieta Denia, Denia, Alicante, Spain; Clínica Rehabilitación Marina Alta (REMA)/Cardiología Deportiva Denia, Denia, Alicante, Spain; Hospital Clínica Benidorm (HCB), Benidorm, Alicante, Spain
| | - Leonel Díaz González
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain; Clínica CEMTRO, Madrid, Spain
| | | | - Román Freixa-Pamias
- Servicio de Cardiología, Complex Hospitalari Moisès Broggi, Sant Joan Despí, Barcelona, Spain
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14
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Weizman O, Marijon E. [Physical activity to reduce cardiovascular risk -Why deprive yourself ?]. Ann Cardiol Angeiol (Paris) 2024; 73:101764. [PMID: 38723317 DOI: 10.1016/j.ancard.2024.101764] [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: 03/22/2024] [Revised: 03/29/2024] [Accepted: 04/02/2024] [Indexed: 06/05/2024]
Abstract
Sports-related sudden death is an uncommon event, affecting mainly middle-aged men who practice leisure sports, and is related to unknown coronary artery disease. In athletes, cardiac causes are also predominant, with a greater proportion of structural and electrical heart disease. If first-aid resuscitation measures are initiated, survival easily exceeds 50%, and this is an excellent educational illustration of how to improve the prognosis of non-sport-related cardiac arrest. Prevention of a sport-related cardiovascular event remains difficult, and relies on clinical examination, questioning (including family history) and resting ECG in participants >35 years old. The non-contraindication visit is also an opportunity to pass on to the patient the rules of good sports "hygiene" and life-saving gestures in the event of sudden death during sport in one of the partners (and the importance of regularly educating oneself in life-saving gestures...).
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Affiliation(s)
| | - Eloi Marijon
- European Georges Pompidou Hospital, Paris, France.
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15
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Ho CL, Anantharaman V. Relevance of the Get Active Questionnaire for Pre-Participation Exercise Screening in the General Population in a Tropical Environment. Healthcare (Basel) 2024; 12:815. [PMID: 38667577 PMCID: PMC11050380 DOI: 10.3390/healthcare12080815] [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: 03/19/2024] [Revised: 04/05/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
The Get Active Questionnaire (GAQ), developed by the Canadian Society for Exercise Professionals (CSEP), was recently recommended for pre-participation screening of the general population in Singapore before increasing their exercise levels. This literature review examines the evidence behind the GAQ and its relevance to our tropical environment. Searches were carried out via Pubmed, MEDLINE and the Cochrane Central Register of Controlled Trials. Resources referenced by the CSEPs were hand searched. The CSEP was also contacted for further information. The evidence behind each GAQ question was compared to international literature and guidelines, where applicable. Out of 273 studies, 49 were suitable for analysis. Two GAQ studies commissioned by the CSEP showed a high negative predictive value but high false negative rate. Of the nine GAQ questions, those on dizziness, joint pains and chronic diseases appear to be justified. Those on heart disease/stroke, hypertension, breathlessness and concussion require modification. The one on syncope can be amalgamated into the dizziness question. The remaining question may be deleted. No long-term studies were available to validate the use of the GAQ. Heat disorders were not considered in the GAQ. Modification of the GAQ, including the inclusion of environmental factors, may make it more suitable for the general population and should be considered.
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Affiliation(s)
- Cuiying Lisa Ho
- Department of Orthopaedic Surgery, Sengkang General Hospital, 110 Sengkang East Way, Singapore 544886, Singapore
| | - Venkataraman Anantharaman
- Department of Emergency Medicine, Singapore General Hospital, Duke-NUS Academic Medical Centre, Outram Road, Singapore 169608, Singapore
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16
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Chugh SS. Prevention of Sudden Cardiac Death: Beyond Automated External Defibrillators and Implantable Cardioverter Defibrillators. Circulation 2024; 149:1059-1061. [PMID: 38557124 PMCID: PMC11192245 DOI: 10.1161/circulationaha.123.066984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Affiliation(s)
- Sumeet S Chugh
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute. Division of Artificial Intelligence in Medicine, Department of Medicine. Cedars-Sinai Health System, Los Angeles, CA
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17
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Larsen MB, Blom-Hanssen E, Gnesin F, Kragholm KH, Lass Klitgaard T, Christensen HC, Lippert F, Folke F, Torp-Pedersen C, Ringgren KB. Prodromal complaints and 30-day survival after emergency medical services-witnessed out-of-hospital cardiac arrest. Resuscitation 2024; 197:110155. [PMID: 38423500 DOI: 10.1016/j.resuscitation.2024.110155] [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: 12/30/2023] [Revised: 02/17/2024] [Accepted: 02/20/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) is a frequent and lethal condition with a yearly incidence of approximately 5000 in Denmark. Thirty-day survival is associated with the patient's prodromal complaints prior to cardiac arrest. This paper examines the odds of 30-day survival dependent on the reported prodromal complaints among OHCAs witnessed by the emergency medical services (EMS). METHODS EMS-witnessed OHCAs in the Capital Region of Denmark from 2016-2018 were included. Calls to the emergency number 1-1-2 and the medical helpline for out-of-hours were analyzed according to the Danish Index; data regarding the OHCA was collected from the Danish Cardiac Arrest Registry. We performed multiple logistic regression to calculate the odds ratio (OR) of 30-day survival with adjustment for sex and age. RESULTS We identified 311 eligible OHCAs of which 79 (25.4%) survived. The most commonly reported complaints were dyspnea (n = 209, OR 0.79 [95% CI 0.46: 1.36]) and 'feeling generally unwell' (n = 185, OR 1.07 [95% CI 0.63: 1.81]). Chest pain (OR 9.16 [95% CI 5.09:16.9]) and heart palpitations (OR 3.15 [95% CI 1.07:9.46]) had the highest ORs, indicating favorable odds for 30-day survival, while unresponsiveness (OR 0.22 [95% CI 0.11:0.43]) and blue skin or lips (OR 0.30, 95% CI 0.09, 0.81) had the lowest, indicating lesser odds of 30-day survival. CONCLUSION Experiencing chest pain or heart palpitations prior to EMS-witnessed OHCA was associated with higher 30-day survival. Conversely, complaints of unresponsiveness or having blue skin or lips implied reduced odds of 30-day survival.
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Affiliation(s)
- Mia Bang Larsen
- Department of Clinical Medicine, Aalborg University, Denmark.
| | | | - Filip Gnesin
- Department of Cardiology, Nordsjaellands Hospital, Denmark
| | - Kristian Hay Kragholm
- Department of Clinical Medicine, Aalborg University, Denmark; Department of Cardiology, Aalborg University Hospital, Denmark
| | | | | | - Freddy Lippert
- Falck, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Fredrik Folke
- Department of Clinical Medicine, University of Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Denmark; Copenhagen Emergency Medical Services, University of Copenhagen, Denmark
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18
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Nakamura K, Reinier K, Chugh SS. Ventricular fibrillation and the proteome problem: can we solve it? EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2024; 13:273-274. [PMID: 38038354 PMCID: PMC10926977 DOI: 10.1093/ehjacc/zuad148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Affiliation(s)
- Kotoka Nakamura
- Department of Cardiology, Center for Cardiac Arrest Prevention, Smidt Heart Institute, Cedars-Sinai Medical Center, Suite A3100, 127 S. San Vicente Blvd., Los Angeles, CA 90048, USA
| | - Kyndaron Reinier
- Department of Cardiology, Center for Cardiac Arrest Prevention, Smidt Heart Institute, Cedars-Sinai Medical Center, Suite A3100, 127 S. San Vicente Blvd., Los Angeles, CA 90048, USA
| | - Sumeet S Chugh
- Department of Cardiology, Center for Cardiac Arrest Prevention, Smidt Heart Institute, Cedars-Sinai Medical Center, Suite A3100, 127 S. San Vicente Blvd., Los Angeles, CA 90048, USA
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19
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Baswaraj D, Flaker G. Syncope in Athletes: A Prelude to Sudden Cardiac Death? MISSOURI MEDICINE 2024; 121:52-59. [PMID: 38404441 PMCID: PMC10887456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Athletes are generally healthy but might have certain cardiac disorders which might, during athletic participation or training, result in cardiac symptoms including syncope. Vasovagal syncope is probably the most common cause of syncope in athletes, but syncope in the context of these cardiac disorders might be a warning of sudden death.
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Affiliation(s)
- Deepa Baswaraj
- Chief Fellow in Cardiovascular Disease, Department of Medicine, University of Missouri - Columbia School of Medicine, Columbia, Missouri
| | - Greg Flaker
- Division of Cardiolog, Department of Medicine, University of Missouri - Columbia School of Medicine, Columbia, Missouri
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20
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Gessman LJ, Schacknow PN, Brindis RG. Sudden Cardiac Death at Home: Potential Lives Saved With Fully Automated External Defibrillators. Ann Emerg Med 2024; 83:35-41. [PMID: 37725020 DOI: 10.1016/j.annemergmed.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/03/2023] [Accepted: 08/03/2023] [Indexed: 09/21/2023]
Abstract
Sudden cardiac death from ventricular arrhythmia kills about 350,000 people annually in the United States. This number has not improved since the widespread public availability of semi-automated external defibrillators (AEDs) and the teaching of nonbreathing cardiopulmonary resuscitation (CPR) procedures. When an out-of-hospital cardiac arrest occurs in a public space, lay witnesses do CPR in 40% of the cases and use AEDs on only 7.4% of the victims before emergency medical services (EMS) arrive. About 70% of sudden cardiac death occurs at home, where an AED is usually unavailable until EMS appears. The time from a 911 call to shock averages approximately 7 minutes in urban areas and is more than 14.5 minutes in rural environments. Because arrest onset is often not observed, arrest onset to shock times maybe even longer. Survival from cardiac arrest decreases by approximately 7 to 10% per minute of ventricular arrhythmia. A prearrest protocol is proposed for the at-home use of fully automated external defibrillators in select cardiac patients, which should reduce the arrest-to-shock interval to under 1 minute and may eliminate the need for CPR in some cases.
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Affiliation(s)
- Lawrence J Gessman
- Department of Medicine, Cardiovascular Diseases, Cooper Medical School of Rowan University, Camden, NJ
| | - Paul N Schacknow
- Department of Ophthalmology, Nova Southeastern University, Fort Lauderdale, FL.
| | - Ralph G Brindis
- Department of Medicine & the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA
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21
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Böckler B, Preisner A, Bathe J, Rauch S, Ristau P, Wnent J, Gräsner JT, Seewald S, Lefering R, Fischer M. Gender-related differences in adults concerning frequency, survival and treatment quality after out-of-hospital cardiac arrest (OHCA): An observational cohort study from the German resuscitation registry. Resuscitation 2024; 194:110060. [PMID: 38013146 DOI: 10.1016/j.resuscitation.2023.110060] [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: 10/02/2023] [Revised: 11/16/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND In Germany approximately 20,500 women and 41,000 men were resuscitated after out-of-hospital cardiac arrest (OHCA) each year. We are currently experiencing a discussion about the possible undersupply of women in healthcare. The aim of the present study was to examine the prevalence of OHCA in Germany, as well as the outcome and quality of resuscitation care for both women and men. METHODS We present a cohort study from the German Resuscitation Registry (2006-2022). The quality of care was assessed for both EMS and hospital care based on risk-adjusted survival rates with the endpoints: "hospital admission with return of spontaneous circulation" (ROSCadmission) for all patients and "discharge with favourable neurological recovery" (CPC1/2discharge) for all admitted patients. Risk adjustment was performed using logistic regression analysis (LRA). If sex was significantly associated with survival, a matched-pairs-analysis (MPA) followed to explore the frequency of guideline adherence. RESULTS 58,798 patients aged ≥ 18 years with OHCA and resuscitation were included (men = 65.2%, women = 34.8%). In the prehospital phase the male gender was associated with lower ROSCadmission-rate (LRA: OR = 0.79, CI = 0.759-0.822). A total of 27,910 patients were admitted. During hospital care, men demonstrated a better prognosis (OR = 1.10; CI = 1.015-1.191). MPA revealed a more intensive therapy for men both during EMS and hospital care. Looking at the complete chain of survival, LRA revealed no difference for men and women concerning CPC1/2discharge (n = 58,798; OR = 0.95; CI = 0.888-1.024). CONCLUSION In Germany, 80% more men than women experience OHCA. The prognosis for CPC1/2discharge remains low (men = 10.5%, women = 7.1%), but comparable after risk adjustment. There is evidence of undersupply of care for women during hospital treatment, which could be associated with a worse prognosis. Further investigations are required to clarify these findings.
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Affiliation(s)
- Bastian Böckler
- Clinic for Anaesthesiology, Klinikum Großhadern/Innenstadt, Ludwig-Maximilians-Universität München, Munich, Germany; Clinic for Anaesthesiology, Intensive Care Medicine, Emergency Medicine, and Pain Therapy, Alb Fils Kliniken, Göppingen, Germany
| | - Achim Preisner
- Clinic for Anaesthesiology, Intensive Care Medicine, Emergency Medicine, and Pain Therapy, Alb Fils Kliniken, Göppingen, Germany; Women's Clinic with Gynaecology and Obstetrics, Alb Fils Kliniken, Göppingen, Germany
| | - Janina Bathe
- University-Hospital Schleswig-Holstein, Institute for Emergency Medicine, Kiel, Germany
| | - Stefan Rauch
- Clinic for Anaesthesiology, Intensive Care Medicine, Emergency Medicine, and Pain Therapy, Alb Fils Kliniken, Göppingen, Germany
| | - Patrick Ristau
- University-Hospital Schleswig-Holstein, Institute for Emergency Medicine, Kiel, Germany
| | - Jan Wnent
- University-Hospital Schleswig-Holstein, Institute for Emergency Medicine, Kiel, Germany; University-Hospital Schleswig-Holstein, Department of Anaesthesiology and Intensive Care, Kiel, Germany
| | - Jan-Thorsten Gräsner
- University-Hospital Schleswig-Holstein, Institute for Emergency Medicine, Kiel, Germany; University-Hospital Schleswig-Holstein, Department of Anaesthesiology and Intensive Care, Kiel, Germany
| | - Stephan Seewald
- University-Hospital Schleswig-Holstein, Institute for Emergency Medicine, Kiel, Germany; University-Hospital Schleswig-Holstein, Department of Anaesthesiology and Intensive Care, Kiel, Germany
| | - Rolf Lefering
- Universität Witten/Herdecke Institute for Research in Operative Medicine (IFOM), Cologne, Germany
| | - Matthias Fischer
- Clinic for Anaesthesiology, Intensive Care Medicine, Emergency Medicine, and Pain Therapy, Alb Fils Kliniken, Göppingen, Germany.
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22
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van den Beuken WM, Sayre MR, Olasveengen TM, Sunshine JE. Wolf Creek XVII part 3: Automated cardiac arrest diagnosis. Resusc Plus 2023; 16:100499. [PMID: 38059269 PMCID: PMC10696380 DOI: 10.1016/j.resplu.2023.100499] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023] Open
Abstract
Introduction Automated cardiac arrest diagnosis offers the possibility to significantly shorten the interval between onset of out-of-hospital cardiac arrest (OHCA) and notification of EMS, providing the opportunity for earlier resuscitation and possibly increased survival. Methods Automated cardiac arrest diagnosis was one of six focus topics for the Wolf Creek XVII Conference held on June 14-17 2023 in Ann Arbor, Michigan, USA. Conference invitees included international thought leaders and scientists in the field of cardiac arrest resuscitation from academia and industry. Participants submitted via online survey knowledge gaps, barriers to translation and research priorities for each focus topic. Expert panels used the survey results and their own perspectives and insights to create and present a preliminary unranked list for each category that was debated, revised and ranked by all attendees to identify the top 5 for each category. Results Top knowledge gaps include the accuracy of automated OHCA detection technologies and the feasibility and reliability of automated EMS activation. The main barriers to translation are the risk of false positives potentially overburdening EMS, development and application costs of technology and the challenge of integrating new technology in EMS IT systems. The top research priorities are large-scale evaluation studies to measure real world performance and user research regarding the willingness to adopt these technologies. Conclusion Automated cardiac arrest diagnosis has the potential to significantly impact time to resuscitation and survival of OHCA because it could convert unwitnessed events into witnessed events. Validation and feasibility studies are needed. The specificity of the technology must be high not to overburden limited EMS resources. If adequate event classification is achieved, future research could shift toward event prediction, focusing on identifying potential digital biomarkers and signatures of imminent cardiac arrest. Implementation could be challenging due to high costs of development, regulatory considerations and instantiation logistics.
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Affiliation(s)
| | - Michael R. Sayre
- Department of Emergency Medicine, University of Washington, Seattle, WA, United States
| | - Theresa M. Olasveengen
- Department of Anesthesia and Intensive Care, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway
| | - Jacob E. Sunshine
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, United States
- Paul G Allen School of Computer Science and Engineering, University of Washington, Seattle, WA, United States
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23
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Slotta T, Wolters C, Marx Z, Witthöft M, Gerlach AL, Pohl A. Respiratory Interoception and Pathological Illness Anxiety: Disentangling Bias. Psychosom Med 2023; 85:778-784. [PMID: 37594228 DOI: 10.1097/psy.0000000000001244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
OBJECTIVE Biased interoception decoupled from physiology might be relevant in the etiology of pathological illness anxiety (PIA). Empirical evidence for interoceptive deviations in illness anxiety is scarce but potentially informative to optimize treatments. We hypothesized that persons with PIA differ fundamentally in the classification of bodily sensations from those without PIA. METHODS In a respiratory categorization task, participants breathed into a pulmonary training device. Inspiration effort was varied by eight resistive loads. The lower/higher four loads were introduced as belonging to arbitrary categories "A"/"B," respectively. Participants memorized respiratory sensations in a first experimental block and were asked to label the resistances in a second block. We calculated the sensitivity of resistance classification according to category and response bias in terms of categorical misclassification. Data of 39 participants with PIA and 35 controls were compared with regard to sensitivity and response bias by group, resistive load, and their interaction in a multiple regression. RESULTS With similar sensitivity, patients more often labeled loads above the categorical border erroneously as belonging to category A, thus underestimating their resistance ( β = -0.06, p = .001; η2 = 0.02). CONCLUSIONS Individuals with PIA showed a systematic "wait and see" approach. Altered respiroception in PIA might stem from biased perception during training phase, the recognition phase, biased memory, or a combination of these. Its exact characteristics remain unknown, and future research must address the challenge of developing reliable and valid paradigms accounting for the variability of interoceptive biases. REGISTRATION This work was preregistered on OSF ( https://osf.io/9shcw ).
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Affiliation(s)
- Timo Slotta
- From the Institute of Clinical Psychology and Psychotherapy (Slotta, Wolters, Marx, Gerlach, Pohl), University of Cologne, Cologne, Germany; and Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology (Witthöft), Johannes Gutenberg-University Mainz, Mainz, Germany
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24
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Reinier K, Dizon B, Chugh H, Bhanji Z, Seifer M, Sargsyan A, Uy-Evanado A, Norby FL, Nakamura K, Hadduck K, Shepherd D, Grogan T, Elashoff D, Jui J, Salvucci A, Chugh SS. Warning symptoms associated with imminent sudden cardiac arrest: a population-based case-control study with external validation. Lancet Digit Health 2023; 5:e763-e773. [PMID: 37640599 PMCID: PMC10746352 DOI: 10.1016/s2589-7500(23)00147-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 07/07/2023] [Accepted: 07/18/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Sudden cardiac arrest is a global public health problem with a mortality rate of more than 90%. Prearrest warning symptoms could be harnessed using digital technology to potentially improve survival outcomes. We aimed to estimate the strength of association between symptoms and imminent sudden cardiac arrest. METHODS We conducted a case-control study of individuals with sudden cardiac arrest and participants without sudden cardiac arrest who had similar symptoms identified from two US community-based studies of patients with sudden cardiac arrest in California state, USA (discovery population; the Ventura Prediction of Sudden Death in Multi-Ethnic Communities [PRESTO] study), and Oregon state, USA (replication population; the Oregon Sudden Unexpected Death Study [SUDS]). Participant data were obtained from emergency medical services reports for people aged 18-85 years with witnessed sudden cardiac arrest (between Feb 1, 2015, and Jan 31, 2021) and an inclusion symptom. Data were also obtained from corresponding control populations without sudden cardiac arrest who were attended by emergency medical services for similar symptoms (between Jan 1 and Dec 31, 2019). We evaluated the association of symptoms with sudden cardiac arrest in the discovery population and validated our results in the replication population by use of logistic regression models. FINDINGS We identified 1672 individuals with sudden cardiac arrest from the PRESTO study, of whom 411 patients (mean age 65·7 [SD 12·4] years; 125 women and 286 men) were included in the analysis for the discovery population. From a total of 76 734 calls to emergency medical services, 1171 patients (mean age 61·8 [SD 17·3] years; 643 women, 514 men, and 14 participants without data for sex) were included in the control group. Patients with sudden cardiac arrest were more likely to have dyspnoea (168 [41%] of 411 vs 262 [22%] of 1171; p<0·0001), chest pain (136 [33%] vs 296 [25%]; p=0·0022), diaphoresis (50 [12%] vs 90 [8%]; p=0·0059), and seizure-like activity (43 [11%] vs 77 [7%], p=0·011). Symptom frequencies and patterns differed significantly by sex. Among men, chest pain (odds ratio [OR] 2·2, 95% CI 1·6-3·0), dyspnoea (2·2, 1·6-3·0), and diaphoresis (1·7, 1·1-2·7) were significantly associated with sudden cardiac arrest, whereas among women, only dyspnoea was significantly associated with sudden cardiac arrest (2·9, 1·9-4·3). 427 patients with sudden cardiac arrest (mean age 62·2 [SD 13·5]; 122 women and 305 men) were included in the analysis for the replication population and 1238 patients (mean age 59·3 [16·5] years; 689 women, 548 men, and one participant missing data for sex) were included in the control group. Findings were mostly consistent in the replication population; however, notable differences included that, among men, diaphoresis was not associated with sudden cardiac arrest and chest pain was associated with sudden cardiac arrest only in the sex-stratified multivariable analysis. INTERPRETATION The prevalence of warning symptoms was sex-specific and differed significantly between patients with sudden cardiac arrest and controls. Warning symptoms hold promise for prediction of imminent sudden cardiac arrest but might need to be augmented with additional features to maximise predictive power. FUNDING US National Heart Lung and Blood Institute.
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Affiliation(s)
- Kyndaron Reinier
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA, USA
| | - Bernadine Dizon
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA, USA
| | - Harpriya Chugh
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA, USA
| | - Ziana Bhanji
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA, USA
| | - Madison Seifer
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA, USA
| | - Arayik Sargsyan
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA, USA
| | - Audrey Uy-Evanado
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA, USA
| | - Faye L Norby
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA, USA
| | - Kotoka Nakamura
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA, USA
| | - Katy Hadduck
- Ventura County Health Care Agency, Ventura, CA, USA
| | | | - Tristan Grogan
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - David Elashoff
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jonathan Jui
- Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, USA
| | | | - Sumeet S Chugh
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA, USA; Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Health System, Los Angeles, CA, USA.
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25
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Rojo MO, Prince LY, Li C, McSweeney JC. Heart Disease Knowledge and Awareness in African American and Hispanic Women. South Med J 2023; 116:783-789. [PMID: 37788811 PMCID: PMC10558080 DOI: 10.14423/smj.0000000000001610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
OBJECTIVES Coronary heart disease (CHD) is the leading cause of morbidity and mortality among US women. Minority women have higher rates of CHD and are more likely to experience adverse outcomes. Because of racial disparities in CHD outcomes, the purpose of this study was to assess CHD knowledge and awareness in African American and Hispanic women. METHODS Using a survey research design, a convenience sample of African American and Hispanic women was surveyed in their local communities. CHD knowledge, awareness, and demographic data were collected using an online survey. The survey was administered in English and Spanish using an iPad. CHD knowledge was assessed using a 7-item survey based on the American Heart Association's Life's Simple 7 brochure. CHD awareness was assessed using a 7-item survey adapted from the American Heart Association's Survey of Women's Cardiovascular Disease Awareness. CHD knowledge was scored on a scale of 0 to 7, and awareness was assessed based on responses to each question. The data analysis consisted of cross-tabulations and multivariable repeated measures analysis. We assessed differences in CHD knowledge and awareness based on race/ethnicity. We hypothesized that there would be statistically significant differences in CHD knowledge and awareness based on specific demographic factors (eg, age, income, education, health literacy). RESULTS A total of 100 African American (n=50) and Hispanic (n = 50) women participated in the study. Results revealed that CHD knowledge and awareness were limited for both groups. Seventy-three percent of participants (African American 66%; Hispanic 80%) did not know that CHD is the leading cause of death in women and 75% (African American 60%; Hispanic 90%) were moderately or not at all informed about CHD. CONCLUSIONS These findings support the need for more research on innovative strategies to improve CHD knowledge and awareness, particularly in African American and Hispanic women who are at highest risk, thereby addressing racial/ethnic and gender disparities in CHD morbidity and mortality.
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Affiliation(s)
| | | | - Chenghui Li
- the College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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26
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Nehme Z, Cameron P, Nehme E, Finn J, Bosley E, Brink D, Ball S, Doan TN, Bray JE. Effect of a national awareness campaign on ambulance attendances for chest pain and out-of-hospital cardiac arrest. Resuscitation 2023; 191:109932. [PMID: 37562665 DOI: 10.1016/j.resuscitation.2023.109932] [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: 05/19/2023] [Revised: 07/23/2023] [Accepted: 08/01/2023] [Indexed: 08/12/2023]
Abstract
AIM Awareness of heart attack symptoms may enhance health-seeking behaviour and prevent premature deaths from out-of-hospital cardiac arrest (OHCA). We sought to investigate the impact of a national awareness campaign on emergency medical service (EMS) attendances for chest pain and OHCA. METHODS Between January 2005 and December 2017, we included registry data for 97,860 EMS-attended OHCA cases from 3 Australian regions and dispatch data for 1,631,217 EMS attendances for chest pain across 5 Australian regions. Regions were exposed to between 11 and 28 months of television, radio, and print media activity. Multivariable negative binomial models were used to explore the effect of campaign activity on the monthly incidence of EMS attendances for chest pain and OHCA. RESULTS Months with campaign activity were associated with an 8.8% (IRR 1.09, 95% CI: 1.07, 1.11) increase in the incidence of EMS attendances for chest pain and a 5.6% (IRR 0.94, 95% CI: 0.92, 0.97) reduction in OHCA attendances. Larger intervention effects were associated with increasing months of campaign activity, increasing monthly media spending and media exposure in 2013. In stratified analyses of OHCA cases, the largest reduction in incidence during campaign months was observed for unwitnessed arrests (IRR 0.93, 95% CI: 0.90, 0.96), initial non-shockable arrests (IRR 0.93, 95% CI: 0.90, 0.97) and arrests occurring in private residences (IRR 0.95, 95% CI: 0.91, 0.98). CONCLUSION A national awareness campaign targeting knowledge of heart attack symptoms was associated with an increase in EMS use for chest pain and a reduction in OHCA incidence and may serve as an effective primary prevention strategy for OHCA.
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Affiliation(s)
- Ziad Nehme
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Centre for Research and Evaluation,Ambulance Victoria, Blackburn North, Victoria, Australia; Department of Paramedicine, Monash University, Frankston, Victoria, Australia.
| | - Peter Cameron
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Alfred Hospital,Alfred Health, Prahran, Victoria, Australia
| | - Emily Nehme
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Centre for Research and Evaluation,Ambulance Victoria, Blackburn North, Victoria, Australia
| | - Judith Finn
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; PRECRU, School of Nursing, Curtin University, Western Australia, Australia; St John Ambulance, Belmont, Western Australia, Australia
| | - Emma Bosley
- Queensland Ambulance Service, Queensland Government Department of Health, Brisbane, Queensland, Australia; School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Deon Brink
- PRECRU, School of Nursing, Curtin University, Western Australia, Australia; St John Ambulance, Belmont, Western Australia, Australia
| | - Stephen Ball
- PRECRU, School of Nursing, Curtin University, Western Australia, Australia; St John Ambulance, Belmont, Western Australia, Australia
| | - Tan N Doan
- Queensland Ambulance Service, Queensland Government Department of Health, Brisbane, Queensland, Australia; Department of Medicine at The Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Janet E Bray
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; PRECRU, School of Nursing, Curtin University, Western Australia, Australia
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Marijon E, Narayanan K, Smith K, Barra S, Basso C, Blom MT, Crotti L, D'Avila A, Deo R, Dumas F, Dzudie A, Farrugia A, Greeley K, Hindricks G, Hua W, Ingles J, Iwami T, Junttila J, Koster RW, Le Polain De Waroux JB, Olasveengen TM, Ong MEH, Papadakis M, Sasson C, Shin SD, Tse HF, Tseng Z, Van Der Werf C, Folke F, Albert CM, Winkel BG. The Lancet Commission to reduce the global burden of sudden cardiac death: a call for multidisciplinary action. Lancet 2023; 402:883-936. [PMID: 37647926 DOI: 10.1016/s0140-6736(23)00875-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 04/13/2023] [Accepted: 04/25/2023] [Indexed: 09/01/2023]
Abstract
Despite major advancements in cardiovascular medicine, sudden cardiac death (SCD) continues to be an enormous medical and societal challenge, claiming millions of lives every year. Efforts to prevent SCD are hampered by imperfect risk prediction and inadequate solutions to specifically address arrhythmogenesis. Although resuscitation strategies have witnessed substantial evolution, there is a need to strengthen the organisation of community interventions and emergency medical systems across varied locations and health-care structures. With all the technological and medical advances of the 21st century, the fact that survival from sudden cardiac arrest (SCA) remains lower than 10% in most parts of the world is unacceptable. Recognising this urgent need, the Lancet Commission on SCD was constituted, bringing together 30 international experts in varied disciplines. Consistent progress in tackling SCD will require a completely revamped approach to SCD prevention, with wide-sweeping policy changes that will empower the development of both governmental and community-based programmes to maximise survival from SCA, and to comprehensively attend to survivors and decedents' families after the event. International collaborative efforts that maximally leverage and connect the expertise of various research organisations will need to be prioritised to properly address identified gaps. The Commission places substantial emphasis on the need to develop a multidisciplinary strategy that encompasses all aspects of SCD prevention and treatment. The Commission provides a critical assessment of the current scientific efforts in the field, and puts forth key recommendations to challenge, activate, and intensify efforts by both the scientific and global community with new directions, research, and innovation to reduce the burden of SCD worldwide.
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Affiliation(s)
- Eloi Marijon
- Division of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France; Université Paris Cité, Inserm, PARCC, Paris, France; Paris-Sudden Death Expertise Center (Paris-SDEC), Paris, France.
| | - Kumar Narayanan
- Université Paris Cité, Inserm, PARCC, Paris, France; Paris-Sudden Death Expertise Center (Paris-SDEC), Paris, France; Medicover Hospitals, Hyderabad, India
| | - Karen Smith
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Silverchain Group, Melbourne, VIC, Australia
| | - Sérgio Barra
- Department of Cardiology, Hospital da Luz Arrábida, Vila Nova de Gaia, Portugal
| | - Cristina Basso
- Cardiovascular Pathology Unit-Azienda Ospedaliera and Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Marieke T Blom
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Lia Crotti
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy; Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin, Cardiomyopathy Unit and Laboratory of Cardiovascular Genetics, Department of Cardiology, Milan, Italy
| | - Andre D'Avila
- Department of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Cardiology, Hospital SOS Cardio, Santa Catarina, Brazil
| | - Rajat Deo
- Department of Cardiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Florence Dumas
- Université Paris Cité, Inserm, PARCC, Paris, France; Paris-Sudden Death Expertise Center (Paris-SDEC), Paris, France; Emergency Department, Cochin Hospital, Paris, France
| | - Anastase Dzudie
- Cardiology and Cardiac Arrhythmia Unit, Department of Internal Medicine, DoualaGeneral Hospital, Douala, Cameroon; Yaounde Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
| | - Audrey Farrugia
- Hôpitaux Universitaires de Strasbourg, France, Strasbourg, France
| | - Kaitlyn Greeley
- Division of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France; Université Paris Cité, Inserm, PARCC, Paris, France; Paris-Sudden Death Expertise Center (Paris-SDEC), Paris, France
| | | | - Wei Hua
- Cardiac Arrhythmia Center, FuWai Hospital, Beijing, China
| | - Jodie Ingles
- Centre for Population Genomics, Garvan Institute of Medical Research and UNSW Sydney, Sydney, NSW, Australia
| | - Taku Iwami
- Kyoto University Health Service, Kyoto, Japan
| | - Juhani Junttila
- MRC Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Rudolph W Koster
- Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | | | - Theresa M Olasveengen
- Department of Anesthesia and Intensive Care Medicine, Oslo University Hospital and Institute of Clinical Medicine, Oslo, Norway
| | - Marcus E H Ong
- Singapore General Hospital, Duke-NUS Medical School, Singapore
| | - Michael Papadakis
- Cardiovascular Clinical Academic Group, St George's University of London, London, UK
| | | | - Sang Do Shin
- Department of Emergency Medicine at the Seoul National University College of Medicine, Seoul, South Korea
| | - Hung-Fat Tse
- University of Hong Kong, School of Clinical Medicine, Queen Mary Hospital, Hong Kong Special Administrative Region, China; Cardiac and Vascular Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Zian Tseng
- Division of Cardiology, UCSF Health, University of California, San Francisco Medical Center, San Francisco, California
| | - Christian Van Der Werf
- University of Amsterdam, Heart Center, Amsterdam, Netherlands; Department of Clinical and Experimental Cardiology, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Fredrik Folke
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christine M Albert
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Bo Gregers Winkel
- Department of Cardiology, University Hospital Copenhagen, Rigshospitalet, Copenhagen, Denmark
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Waldmann V, Narayanan K, Marijon E. Sudden cardiac arrest in adult congenital heart disease: a challenge to be tackled. Eur Heart J 2023; 44:3275-3277. [PMID: 37409418 DOI: 10.1093/eurheartj/ehad416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Affiliation(s)
- Victor Waldmann
- Service de Cardiologie, Hôpital Européen Georges Pompidou, 20 rue Leblanc, F-75015 Paris, France
- Université Paris Cité, Inserm, PARCC, F-75015 Paris, France
| | - Kumar Narayanan
- Université Paris Cité, Inserm, PARCC, F-75015 Paris, France
- Cardiology, Medicover Hospitals, Hyderabad, India
| | - Eloi Marijon
- Service de Cardiologie, Hôpital Européen Georges Pompidou, 20 rue Leblanc, F-75015 Paris, France
- Université Paris Cité, Inserm, PARCC, F-75015 Paris, France
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Tfelt-Hansen J, Garcia R, Albert C, Merino J, Krahn A, Marijon E, Basso C, Wilde AAM, Haugaa KH. Risk stratification of sudden cardiac death: a review. Europace 2023; 25:euad203. [PMID: 37622576 PMCID: PMC10450787 DOI: 10.1093/europace/euad203] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 07/03/2023] [Indexed: 08/26/2023] Open
Abstract
Sudden cardiac death (SCD) is responsible for several millions of deaths every year and remains a major health problem. To reduce this burden, diagnosing and identification of high-risk individuals and disease-specific risk stratification are essential. Treatment strategies include treatment of the underlying disease with lifestyle advice and drugs and decisions to implant a primary prevention implantable cardioverter-defibrillator (ICD) and perform ablation of the ventricles and novel treatment modalities such as left cardiac sympathetic denervation in rare specific primary electric diseases such as long QT syndrome and catecholaminergic polymorphic ventricular tachycardia. This review summarizes the current knowledge on SCD risk according to underlying heart disease and discusses the future of SCD prevention.
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Affiliation(s)
- Jacob Tfelt-Hansen
- Cardiology Department, Copenhagen University Hospital-Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark
- Section of Forensic Genetics, Department of Forensic Medicine, Copenhagen University, Frederik V’s Vej 11, Copenhagen 2100, Denmark
| | - Rodrigue Garcia
- Cardiology Department, University Hospital of Poitiers, 2 rue de la Milétrie, Poitiers 86000, France
- Centre d'Investigation Clinique 1402, University Hospital of Poitiers, 2 rue de la Milétrie, Poitiers 86000, France
| | - Christine Albert
- Cardiology Department, Smidt Heart Institute, Cedars-Sinai Hospital, Los Angeles, CA, USA
| | - Jose Merino
- Department of Cardiology, La Paz University Hospital, IdiPaz, P. Castellana, 261, Madrid 28046, Spain
- Department of Cardiology, Viamed Santa Elena University Hospital, C/La Granja, 8, Madrid 28003, Spain
| | - Andrew Krahn
- Centre for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eloi Marijon
- Cardiology Department, European Georges Pompidou Hospital, Paris, France
| | - Cristina Basso
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, Padova 35121, Italy
| | - Arthur A M Wilde
- Department of Cardiology, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Department of Cardiology, Heart Failure and Arrhythmias, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Kristina Hermann Haugaa
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
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Holmstrom L, Chugh H, Uy-Evanado A, Salvucci A, Jui J, Reinier K, Chugh SS. Determinants of survival in sudden cardiac arrest manifesting with pulseless electrical activity. Resuscitation 2023; 187:109798. [PMID: 37080333 PMCID: PMC10202052 DOI: 10.1016/j.resuscitation.2023.109798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/06/2023] [Accepted: 04/10/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVE The proportion of sudden cardiac arrests (SCA) manifesting with pulseless electrical activity (PEA) has increased significantly, and the survival rate remains lower than ventricular fibrillation (VF). However, a subgroup of PEA-SCA cases does survive and may yield key predictors of improved outcomes when compared to non-survivors. We aimed to identify key predictors of survival from PEA-SCA. METHODS Our study sample is drawn from two ongoing community-based, prospective studies of out-of-hospital SCA: Oregon SUDS from the Portland, OR metro area (Pop. approx. 1 million; 2002-2017) and Ventura PRESTO from Ventura County, CA (Pop. approx. 850,000, 2015-2021). For the present sub-study, we included SCA cases with PEA as the presenting rhythm where emergency medical services (EMS) personnel attempted resuscitation. RESULTS We identified 1,704 PEA-SCA cases, of which 173 (10.2%) were survivors and 1,531 (89.8%) non-survivors. Patients whose PEA-SCA occurred in a healthcare unit (16.9%) or public location (18.1%) had higher survival than those whose PEA-SCA occurred at home (9.3%) or in a care facility (5.7%). Young age, witness status, PEA-SCA location and pre-existing COPD/asthma were independent predictors of survival. Among witnessed cases the survival rate was 10% even if EMS response time was >10 minutes. CONCLUSIONS Key determinants for survival from PEA-SCA were young age, witnessed status, public location and pre-existing COPD/asthma. Survival outcomes in witnessed PEA cases were better than expected, even with delayed EMS response.
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Affiliation(s)
- L Holmstrom
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA, United States
| | - H Chugh
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA, United States
| | - A Uy-Evanado
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA, United States
| | - A Salvucci
- Ventura County Health Care Agency, Ventura, CA, United States
| | - J Jui
- Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, United States
| | - K Reinier
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA, United States
| | - S S Chugh
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA, United States.
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Holmström L, Zhang FZ, Ouyang D, Dey D, Slomka PJ, Chugh SS. Artificial Intelligence in Ventricular Arrhythmias and Sudden Death. Arrhythm Electrophysiol Rev 2023; 12:e17. [PMID: 37457439 PMCID: PMC10345967 DOI: 10.15420/aer.2022.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 03/16/2023] [Indexed: 07/18/2023] Open
Abstract
Sudden cardiac arrest due to lethal ventricular arrhythmias is a major cause of mortality worldwide and results in more years of potential life lost than any individual cancer. Most of these sudden cardiac arrest events occur unexpectedly in individuals who have not been identified as high-risk due to the inadequacy of current risk stratification tools. Artificial intelligence tools are increasingly being used to solve complex problems and are poised to help with this major unmet need in the field of clinical electrophysiology. By leveraging large and detailed datasets, artificial intelligence-based prediction models have the potential to enhance the risk stratification of lethal ventricular arrhythmias. This review presents a synthesis of the published literature and a discussion of future directions in this field.
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Affiliation(s)
- Lauri Holmström
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Health System, Los Angeles, CA, US
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA, US
| | - Frank Zijun Zhang
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Health System, Los Angeles, CA, US
| | - David Ouyang
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Health System, Los Angeles, CA, US
| | - Damini Dey
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Health System, Los Angeles, CA, US
| | - Piotr J Slomka
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Health System, Los Angeles, CA, US
| | - Sumeet S Chugh
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Health System, Los Angeles, CA, US
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA, US
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Yu H, Wen Q, Zhang X, Zhang H, Wu X. Cardiac involved and autopsy in two patients with systemic sclerosis: Two cases report. Heliyon 2023; 9:e15555. [PMID: 37159691 PMCID: PMC10163610 DOI: 10.1016/j.heliyon.2023.e15555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 04/10/2023] [Accepted: 04/13/2023] [Indexed: 05/11/2023] Open
Abstract
Systemic sclerosis (SSc) is a connective tissue disease with high mortality. One of the most common causes of death in potential SSc patients is cardiac arrest. However, the pathogenesis of cardiac death is not very clear. As far as we know, there are few autopsy reports on this subject. Our autopsy report on two fatal cases of heart injury in SSc patients revealed evidence of myocarditis, focal myocardial necrosis, and myocardial fibrosis. Our findings suggest that chronic inflammation of the heart may lead to extensive fibrosis, which could contribute to the high mortality rate observed in SSc patients. Early detection of heart injury in SSc patients using existing technology is necessary to improve patient outcomes. Future research should focus on developing more effective methods for early detection and management of heart involvement in SSc.
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Affiliation(s)
- Hang Yu
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Ningbo University, 59 Liuting Road, Ningbo, Zhejiang, 315010, PR China
- School of Medicine, Ningbo University, Ningbo, Zhejiang, 315211, PR China
| | - Qinwen Wen
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Ningbo University, 59 Liuting Road, Ningbo, Zhejiang, 315010, PR China
| | - Xiaolu Zhang
- School of Medicine, Ningbo University, Ningbo, Zhejiang, 315211, PR China
| | - Hanqing Zhang
- School of Medicine, Ningbo University, Ningbo, Zhejiang, 315211, PR China
| | - Xiudi Wu
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Ningbo University, 59 Liuting Road, Ningbo, Zhejiang, 315010, PR China
- Corresponding author.
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Alm-Kruse K, Tjelmeland I, Reiner A, Kvåle R, Kramer-Johansen J. Use of healthcare services before and after out-of-hospital cardiac arrest. Resuscitation 2023; 187:109805. [PMID: 37088268 DOI: 10.1016/j.resuscitation.2023.109805] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/27/2023] [Accepted: 04/13/2023] [Indexed: 04/25/2023]
Abstract
INTRODUCTION Knowledge about the use of healthcare services in patients experiencing out-of-hospital cardiac arrest (OHCA) is limited. We aimed to describe and compare the use of healthcare by OHCA survivors two years before and one year after cardiac arrest. METHODS Adult patients with OHCA of medical cause, who survived >30 days, were identified in the Norwegian Cardiac Arrest Registry. The Norwegian Patient Registry, The Cause of Death Registry, and The Norwegian Registry for Primary Healthcare provided data on survival and the use of healthcare services. We investigated the use of primary, specialist and mental healthcare, as well as rehabilitation services. RESULTS In 2015-2018, 13,112 OHCA cases were identified; 1435 (14%) patients survived >30 days (6.8/100,000 patients/year). The proportion of patients in the cohort that used primary healthcare each month increased form 43% before to 69% after OHCAto (p<0.001). We found a doubling of monthly healthcare contacts in both specialist healthcare (from 26% to 57%, p<0.001) and mental healthcare (from 3% to 8%, p>0.001). The observed increases in primary, specialist and mental healthcare use started two weeks, six months, and eight months before OHCA, respectively. Half of the patients had contact with primary healthcare services on the same day as the cardiac arrest. Two out of five patients were registered for rehabilitation after OHCA. CONCLUSION The use of primary, specialist and mental healthcare services increased before OHCA and remained significantly higher the year after OHCA. Less than half of the patients surviving cardiac arrest were registered for rehabilitation.
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Affiliation(s)
- Kristin Alm-Kruse
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingvild Tjelmeland
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Institute for Emergency Medicine, University-Hospital Schleswig-Holstein, Kiel, Germany
| | - Andrew Reiner
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Rune Kvåle
- Department of Oncology, Haukeland University Hospital, Bergen, Norway; Department of Health Registry Research and Development, National Institute of Public Health, Bergen, Norway
| | - Jo Kramer-Johansen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
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Zylyftari N, Lee CJY, Gnesin F, Møller AL, Mills EHA, Møller SG, Jensen B, Ringgren KB, Kragholm K, Christensen HC, Blomberg SNF, Tan HL, Folke F, Køber L, Gislason G, Torp-Pedersen C. Registered prodromal symptoms of out-of-hospital cardiac arrest among patients calling the medical helpline services. Int J Cardiol 2023; 374:42-50. [PMID: 36496039 DOI: 10.1016/j.ijcard.2022.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/12/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
Background Early identification of warning symptoms among out-of-hospital cardiac arrest (OHCA) patients remains challenging. Thus, we examined the registered prodromal symptoms of patients who called medical helpline services within 30-days before OHCA. Methods Patients unwitnessed by emergency medical services (EMS) aged ≥18 years during their OHCA were identified from the Danish Cardiac Arrest Registry (2014-2018) and linked to phone records from the 24-h emergency helpline (1-1-2) and out-of-hours medical helpline (1813-Medical Helpline) in Copenhagen before the arrest. The registered symptoms were categorized into chest pain; breathing problems; central nervous system (CNS)-related/unconsciousness; abdominal/back/urinary; psychiatric/addiction; infection/fever; trauma/exposure; and unspecified (diverse from the beforementioned categories). Analyses were divided by the time-period of calls (0-7 days/8-30 days preceding OHCA) and call type (1-1-2/1813-Medical Helpline). Results Of all OHCA patients, 18% (974/5442) called helpline services (males 56%, median age 76 years[Q1-Q3:65-84]). Among these, 816 had 1145 calls with registered symptoms. The most common symptom categories (except for unspecified, 33%) were breathing problems (17%), trauma/exposure (17%), CNS/unconsciousness (15%), abdominal/back/urinary (12%), and chest pain (9%). Most patients (61%) called 1813-Medical Helpline, especially for abdominal/back/urinary (17%). Patients calling 1-1-2 had breathing problems (24%) and CNS/unconsciousness (23%). Nearly half of the patients called within 7 days before their OHCA, and CNS/unconsciousness (19%) was the most registered. The unspecified category remained the most common during both time periods (32%;33%) and call type (24%;39%). Conclusions Among patients who called medical helplines services up to 30-days before their OHCA, besides symptoms being highly varied (unspecified (33%)), breathing problems (17%) were the most registered symptom-specific category.
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Affiliation(s)
- Nertila Zylyftari
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark; Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark.
| | - Christina Ji-Young Lee
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark; Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark
| | - Filip Gnesin
- Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark
| | | | - Elisabeth Helen Anna Mills
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Sidsel G Møller
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, Denmark; Copenhagen Emergency Medical Services, Denmark
| | - Britta Jensen
- Public Health and Epidemiology, Department of Health Science and Technology, Aalborg University, Denmark
| | - Kristian Bundgaard Ringgren
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Department of Anesthesia and Intensive Care, North Denmark Regional Hospital, Denmark
| | - Kristian Kragholm
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | | | - Hanno L Tan
- Department of Clinical and Experimental Cardiology, Amsterdam University Medical Center AMC, University of Amsterdam, the Netherlands; Netherlands Heart Institute, Utrecht, the Netherlands
| | - Fredrik Folke
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark; Copenhagen Emergency Medical Services, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Lars Køber
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark; The Danish Heart Foundation, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
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Paratz ED, van Heusden A, Zentner D, Morgan N, Smith K, Thompson T, James P, Connell V, Pflaumer A, Semsarian C, Ingles J, Parsons S, Stub D, Gerche AL. Causes, circumstances, and potential preventability of cardiac arrest in the young: insights from a state-wide clinical and forensic registry. Europace 2022; 24:1933-1941. [PMID: 36037012 DOI: 10.1093/europace/euac141] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/21/2022] [Indexed: 12/14/2022] Open
Abstract
AIMS The causes, circumstances, and preventability of young sudden cardiac arrest remain uncertain. METHODS AND RESULTS A prospective state-wide multi-source registry identified all out-of-hospital cardiac arrests (OHCAs) in 1-50 year olds in Victoria, Australia, from 2019 to 2021. Cases were adjudicated using hospital and forensic records, clinic assessments and interviews of survivors and family members. For confirmed cardiac causes of OHCA, circumstances and cardiac history were collected. National time-use data was used to contextualize circumstances. 1319 OHCAs were included. 725 (55.0%) cases had a cardiac aetiology of OHCA, with coronary disease (n = 314, 23.8%) the most common pathology. Drug toxicity (n = 226, 17.1%) was the most common non-cardiac cause of OHCA and the second-most common cause overall. OHCAs were most likely to occur in sleep (n = 233, 41.2%). However, when compared to the typical Australian day, OHCAs occurred disproportionately more commonly during exercise (9% of patients vs. 1.3% of typical day, P = 0.018) and less commonly while sedentary (39.6 vs. 54.6%, P = 0.047). 38.2% of patients had known standard modifiable cardiovascular risk factors. 77% of patients with a cardiac cause of OHCA had not reported cardiac symptoms nor been evaluated by a cardiologist prior to their OHCA. CONCLUSION Approximately half of OHCAs in the young have a cardiac cause, with coronary disease and drug toxicity dominant aetiologies. OHCAs disproportionately occur during exercise. Of patients with cardiac cause of OHCA, almost two-thirds have no standard modifiable cardiovascular risk factors, and more than three-quarters had no prior warning symptoms or interaction with a cardiologist.
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Affiliation(s)
- Elizabeth D Paratz
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC 3181, Australia.,Alfred Hospital, 55 Commercial Rd, Prahran, VIC 3181, Australia.,St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC 3065, Australia
| | | | - Dominica Zentner
- Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC 3050, Australia.,Royal Melbourne Hospital Clinical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC 3000, Australia
| | - Natalie Morgan
- Victorian Institute of Forensic Medicine, 65 Kavanagh St, Southbank, VIC 3006, Australia
| | - Karen Smith
- Ambulance Victoria, 375 Manningham Rd, Doncaster, VIC 3108, Australia.,Department of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia.,Department of Paramedicine, Monash University, Melbourne, VIC, Australia
| | - Tina Thompson
- Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC 3050, Australia
| | - Paul James
- Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC 3050, Australia
| | - Vanessa Connell
- Royal Children's Hospital, 50 Flemington Rd, Parkville Melbourne, VIC 3052, Australia
| | - Andreas Pflaumer
- Royal Children's Hospital, 50 Flemington Rd, Parkville Melbourne, VIC 3052, Australia.,Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Rd, Parkville, VIC 3052, Australia.,Department of Paediatrics, Melbourne University, Parkville, VIC 3010, Australia
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Missenden Rd, Sydney, NSW 2050, Australia
| | - Jodie Ingles
- Centre for Population Genomics, Garvan Institute of Medical Research, and UNSW Sydney, Sydney, NSW, Australia.,Centre for Population Genomics, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Sarah Parsons
- Victorian Institute of Forensic Medicine, 65 Kavanagh St, Southbank, VIC 3006, Australia.,Department of Forensic Medicine, Monash University, 65 Kavanagh St, Southbank, VIC 3006, Australia
| | - Dion Stub
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC 3181, Australia.,Alfred Hospital, 55 Commercial Rd, Prahran, VIC 3181, Australia.,Ambulance Victoria, 375 Manningham Rd, Doncaster, VIC 3108, Australia.,Department of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia
| | - Andre La Gerche
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC 3181, Australia.,Alfred Hospital, 55 Commercial Rd, Prahran, VIC 3181, Australia.,St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC 3065, Australia
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Gnesin F, Mills EHA, Jensen B, Møller AL, Zylyftari N, Bøggild H, Ringgren KB, Kragholm K, Blomberg SNF, Christensen HC, Lippert F, Køber L, Folke F, Torp-Pedersen C. Symptoms reported in calls to emergency medical services within 24 hours prior to out-of-hospital cardiac arrest. Resuscitation 2022; 181:86-96. [PMID: 36334842 DOI: 10.1016/j.resuscitation.2022.10.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/24/2022] [Accepted: 10/27/2022] [Indexed: 11/11/2022]
Abstract
AIM There is limited evidence regarding prodromal symptoms of out-of-hospital cardiac arrest (OHCA). We aimed to describe patient characteristics, prodromal symptoms, and prognosis of patients contacting emergency medical services (EMS) within 24 hours before OHCA. METHODS We identified all OHCA treated by Copenhagen EMS from 2016 through 2018 using the Danish Cardiac Arrest Registry and linked them to emergency calls. We included all pre-arrest calls by patients or bystanders if they were performed 1) within 24 hours before the OHCA call or 2) during the OHCA event for EMS-witnessed OHCA. Calls were reviewed by healthcare professionals using a survey guide. RESULTS Among 4,071 patients, 481 patients (12 %) had 539 calls within 24 hours prior to OHCA (60 % male, median age 74 years of age). The patient spoke on the phone in 25 % of calls. The most common symptoms were breathing problems (59 %), confusion (23 %), unconsciousness (20 %), chest pain (20 %), and paleness (19 %). Patients with breathing problems compared to chest pain were more likely to be ≤ 75 years of age (55 % versus 35 %), less likely to be male (52 % versus 73 %), have shockable rhythm (10 % versus 38 %), receive bystander defibrillation (6 % versus 19 %) or EMS defibrillation (15 % versus 65 %), achieve return of spontaneous circulation (37 % versus 68 %) and survive 30 days following OHCA (10 % versus 50 %). CONCLUSION More than 10% of patients with OHCA had a call to EMS within 24 hours before OHCA. The most common symptom was breathing problems which compared to chest pain had lower 30-day survival.
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Affiliation(s)
- Filip Gnesin
- Department of Cardiology, Nordsjællands Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark.
| | | | - Britta Jensen
- Public Health and Epidemiology, Department of Health Science and Technology, Aalborg University, Niels Jernes Vej 14, 9220 Aalborg E, Denmark
| | | | - Nertila Zylyftari
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Gentofte Hospitalsvej 6, 2900 Hellerup, Denmark
| | - Henrik Bøggild
- Public Health and Epidemiology, Department of Health Science and Technology, Aalborg University, Niels Jernes Vej 14, 9220 Aalborg E, Denmark
| | | | - Kristian Kragholm
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
| | | | - Helle Collatz Christensen
- Copenhagen Emergency Medical Services, University of Copenhagen, Telegrafvej 5, 2750 Ballerup, Denmark; Danish Clinical Quality Program (RKKP), National Clinical Registries, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
| | - Freddy Lippert
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
| | - Lars Køber
- Department of Cardiology, Heart Center, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Fredrik Folke
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Gentofte Hospitalsvej 6, 2900 Hellerup, Denmark; Copenhagen Emergency Medical Services, University of Copenhagen, Telegrafvej 5, 2750 Ballerup, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Nordsjællands Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark; Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1353 København K, Denmark
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Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA, Charron P, Corrado D, Dagres N, de Chillou C, Eckardt L, Friede T, Haugaa KH, Hocini M, Lambiase PD, Marijon E, Merino JL, Peichl P, Priori SG, Reichlin T, Schulz-Menger J, Sticherling C, Tzeis S, Verstrael A, Volterrani M. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J 2022; 43:3997-4126. [PMID: 36017572 DOI: 10.1093/eurheartj/ehac262] [Citation(s) in RCA: 1192] [Impact Index Per Article: 397.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Hardeland C, Leonardsen ACL, Isern CB, Berge HM. Experiences of cardiac arrest survivors among young exercisers in Norway: A qualitative study. Resusc Plus 2022; 11:100293. [PMID: 36051158 PMCID: PMC9424599 DOI: 10.1016/j.resplu.2022.100293] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/03/2022] [Accepted: 08/04/2022] [Indexed: 11/26/2022] Open
Abstract
Aim To explore how young exercisers experience surviving sudden cardiac arrest (SCA), focusing on interpretation of warning signs and experiences with the healthcare system. Methods The study had a qualitative design, and data was collected using individual, semi-structured interviews. Inclusion criteria were SCA survivors aged 18–50 years old who reported at least five hours of exercise/week prior to SCA, or who suffered SCA during or ≤60 min after exercise. Results 18 interviews were performed (4 females), age range 19–49 years old. Analysis identified the themes [1] neglected warning signs, [2] fluctuating between gratitude and criticism and [3] one size does not fit all. When young exercisers experienced symptoms such as fainting, chest pain, arrythmia, shortness of breath and fatigue, these were often ignored by either the participants, healthcare personnel or both. SCA survivors were grateful to the healthcare system and for the efforts made by healthcare personnel, but experienced a mismatch between what patients needed and could utilize, and what they actually received regarding both information and individualised services. Being young exercisers, the participants reported to have individual needs, but treatment and rehabilitation were not adapted and were mainly targeted to rehabilitation of older patients. Conclusion Patients and healthcare personnel should be aware of cardiac related symptoms and warning signs for SCA, and these should be properly assessed in the population of young exercisers. SCA survivors need useful and repeated information. The needs of SCA survivors among young exercisers require individualisation of services.
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Zheng K, Bai Y, Zhai QR, Du LF, Ge HX, Wang GX, Ma QB. Correlation between the warning symptoms and prognosis of cardiac arrest. World J Clin Cases 2022; 10:7738-7748. [PMID: 36158514 PMCID: PMC9372869 DOI: 10.12998/wjcc.v10.i22.7738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 05/21/2022] [Accepted: 06/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A low survival rate in patients with cardiac arrest is associated with failure to recognize the condition in its initial stage. Therefore, recognizing the warning symptoms of cardiac arrest in the early stage may play an important role in survival.
AIM To investigate the warning symptoms of cardiac arrest and to determine the correlation between the symptoms and outcomes.
METHODS We included all adult patients with all-cause cardiac arrest who visited Peking University Third Hospital or Beijing Friendship Hospital between January 2012 and December 2014. Data on population, symptoms, resuscitation parameters, and outcomes were analysed.
RESULTS Of the 1021 patients in the study, 65.9% had symptoms that presented before cardiac arrest, 25.2% achieved restoration of spontaneous circulation (ROSC), and 7.2% survived to discharge. The patients with symptoms had higher rates of an initial shockable rhythm (12.2% vs 7.5%, P = 0.020), ROSC (29.1% vs 17.5%, P = 0.001) and survival (9.2% vs 2.6%, P = 0.001) than patients without symptoms. Compared with the out-of-hospital cardiac arrest (OHCA) without symptoms subgroup, the OHCA with symptoms subgroup had a higher rate of calls before arrest (81.6% vs 0.0%, P < 0.001), health care provider-witnessed arrest (13.0% vs 1.4%, P = 0.001) and bystander cardiopulmonary resuscitation (15.5% vs 4.9%, P = 0.002); a shorter no flow time (11.7% vs 2.8%, P = 0.002); and a higher ROSC rate (23.8% vs 13.2%, P = 0.011). Compared to the in-hospital cardiac arrest (IHCA) without symptoms subgroup, the IHCA with symptoms subgroup had a higher mean age (66.2 ± 15.2 vs 62.5 ± 16.3 years, P = 0.005), ROSC (32.0% vs 20.6%, P = 0.003), and survival rates (10.6% vs 2.5%, P < 0.001). The top five warning symptoms were dyspnea (48.7%), chest pain (18.3%), unconsciousness (15.2%), paralysis (4.3%), and vomiting (4.0%). Chest pain (20.9% vs 12.7%, P = 0.011), cardiac etiology (44.3% vs 1.5%, P < 0.001) and survival (33.9% vs 16.7%, P = 0.001) were more common in males, whereas dyspnea (54.9% vs 45.9%, P = 0.029) and a non-cardiac etiology (53.3% vs 41.7%, P = 0.003) were more common in females.
CONCLUSION Most patients had warning symptoms before cardiac arrest. Dyspnea, chest pain, and unconsciousness were the most common symptoms. Immediately recognizing these symptoms and activating the emergency medical system prevents resuscitation delay and improves the survival rate of OHCA patients in China.
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Affiliation(s)
- Kang Zheng
- Department of Emergency Medicine, Peking University Third Hospital, Beijing 100191, China
| | - Yi Bai
- Department of Emergency Medicine, Peking University Third Hospital, Beijing 100191, China
| | - Qiang-Rong Zhai
- Department of Emergency Medicine, Peking University Third Hospital, Beijing 100191, China
| | - Lan-Fang Du
- Department of Emergency Medicine, Peking University Third Hospital, Beijing 100191, China
| | - Hong-Xia Ge
- Department of Emergency Medicine, Peking University Third Hospital, Beijing 100191, China
| | - Guo-Xing Wang
- Department of Emergency Medicine, Beijing Friendship Hospital, Beijing 100050, China
| | - Qing-Bian Ma
- Department of Emergency Medicine, Peking University Third Hospital, Beijing 100191, China
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Holmström L, Reinier K, Toft L, Halperin H, Salvucci A, Jui J, Chugh SS. Out-of-hospital cardiac arrest with onset witnessed by emergency medical services: Implications for improvement in overall survival. Resuscitation 2022; 175:19-27. [PMID: 35421535 PMCID: PMC10306322 DOI: 10.1016/j.resuscitation.2022.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/01/2022] [Accepted: 04/04/2022] [Indexed: 01/18/2023]
Abstract
Out-of-hospital cardiac arrest (OHCA) remains a major public health problem. Even in high-income countries, survival rates have plateaued in the range of ten percent, stimulating an ongoing interest in developing novel approaches to resuscitation. Emergency Medical Services (EMS)-witnessed OHCAs constitute a subgroup of overall OHCA that occur after the arrival of EMS, leading to rapid initiation of resuscitation and significantly improved survival. In this narrative review we summarize and interpret recent developments in knowledge of EMS-witnessed OHCA regarding prevalence, demographics, location, circumstances, survival outcomes and clinical profile. We examine the possibility of informing novel resuscitation approaches and enhancing mechanistic knowledge by studying EMS-witnessed OHCA, with the goal of improving overall survival from OHCA.
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Affiliation(s)
- Lauri Holmström
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA, United States; Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Kyndaron Reinier
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA, United States
| | - Lorrel Toft
- Department of Medicine, Cardiology, University of Nevada, Reno School of Medicine, United States
| | - Henry Halperin
- Division of Cardiology, The Johns Hopkins University, United States
| | - Angelo Salvucci
- Ventura County Health Care Agency, Ventura, CA, United States
| | - Jonathan Jui
- Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, United States
| | - Sumeet S Chugh
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA, United States; Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Health System, Los Angeles, CA, United States.
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41
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Tesche C, Giesen A, Korosoglou G. Commentary: Plaque Features and Epicardial Fat Volume for Cardiovascular Risk Assessment—A Key Role With Cardiac Computed Tomography? Front Cardiovasc Med 2022; 9:896321. [PMID: 35571220 PMCID: PMC9099000 DOI: 10.3389/fcvm.2022.896321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Christian Tesche
- Department of Cardiology, Clinic Augustinum Munich, Munich, Germany
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States
| | - Alexander Giesen
- Department of Cardiology, Vascular Medicine and Pneumology, Gesundheitszentrum Rhein-Neckar Hospital Weinheim, Weinheim, Germany
- Cardiac Imaging Center Weinheim, Hector Foundation, Weinheim, Germany
| | - Grigorios Korosoglou
- Department of Cardiology, Vascular Medicine and Pneumology, Gesundheitszentrum Rhein-Neckar Hospital Weinheim, Weinheim, Germany
- Cardiac Imaging Center Weinheim, Hector Foundation, Weinheim, Germany
- *Correspondence: Grigorios Korosoglou
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42
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Wang S, Wu D, Li G, Song X, Qiao A, Li R, Liu Y, Anzai H, Liu H. A machine learning strategy for fast prediction of cardiac function based on peripheral pulse wave. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 216:106664. [PMID: 35104684 DOI: 10.1016/j.cmpb.2022.106664] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 01/13/2022] [Accepted: 01/24/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Pulse wave has been considered as a message carrier in the cardiovascular system (CVS), capable of inferring CVS conditions while diagnosing cardiovascular diseases (CVDs). Clarification and prediction of cardiovascular function by means of powerful feature-abstraction capability of machine learning method based on pulse wave is of great clinical significance in health monitoring and CVDs diagnosis, which remains poorly studied. METHODS Here we propose a machine learning (ML)-based strategy aiming to achieve a fast and accurate prediction of three cardiovascular function parameters based on a 412-subject database of pulse waves. We proposed and optimized an ML-based model with multi-layered, fully connected network while building up two high-quality pulse wave datasets comprising a healthy-subject group and a CVD-subject group to predict arterial compliance (AC), total peripheral resistance (TPR), and stroke volume (SV), which are essential messengers in monitoring CVS conditions. RESULTS Our ML model is validated through consistency analysis of the ML-predicted three cardiovascular function parameters with clinical measurements and is proven through error analysis to have capability of achieving a high-accurate prediction on TPR and SV for both healthy-subject group (accuracy: 85.3%, 86.9%) and CVD-subject group (accuracy: 88.3%, 89.2%). DISCUSSION The independent sample t-test proved that our subject groups could represent the typical physiological characteristics of the corresponding population. While we have more subjects in our datasets rather than previous studies after strict data screening, the proposed ML-based strategy needs to be further improved to achieve a disease-specific prediction of heart failure and other CVDs through training with larger datasets and clinical measurements. CONCLUSION Our study points to the feasibility and potential of the pulse wave-based prediction of physiological and pathological CVS conditions in clinical application.
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Affiliation(s)
- Sirui Wang
- Graduate School of Engineering, Chiba University, Chiba, 263-8522, Japan
| | - Dandan Wu
- Graduate School of Engineering, Chiba University, Chiba, 263-8522, Japan
| | - Gaoyang Li
- Institute of Fluid Science, Tohoku University, Miyagi, 980-8577, Japan
| | - Xiaorui Song
- Department of Radiology, Shandong First Medical University & Shandong Academic of Medical Sciences, Shandong, 271000, China
| | - Aike Qiao
- Faculty of Environment and Life, Beijing University of Technology, Beijing, 100124, China
| | - Ruichen Li
- Graduate School of Engineering, Chiba University, Chiba, 263-8522, Japan
| | - Youjun Liu
- Faculty of Environment and Life, Beijing University of Technology, Beijing, 100124, China
| | - Hitomi Anzai
- Institute of Fluid Science, Tohoku University, Miyagi, 980-8577, Japan
| | - Hao Liu
- Graduate School of Engineering, Chiba University, Chiba, 263-8522, Japan.
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43
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Carotid ultrasound and coronary calcium for the prediction of incident cardiac disease in asymptomatic individuals: A further step towards precision medicine especially in women? Atherosclerosis 2022; 346:79-81. [DOI: 10.1016/j.atherosclerosis.2022.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 02/18/2022] [Indexed: 11/23/2022]
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44
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Ghanem YM, Ayad MW, Kareem AA, Guirguis MO, Alkafafy AM, Badrah MH. Glycemic gap and the outcome of diabetic patients presenting with acute coronary syndrome. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2022. [DOI: 10.1186/s43162-022-00099-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Abstract
Background
Acute hyperglycemia is a common finding in both diabetic and non-diabetic patients with acute coronary syndrome (ACS) who present to the emergency department (ED). The prognostic role of hyperglycemia in diabetic patients with ACS remains controversial at least on the short-term basis. The aim of the present study was to find the relation between the glycemic gap and clinical outcome in diabetic patients with ACS.
Methods
The study included 100 diabetic patients with ACS to who were prospectively followed during their hospital stay. Admission blood glucose was measured and glycemic gap was calculated.
Results
In diabetic patients suffering ACS, there was a significant relation between the glycemic gap value, occurrence of major adverse cardiovascular events (MACE) and length of hospital stay.
Conclusion
Glycemic gap is a better marker than admission blood glucose alone in diabetic patients presenting with ACS. This study added the optimal cut-off value for this important biomarker.
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45
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Evolution of Incidence, Management, and Outcomes Over Time in Sports-Related Sudden Cardiac Arrest. J Am Coll Cardiol 2022; 79:238-246. [DOI: 10.1016/j.jacc.2021.11.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/28/2021] [Accepted: 11/01/2021] [Indexed: 12/11/2022]
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46
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Marijon E, Garcia R, Narayanan K, Karam N, Jouven X. OUP accepted manuscript. Eur Heart J 2022; 43:1457-1464. [PMID: 35139183 PMCID: PMC9009402 DOI: 10.1093/eurheartj/ehab903] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 12/16/2021] [Accepted: 12/21/2021] [Indexed: 11/24/2022] Open
Abstract
More than 40 years after the first implantable cardioverter-defibrillator (ICD) implantation, sudden cardiac death (SCD) still accounts for more than five million deaths worldwide every year. Huge efforts in the field notwithstanding, it is now increasingly evident that the current strategy of long-term prevention based on left ventricular ejection fraction as the key selection criterion is actually of very limited impact, also because the largest absolute numbers of SCD are encountered in the general population not known to be at risk. It has been recently reemphasized that SCD is often not so sudden, with almost half of the victims experiencing typical warning symptoms preceding the event. Importantly, heeded and prompt medical attention can dramatically improve survival. Essentially, such timely action increases the chances of the SCD event being witnessed by emergency medical services and provides the opportunity for early intervention. In addition, newer technologies incorporating digital data acquisition, transfer between interconnected devices, and artificial intelligence, should allow dynamic, real-time monitoring of diverse parameters and therefore better identification of subjects at short-term SCD risk. Along with warning symptoms, these developments allow a new approach of near-term prevention based on the hours and minutes preceding SCD. In the present review, we challenge the current paradigm of mid- and long-term prevention using ICD in patients at the highest risk of SCD, and introduce a complementary concept applicable to the entire population that would aim to pre-empt SCD by timely detection and intervention within the minutes or hours prior to the event.
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Affiliation(s)
- Eloi Marijon
- Corresponding author. Tel: +33 6 62 83 38 48, Fax: +33 1 56 09 30 47,
| | | | - Kumar Narayanan
- Université de Paris, PARCC, INSERM, F-75015 Paris, France
- Paris-Sudden Death Expertise Center (SDEC), Paris, France
- Cardiology Department, Medicover Hospitals, Hyderabad, India
| | - Nicole Karam
- Université de Paris, PARCC, INSERM, F-75015 Paris, France
- Cardiology Department, European Georges Pompidou Hospital, Paris, France
- Paris-Sudden Death Expertise Center (SDEC), Paris, France
| | - Xavier Jouven
- Université de Paris, PARCC, INSERM, F-75015 Paris, France
- Cardiology Department, European Georges Pompidou Hospital, Paris, France
- Paris-Sudden Death Expertise Center (SDEC), Paris, France
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47
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van Dongen LH, Blom MT, de Haas SCM, van Weert HCPM, Elders P, Tan H. Higher chances of survival to hospital admission after out-of-hospital cardiac arrest in patients with previously diagnosed heart disease. Open Heart 2021; 8:openhrt-2021-001805. [PMID: 34933962 PMCID: PMC8693164 DOI: 10.1136/openhrt-2021-001805] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 11/19/2021] [Indexed: 12/05/2022] Open
Abstract
Aim This study aimed to determine whether patients suffering from out-of-hospital cardiac arrest (OHCA) with a pre-OHCA diagnosis of heart disease have higher survival chances than patients without such a diagnosis and to explore possible underlying mechanisms. Methods A retrospective cohort study in 3760 OHCA patients from the Netherlands (2010–2016) was performed. Information from emergency medical services, treating hospitals, general practitioner, resuscitation ECGs and civil registry was used to assess medical histories and the presence of pre-OHCA diagnosis of heart disease. We used multivariable regression analysis to calculate associations with survival to hospital admission or discharge, immediate causes of OHCA (acute myocardial infarction (AMI) vs non-AMI) and initial recorded rhythm. Results Overall, 48.1% of OHCA patients had pre-OHCA heart disease. These patients had higher odds to survive to hospital admission than patients without pre-OHCA heart disease (OR 1.25 (95%CI 1.05 to 1.47)), despite being older and more often having cardiovascular risk factors and some non-cardiac comorbidities. These patients also had higher odds of shockable initial rhythm (SIR) (OR 1.60 (1. 36 to 1.89)) and a lower odds of AMI as immediate cause of OHCA (OR 0.33 (0.25 to 0.42)). Their chances of survival to hospital discharge were not significantly larger (OR 1.16 (0.95 to 1.42)). Conclusion Having pre-OHCA diagnosed heart disease is associated with better odds to survive to hospital admission, but not to hospital discharge. This is associated with higher odds of a SIR and in a subgroup with available diagnosis a lower proportion of AMI as immediate cause of OHCA.
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Affiliation(s)
- Laura Helena van Dongen
- Department of Cardiology, Heart Center, Amsterdam UMC Location AMC, Amsterdam, North Holland, The Netherlands
| | - Marieke T Blom
- Department of Cardiology, Heart Center, Amsterdam UMC Location AMC, Amsterdam, North Holland, The Netherlands
| | - Sandra C M de Haas
- Department of Cardiology, Heart Center, Amsterdam UMC Location AMC, Amsterdam, North Holland, The Netherlands
| | - Henk C P M van Weert
- Department of General Practice, Amsterdam Public Health, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Petra Elders
- General Practice Medicine, Amsterdam UMC Locatie VUmc, Amsterdam, Noord-Holland, The Netherlands
| | - Hanno Tan
- Department of Cardiology, Heart Center, Amsterdam UMC Location AMC, Amsterdam, North Holland, The Netherlands .,Netherlands Heart Institute, Utrecht, The Netherlands
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48
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Francis M, Buckley T, Tofler AR, Tofler GH. Masters Age Football And Cardiovascular Risk (MAFACARI). Intern Med J 2021; 52:369-378. [PMID: 34894042 DOI: 10.1111/imj.15660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/08/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Football (soccer) is popular among those of Masters age (≥35 years). Although regular exercise improves health, strenuous exercise causes a transient increase in cardiac risk. AIM The aim of this survey of Masters Age Footballers was to gain insight into cardiac risk factors, symptoms, and knowledge, attitudes and beliefs about myocardial infarction (MI), and support for prevention. METHODS A web-based survey using REDCap was completed by 153 amateur Masters footballers from A grade competition (n=24), B or lower grade (n=95) or social games (n=34) in Sydney, Australia. RESULTS Participants were aged 49.3±7.5 years and primarily male (92.2%), Caucasian (88.9%) and university educated (75.2%). Risk factors included hypercholesterolaemia (37.3%), hypertension (19.6%), smoker (7.8%), overweight (40.5%) or obese (13.1%). One fifth (21.6%) reported ≥1 potential cardiac symptom during activity in the prior year, for which one quarter (24.2%) sought medical attention. Knowledge of typical MI symptoms was high (>80%) but lower (<40%) for less typical symptoms. Half (49.6%) were unconfident to recognise MI in themselves. Half (49.0%) would remain on the field for 5-10 minutes with chest pain. Only 39.9% were aware that warning signs may precede MI by days. They overestimated survival from cardiac arrest (43%). Participants supported training in automatic external defibrillators (AED) and CPR (84%), AEDs at games (85%) and cardiac education (>70%). CONCLUSIONS Cardiac risk factors are common In Masters footballers, with one in five experiencing possible cardiac symptoms in the prior year. While gaps exist in knowledge and optimal responses, strong support exists for preventive measures. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Matthew Francis
- Royal North Shore Hospital, Sydney, Australia.,Sydney Medical School, University of Sydney, Australia
| | - Thomas Buckley
- Royal North Shore Hospital, Sydney, Australia.,Sydney Nursing School, University of Sydney, Australia
| | | | - Geoffrey H Tofler
- Royal North Shore Hospital, Sydney, Australia.,Sydney Medical School, University of Sydney, Australia
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49
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Rajan D, Garcia R, Svane J, Tfelt-Hansen J. Risk of sports-related sudden cardiac death in women. Eur Heart J 2021; 43:1198-1206. [PMID: 34894223 DOI: 10.1093/eurheartj/ehab833] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 09/21/2021] [Accepted: 11/23/2021] [Indexed: 12/20/2022] Open
Abstract
Sudden cardiac death (SCD) is a tragic incident accountable for up to 50% of deaths from cardiovascular disease. Sports-related SCD (SrSCD) is a phenomenon which has previously been associated with both competitive and recreational sport activities. SrSCD has been found to occur 5-33-fold less frequently in women than in men, and the sex difference persists despite a rapid increase in female participation in sports. Establishing the reasons behind this difference could pinpoint targets for improved prevention of SrSCD. Therefore, this review summarizes existing knowledge on epidemiology, characteristics, and causes of SrSCD in females, and elaborates on proposed mechanisms behind the sex differences. Although literature concerning the aetiology of SrSCD in females is limited, proposed mechanisms include sex-specific variations in hormones, blood pressure, autonomic tone, and the presentation of acute coronary syndromes. Consequently, these biological differences impact the degree of cardiac hypertrophy, dilation, right ventricular remodelling, myocardial fibrosis, and coronary atherosclerosis, and thereby the occurrence of ventricular arrhythmias in male and female athletes associated with short- and long-term exercise. Finally, cardiac examinations such as electrocardiograms and echocardiography are useful tools allowing easy differentiation between physiological and pathological cardiac adaptations following exercise in women. However, as a significant proportion of SrSCD causes in women are non-structural or unexplained after autopsy, channelopathies may play an important role, encouraging attention to prodromal symptoms and family history. These findings will aid in the identification of females at high risk of SrSCD and development of targeted prevention for female sport participants.
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Affiliation(s)
- Deepthi Rajan
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - Rodrigue Garcia
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark.,The Department of Cardiology, University Hospital of Poitiers, 2 rue de la Milétrie, 86021 Poitiers, France
| | - Jesper Svane
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark.,Department of Forensic Medicine, Copenhagen University, Frederik V's Vej 11, 2100 Copenhagen, Denmark
| | - Jacob Tfelt-Hansen
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark.,Department of Forensic Medicine, Copenhagen University, Frederik V's Vej 11, 2100 Copenhagen, Denmark
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50
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Zylyftari N, Møller SG, Wissenberg M, Folke F, Barcella CA, Møller AL, Gnesin F, Mills EHA, Jensen B, Lee CJY, Tan HL, Køber L, Lippert F, Gislason GH, Torp-Pedersen C. Contacts With the Health Care System Before Out-of-Hospital Cardiac Arrest. J Am Heart Assoc 2021; 10:e021827. [PMID: 34854313 PMCID: PMC9075404 DOI: 10.1161/jaha.121.021827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background It remains challenging to identify patients at risk of out-of-hospital cardiac arrest (OHCA). We aimed to examine health care contacts in patients before OHCA compared with the general population that did not experience an OHCA. Methods and Results Patients with OHCA with a presumed cardiac cause were identified from the Danish Cardiac Arrest Registry (2001-2014) and their health care contacts (general practitioner [GP]/hospital) were examined up to 1 year before OHCA. In a case-control study (1:9), OHCA contacts were compared with an age- and sex-matched background population. Separately, patients with OHCA were examined by the contact type (GP/hospital/both/no contact) within 2 weeks before OHCA. We included 28 955 patients with OHCA. The weekly percentages of patient contacts with GP the year before OHCA were constant (25%) until 1 week before OHCA when they markedly increased (42%). Weekly percentages of patient contacts with hospitals the year before OHCA gradually increased during the last 6 months (3.5%-6.6%), peaking at the second week (6.8%) before OHCA; mostly attributable to cardiovascular diseases (21%). In comparison, there were fewer weekly contacts among controls with 13% for GP and 2% for hospital contacts (P<0.001). Within 2 weeks before OHCA, 57.8% of patients with OHCA had a health care contact, and these patients had more contacts with GP (odds ratio [OR], 3.17; 95% CI, 3.09-3.26) and hospital (OR, 2.32; 95% CI, 2.21-2.43) compared with controls. Conclusions The health care contacts of patients with OHCA nearly doubled leading up to the OHCA event, with more than half of patients having health care contacts within 2 weeks before arrest. This could have implications for future preventive strategies.
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Affiliation(s)
- Nertila Zylyftari
- Department of Cardiology Copenhagen University Hospital Herlev and Gentofte Hellerup Denmark.,Department of Cardiology Nordsjaellands Hospital Hillerød Denmark
| | - Sidsel G Møller
- Department of Cardiology Copenhagen University Hospital Herlev and Gentofte Hellerup Denmark
| | - Mads Wissenberg
- Department of Cardiology Copenhagen University Hospital Herlev and Gentofte Hellerup Denmark.,Copenhagen Emergency Medical Services and University of Copenhagen Copenhagen Denmark
| | - Frederik Folke
- Department of Cardiology Copenhagen University Hospital Herlev and Gentofte Hellerup Denmark.,Copenhagen Emergency Medical Services and University of Copenhagen Copenhagen Denmark
| | - Carlo A Barcella
- Department of Cardiology Copenhagen University Hospital Herlev and Gentofte Hellerup Denmark
| | | | - Filip Gnesin
- Department of Cardiology Nordsjaellands Hospital Hillerød Denmark
| | | | - Britta Jensen
- Department of Health Science and Technology Aalborg University Aalborg Denmark
| | - Christina Ji-Young Lee
- Department of Cardiology Copenhagen University Hospital Herlev and Gentofte Hellerup Denmark.,Department of Cardiology Nordsjaellands Hospital Hillerød Denmark
| | - Hanno L Tan
- Department of Cardiology Academic Medical Center University of Amsterdam The Netherlands.,Netherlands Heart Institute Utrecht The Netherlands
| | - Lars Køber
- The Heart Centre Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Freddy Lippert
- Copenhagen Emergency Medical Services and University of Copenhagen Copenhagen Denmark
| | - Gunnar H Gislason
- Department of Cardiology Copenhagen University Hospital Herlev and Gentofte Hellerup Denmark.,The Danish Heart Foundation Copenhagen Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology Nordsjaellands Hospital Hillerød Denmark.,Department of Cardiology Aalborg University Hospital Aalborg Denmark
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