151
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Paratz ED, Rowsell L, Zentner D, Parsons S, Morgan N, Thompson T, James P, Pflaumer A, Semsarian C, Smith K, Stub D, La Gerche A. Cardiac arrest and sudden cardiac death registries: a systematic review of global coverage. Open Heart 2020; 7:e001195. [PMID: 32076566 PMCID: PMC6999684 DOI: 10.1136/openhrt-2019-001195] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/16/2019] [Accepted: 01/02/2020] [Indexed: 12/27/2022] Open
Abstract
Background Sudden cardiac death (SCD) is a major global health problem, accounting for up to 20% of deaths in Western societies. Clinical quality registries have been shown in a range of disease conditions to improve clinical management, reduce variation in care and improve outcomes. Aim To identify existing cardiac arrest (CA) and SCD registries, characterising global coverage and methods of data capture and validation. Methods Biomedical and public search engines were searched with the terms ‘registry cardio*’; ‘sudden cardiac death registry’ and ‘cardiac arrest registry’. Registries were categorised as either CA, SCD registries or ‘other’ according to prespecified criteria. SCD registry coordinators were contacted for contemporaneous data regarding registry details. Results Our search strategy identified 49 CA registries, 15 SCD registries and 9 other registries (ie, epistries). Population coverage of contemporary CA and SCD registries is highly variable with registries densely concentrated in North America and Western Europe. Existing SCD registries (n=15) cover a variety of age ranges and subpopulations, with some enrolling surviving patients (n=8) and family members (n=5). Genetic data are collected by nine registries, with the majority of these (n=7) offering indefinite storage in a biorepository. Conclusions Many CA registries exist globally, although with inequitable population coverage. Comprehensive multisource surveillance SCD registries are fewer in number and more challenging to design and maintain. Challenges identified include maximising case identification and case verification. Trial registration number CRD42019118910.
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Affiliation(s)
- Elizabeth Davida Paratz
- Baker Heart Research Institute - BHRI, Melbourne, Victoria, Australia.,Cardiology Department, St Vincent's Hospital, Melbourne, VIC, Australia.,Cardiology, The Alfred Hospital, Melbourne, VIC, Australia
| | - Luke Rowsell
- Baker Heart Research Institute - BHRI, Melbourne, Victoria, Australia
| | - Dominica Zentner
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Sarah Parsons
- Victorian Institute of Forensic Medicine, Southbank, Victoria, Australia
| | - Natalie Morgan
- Victorian Institute of Forensic Medicine, Southbank, Victoria, Australia
| | - Tina Thompson
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Paul James
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Andreas Pflaumer
- Department of Cardiology, Royal Childrens Hospital Melbourne, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | | | - Karen Smith
- Research & Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia.,Community Emergency Health & Paramedic Practice, Monash University, Melbourne, VIC, Australia
| | - Dion Stub
- Cardiology, The Alfred Hospital, Melbourne, VIC, Australia.,Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Andre La Gerche
- Baker Heart Research Institute - BHRI, Melbourne, Victoria, Australia.,Cardiology Department, St Vincent's Hospital, Melbourne, VIC, Australia.,Cardiology, The Alfred Hospital, Melbourne, VIC, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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152
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Allan KS, Morrison LJ, Pinter A, Tu JV, Dorian P. Unexpected High Prevalence of Cardiovascular Disease Risk Factors and Psychiatric Disease Among Young People With Sudden Cardiac Arrest. J Am Heart Assoc 2020; 8:e010330. [PMID: 30661423 PMCID: PMC6497342 DOI: 10.1161/jaha.118.010330] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background It is believed that most sudden cardiac arrests (SCAs) in young people occur in previously healthy people with rare risk factors for sudden death. Few studies have investigated large populations with complete ascertainment. Our objective was to use multisource records to identify and classify all out‐of‐hospital cardiac arrests in the Greater Toronto Area (population 6.6 million) in people aged 2 to 45 years from 2009 to 2012. Methods and Results Expert reviewers employed a systematic process, with emergency medical services, in‐hospital and coroner records, to adjudicate the cause of death as SCA from cardiac or noncardiac causes. We report the adjudicated etiologies, circumstances, triggers, and characteristics of the SCA cohort. Of 2937 eligible out‐of‐hospital cardiac arrest cases, 608 (20.7%) SCAs had an adjudicated etiology of cardiac cause (120 survivors and 488 nonsurvivors). Two thirds of these SCA patients had a history of cardiovascular disease, and over 50% had been diagnosed with ≥1 cardiovascular disease risk factor. Moreover, 20.1% of SCAs were diagnosed with psychiatric disease and 30% had central nervous system drugs prescribed. Over 30% of SCA patients had central nervous system active drugs, including drugs of abuse detected postmortem, with opioids and ethanol being detected most frequently. Potentially heritable structural cardiac diseases accounted for only 6.9% of SCA events, with acquired cardiac diseases comprising the rest. Conclusions The underlying causes of SCA, in people aged 2 to 45 years, often occur in those with previously diagnosed cardiovascular diseases, and are associated with contributory factors including prescribed medications, recreational drugs, and a concomitant psychiatric history. See Editorial by Atkins
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Affiliation(s)
| | - Laurie J Morrison
- 2 Keenan Research Centre Li Ka Shing Knowledge Institute St. Michael's Hospital Toronto Canada.,3 Institute of Health Policy, Management and Evaluation Faculty of Medicine University of Toronto Canada.,4 Division of Emergency Medicine Department of Medicine Rescu Li Ka Shing Knowledge Institute St. Michael's Hospital University of Toronto Canada.,6 Department of Medicine University of Toronto Ontario Canada
| | - Arnold Pinter
- 1 Division of Cardiology St. Michael's Hospital Toronto Canada.,6 Department of Medicine University of Toronto Ontario Canada
| | - Jack V Tu
- 3 Institute of Health Policy, Management and Evaluation Faculty of Medicine University of Toronto Canada.,5 Institute for Clinical and Evaluative Sciences Sunnybrook Health Sciences Centre Toronto Canada.,6 Department of Medicine University of Toronto Ontario Canada
| | - Paul Dorian
- 1 Division of Cardiology St. Michael's Hospital Toronto Canada.,2 Keenan Research Centre Li Ka Shing Knowledge Institute St. Michael's Hospital Toronto Canada.,4 Division of Emergency Medicine Department of Medicine Rescu Li Ka Shing Knowledge Institute St. Michael's Hospital University of Toronto Canada.,6 Department of Medicine University of Toronto Ontario Canada
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153
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Dimos A, Xanthopoulos A, Papamichalis M, Bourazana A, Tavoularis D, Skoularigis J, Triposkiadis F. Sudden Arrhythmic Death at the Higher End of the Heart Failure Spectrum. Angiology 2019; 71:389-396. [DOI: 10.1177/0003319719896475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The risk of sudden cardiac death (SCD) is high in heart failure (HF) patients. Sudden arrhythmic death (SAD) is a frequent cause of exit in HF patients at the lower end of the HF spectrum, and implantable cardioverter–defibrillators have been recommended to prevent these life-threatening rhythm disturbances in select patients. However, less is known regarding the cause of SCD in patients at the upper end of the HF spectrum, despite the fact that the majority of out-of-hospital SCD victims have unknown or near-normal/normal left ventricular ejection fraction (LVEF). In this review, we report the epidemiology, summarize the mechanisms, discuss the diagnostic challenges, and propose a stepwise approach for the prevention of SAD in HF with near-normal/normal LVEF.
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Affiliation(s)
- Apostolos Dimos
- Department of Cardiology, University General Hospital of Larissa, Larisa, Greece
| | - Andrew Xanthopoulos
- Department of Cardiology, University General Hospital of Larissa, Larisa, Greece
| | - Michail Papamichalis
- Department of Cardiology, University General Hospital of Larissa, Larisa, Greece
| | - Angeliki Bourazana
- Department of Cardiology, University General Hospital of Larissa, Larisa, Greece
| | - Dimitrios Tavoularis
- Department of Cardiology, University General Hospital of Larissa, Larisa, Greece
| | - John Skoularigis
- Department of Cardiology, University General Hospital of Larissa, Larisa, Greece
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154
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Haukilahti MAE, Holmström L, Vähätalo J, Kenttä T, Tikkanen J, Pakanen L, Kortelainen ML, Perkiömäki J, Huikuri H, Myerburg RJ, Junttila MJ. Sudden Cardiac Death in Women. Circulation 2019; 139:1012-1021. [PMID: 30779638 DOI: 10.1161/circulationaha.118.037702] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite recent progress in profiling of risk for sudden cardiac death (SCD) and prevention and intervention of cardiac diseases, SCD remains a major cause of death. Among women, the incidence of SCD is significant, but lower than in men, particularly in the premenopausal and early postmenopausal years. Possibly, as a consequence of the difference in population burden, the mechanisms and risk markers of SCD are not as well defined for women. The aim of this study was to determine the autopsy findings and causes of death among women in a large SCD population. Additionally, we sought to classify prior ECG characteristics in male and female subjects with SCD. METHODS The Fingesture study has systematically collected clinical and autopsy data from subjects with SCD in Northern Finland between 1998 and 2017. The cohort consists of 5869 subjects with SCD. Previously recorded ECGs were available and analyzed in 1101 subjects (18.8% of total population; and in 25.3% of women). RESULTS Female subjects with SCD were significantly older than men: 70.1±13.1 years versus 63.5±11.8 years (mean ± standard deviation, P<0.001). The most frequently identified cause of death was ischemic heart disease in both sexes: 71.7% among women versus 75.7% among men, P=0.005. In contrast, women were more likely to have nonischemic cause of SCD than men (28.3% versus 24.3%, P=0.005). The prevalence of primary myocardial fibrosis was higher among women (5.2%, n=64) than in men (2.6%, n=120; P<0.001). Female subjects with SCD were more likely to have normal prior ECG tracings (22.2% versus 15.3% in men, P<0.001). A normal ECG was even more common among nonischemic female subjects with SCD (27.8% versus 16.2% in men, P=0.009). However, ECG markers of left ventricular hypertrophy, with or without repolarization abnormalities, were more common among women (8.2%; 17.9%) than in men (4.9%; 10.6%, P=0.036; P<0.001, respectively). CONCLUSIONS Women were considerably older at the time of SCD and more commonly had nonischemic causes. Women were also more likely to have a prior normal ECG than men, but an increased marker for SCD risk based on ECG criteria for left ventricular hypertrophy with repolarization abnormalities was more commonly observed in women.
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Affiliation(s)
- M Anette E Haukilahti
- From Research Unit of Internal Medicine (M.A.E.H., L.H., J.V., T.K., J.T., J.P., H.H., M.J.J.), Medical Research Center Oulu, University of Oulu and University Hospital of Oulu, Finland
| | - Lauri Holmström
- From Research Unit of Internal Medicine (M.A.E.H., L.H., J.V., T.K., J.T., J.P., H.H., M.J.J.), Medical Research Center Oulu, University of Oulu and University Hospital of Oulu, Finland
| | - Juha Vähätalo
- From Research Unit of Internal Medicine (M.A.E.H., L.H., J.V., T.K., J.T., J.P., H.H., M.J.J.), Medical Research Center Oulu, University of Oulu and University Hospital of Oulu, Finland
| | - Tuomas Kenttä
- From Research Unit of Internal Medicine (M.A.E.H., L.H., J.V., T.K., J.T., J.P., H.H., M.J.J.), Medical Research Center Oulu, University of Oulu and University Hospital of Oulu, Finland
| | - Jani Tikkanen
- From Research Unit of Internal Medicine (M.A.E.H., L.H., J.V., T.K., J.T., J.P., H.H., M.J.J.), Medical Research Center Oulu, University of Oulu and University Hospital of Oulu, Finland
| | - Lasse Pakanen
- Department of Forensic Medicine, Research Unit of Internal Medicine (L.P., M.-L.K.), Medical Research Center Oulu, University of Oulu and University Hospital of Oulu, Finland.,Forensic Medicine Unit, National Institute for Health and Welfare, Oulu, Finland (L.P.)
| | - Marja-Leena Kortelainen
- Department of Forensic Medicine, Research Unit of Internal Medicine (L.P., M.-L.K.), Medical Research Center Oulu, University of Oulu and University Hospital of Oulu, Finland
| | - Juha Perkiömäki
- From Research Unit of Internal Medicine (M.A.E.H., L.H., J.V., T.K., J.T., J.P., H.H., M.J.J.), Medical Research Center Oulu, University of Oulu and University Hospital of Oulu, Finland
| | - Heikki Huikuri
- From Research Unit of Internal Medicine (M.A.E.H., L.H., J.V., T.K., J.T., J.P., H.H., M.J.J.), Medical Research Center Oulu, University of Oulu and University Hospital of Oulu, Finland
| | - Robert J Myerburg
- Division of Cardiology, University of Miami Miller School of Medicine, FL (R.J.M.)
| | - M Juhani Junttila
- From Research Unit of Internal Medicine (M.A.E.H., L.H., J.V., T.K., J.T., J.P., H.H., M.J.J.), Medical Research Center Oulu, University of Oulu and University Hospital of Oulu, Finland
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155
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Zhang J, Zhou X, Xing Q, Li Y, Zhang L, Zhou Q, Lu Y, Zhai M, Bao J, Tang B. Sudden cardiac death in the Kazakh and Han peoples of Xinjiang, China: A comparative cross-sectional study. Medicine (Baltimore) 2019; 98:e18126. [PMID: 31852072 PMCID: PMC6922496 DOI: 10.1097/md.0000000000018126] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Sudden cardiac death (SCD) is a major cause of mortality in China. This study collected reference data for future programs of prevention of SCD among the ethnic Kazakh and Han populations in Xinjiang, China.From January 1, 2015 to December 31, 2015, 2 monitoring locations in northern Xinjiang China were utilized. These locations were selected based on the geographic, economic, and administrative structures of the ethnic Kazakh settlements in Xinjiang. Investigators were trained to investigate SCDs in Kazakh and Han people, a study population totaling more than 400,000. The populations were compared for SCD incidence.The average age of the Han population was significantly higher than that of the Kazakh. During the year 2015, there were 135 SCDs, specifically 67 and 68 in the Han and Kazakh populations, respectively, incidences of 37.94 and 36.2 per 100,000. After standardizing for age, the incidence in these populations was 29.36 and 51.85 per 100,000. Among those who experienced SCD, the prevalence of hypertension was higher in the Kazakh group than in the Han. The multivariate analysis of populations with SCD showed that, among the patients with coronary heart disease, the Kazakh were more likely to have SCD than the Han (odds ratio: 3.58, confidence interval: 1.18-10.95).Among the elderly, the incidence of SCD was much higher in the Kazakh population than in the Han population. Basic medical services and health education should be strengthened in the Kazakh pastoral areas.
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Affiliation(s)
- Jianghua Zhang
- First Affiliated Hospital of Xinjiang Medical University, Urumqi
| | - Xianhui Zhou
- First Affiliated Hospital of Xinjiang Medical University, Urumqi
| | - Qiang Xing
- First Affiliated Hospital of Xinjiang Medical University, Urumqi
| | - Yaodong Li
- First Affiliated Hospital of Xinjiang Medical University, Urumqi
| | - Ling Zhang
- First Affiliated Hospital of Xinjiang Medical University, Urumqi
| | - Qina Zhou
- First Affiliated Hospital of Xinjiang Medical University, Urumqi
| | - Yanmei Lu
- First Affiliated Hospital of Xinjiang Medical University, Urumqi
| | | | - Jianfu Bao
- Barkol People's Hospital, Barkol, Xinjiang Uygur Autonomous Region, China
| | - Baopeng Tang
- First Affiliated Hospital of Xinjiang Medical University, Urumqi
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156
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Long-term trends in the epidemiology of out-of-hospital cardiac arrest precipitated by suspected drug overdose. Resuscitation 2019; 144:17-24. [DOI: 10.1016/j.resuscitation.2019.08.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 08/12/2019] [Accepted: 08/25/2019] [Indexed: 11/21/2022]
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157
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Simpson TF, Salazar JW, Tseng ZH. Letter by Simpson et al Regarding Article, "Prophylactic Use of Implantable Cardioverter-Defibrillators in the Prevention of Sudden Cardiac Death in Dialysis Patients". Circulation 2019; 140:e742-e743. [PMID: 31657953 DOI: 10.1161/circulationaha.119.042788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Timothy F Simpson
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland (T.F.S.)
| | - James W Salazar
- Department of Medicine (J.W.S.), University of California San Francisco
| | - Zian H Tseng
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine (Z.H.T.), University of California San Francisco
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158
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Nolan JP, Berg RA, Andersen LW, Bhanji F, Chan PS, Donnino MW, Lim SH, Ma MHM, Nadkarni VM, Starks MA, Perkins GD, Morley PT, Soar J. Cardiac Arrest and Cardiopulmonary Resuscitation Outcome Reports: Update of the Utstein Resuscitation Registry Template for In-Hospital Cardiac Arrest: A Consensus Report From a Task Force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia). Circulation 2019; 140:e746-e757. [PMID: 31522544 DOI: 10.1161/cir.0000000000000710] [Citation(s) in RCA: 110] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Utstein-style reporting templates provide a structured framework with which to compare systems of care for cardiac arrest. The 2004 Utstein reporting template encompassed both out-of-hospital and in-hospital cardiac arrest. A 2015 update of the Utstein template focused on out-of-hospital cardiac arrest, which makes this update of the in-hospital template timely. Representatives of the International Liaison Committee on Resuscitation developed an updated in-hospital Utstein reporting template iteratively by meeting face-to-face, by teleconference, and by online surveys between 2013 and 2018. Data elements were grouped by hospital factors, patient variables, pre-event factors, cardiac arrest and postresuscitation processes, and outcomes. Elements were classified as core or supplemental by use of a modified Delphi process. Variables were described as core if they were considered essential. Core variables should enable reasonable comparisons between systems and are considered essential for quality improvement programs. Together with core variables, supplementary variables are considered useful for research.
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159
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Nolan JP, Berg RA, Andersen LW, Bhanji F, Chan PS, Donnino MW, Lim SH, Ma MHM, Nadkarni VM, Starks MA, Perkins GD, Morley PT, Soar J. Cardiac Arrest and Cardiopulmonary Resuscitation Outcome Reports: Update of the Utstein Resuscitation Registry Template for In-Hospital Cardiac Arrest: A Consensus Report From a Task Force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia). Resuscitation 2019; 144:166-177. [PMID: 31536777 DOI: 10.1016/j.resuscitation.2019.08.021] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Utstein-style reporting templates provide a structured framework with which to compare systems of care for cardiac arrest. The 2004 Utstein reporting template encompassed both out-of-hospital and in-hospital cardiac arrest. A 2015 update of the Utstein template focused on out-of-hospital cardiac arrest, which makes this update of the in-hospital template timely. Representatives of the International Liaison Committee on Resuscitation developed an updated in-hospital Utstein reporting template iteratively by meeting face-to-face, by teleconference, and by online surveys between 2013 and 2018. Data elements were grouped by hospital factors, patient variables, pre-event factors, cardiac arrest and postresuscitation processes, and outcomes. Elements were classified as core or supplemental by use of a modified Delphi process. Variables were described as core if they were considered essential. Core variables should enable reasonable comparisons between systems and are considered essential for quality improvement programs. Together with core variables, supplementary variables are considered useful for research.
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160
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Velasquez A, Goldberger JJ. Risk stratification for sudden cardiac death: show me the money! Eur Heart J 2019; 40:2950-2952. [PMID: 31230065 DOI: 10.1093/eurheartj/ehz410] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Alex Velasquez
- Division of Cardiology, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Miami, FL, USA
| | - Jeffrey J Goldberger
- Division of Cardiology, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Miami, FL, USA
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161
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Polsinelli VB, Wang NC, Kancharla K, Bhonsale A, Jain SK, Saba S. Implications of Initial Recorded Rhythm on Cardioverter-Defibrillator Insertion and Subsequent All-Cause Mortality in Sudden Cardiac Arrest Survivors. Am J Cardiol 2019; 124:709-714. [PMID: 31279406 DOI: 10.1016/j.amjcard.2019.05.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/11/2019] [Accepted: 05/16/2019] [Indexed: 10/26/2022]
Abstract
Sudden cardiac arrest (SCA) rhythms have been traditionally divided into shockable [ventricular tachycardia (VT)/ventricular fibrillation (VF)] and nonshockable [(asystole (ASY)/pulseless electrical activity (PEA)] rhythms. It is unclear if the specific rhythm has implications on patient management and outcomes. We evaluated 1,433 patients who were admitted with SCA from 2000 to 2012 and were discharged alive. Of those, 1,123 patients had a recorded initial SCA rhythm. Subjects included were >18 years of age, and without an implantable cardioverter-defibrillator (ICD) in place at the time of the event. The likelihood of receiving an ICD for each SCA rhythm and the time to death were analyzed. Of the overall cohort of 1,123 SCA survivors (age of 62 ± 15 years; 39.2% women; 56.3% in-hospital SCA; 83% white; 67% coronary artery disease), 355 (31.6%) received an ICD, and 493 (43.9%) died over a mean follow-up of 3.8 ± 3.2 years. Patients with VF (n = 254, 43.6%) or VT (n = 83, 43.9%) were more likely to receive ICD therapy compared with those with ASY (n = 9, 5.3%) or PEA (n = 9, 4.8%; p <0.001). All-cause mortality was lower in VF patients compared with the other groups (p <0.0001). ICD therapy was associated with lower risk of death in the VF group (hazard ratio [HR] 0.61 [0.45 to 0.83]; p = 0.002) and strong trends toward less mortality in patients with VT (HR 0.64 [0.40 to 1.03]; p = 0.07) and ASY (HR 0.39 [0.12 to 1.31]; p = 0.13) but not in those with PEA (HR 0.93 [0.39 to 2.23]; p = 0.88). In conclusion, long-term survival in post-SCA patients is influenced by initial SCA rhythm. Although SCA survivors with shockable rhythms were more likely to receive ICDs, the ICD was associated with lower risk of death in most patients, including those with ASY. In conclusion, our data suggest that a more detailed SCA rhythm classification has important implications to patient management and long-term survival in this population.
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Affiliation(s)
- Vincenzo B Polsinelli
- The Heart and Vascular Institute and the Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Norman C Wang
- The Heart and Vascular Institute and the Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Krishna Kancharla
- The Heart and Vascular Institute and the Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Aditya Bhonsale
- The Heart and Vascular Institute and the Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Sandeep K Jain
- The Heart and Vascular Institute and the Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Samir Saba
- The Heart and Vascular Institute and the Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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162
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Tseng ZH. Presumed Sudden Cardiac Deaths Among Persons With HIV and Heart Failure. JACC-HEART FAILURE 2019; 7:768-770. [DOI: 10.1016/j.jchf.2019.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 06/10/2019] [Indexed: 10/26/2022]
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163
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Bruikman C, de Ronde MWJ, Amin A, Levy S, Lof P, de Ruijter U, Hovingh K, Tan HL, Pinto-Sietsma SJ. Sudden cardiac death in families with premature cardiovascular disease. Heart 2019; 106:228-232. [PMID: 31422358 PMCID: PMC6993031 DOI: 10.1136/heartjnl-2019-314861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 06/28/2019] [Accepted: 07/03/2019] [Indexed: 01/05/2023] Open
Abstract
Objective Sudden cardiac death (SCD) in families with premature atherosclerosis (PAS) is generally attributed to lethal arrhythmias during myocardial infarction. Yet, such arrhythmias may also arise from non-ischaemic inherited susceptibility. We aimed to test the hypothesis that Brugada syndrome is prevalent among families with PAS in which SCD occurred. Methods We investigated all patients who underwent Ajmaline testing to screen them for Brugada syndrome because of unexplained familial SCD in the Amsterdam University Medical Centers between 2004 and 2017. We divided the cohort into two groups based on a positive family history for PAS. All individuals with a positive Ajmaline test were screened for SCN5A-mutation. Results In families with SCD and PAS, the prevalence of positive Ajmaline test was similar to families with SCD alone (22% vs 19%). The number of SCD cases in families with SCD and PAS was higher (2.34 vs 1.63, p<0.001) and SCD occurred at older age in families with SCD and PAS (42 years vs 36 years, p<0.001), while the prevalence of SCN5A mutations was lower (3% vs 18%, p<0.05). Conclusions Brugada syndrome has a similar prevalence in families with SCD and PAS as in families with SCD alone, although SCD in families with SCD and PAS occurs in more family members and at older age, while SCN5A mutations in these families are rare. This suggests that the SCD occurring in families with PAS could be related to an underlying genetic predisposition of arrhythmias, with a different genetic origin. It could be considered to screen families with SCD and PAS for Brugada syndrome.
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Affiliation(s)
- Caroline Bruikman
- Department of Vascular Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Maurice W J de Ronde
- Department of Vascular Medicine, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, Amsterdam, The Netherlands
| | - Ahmed Amin
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Sonja Levy
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, Amsterdam, The Netherlands
| | - Pien Lof
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, Amsterdam, The Netherlands
| | - Ursula de Ruijter
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, Amsterdam, The Netherlands
| | - Kees Hovingh
- Department of Vascular Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Hanno L Tan
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Sara-Joan Pinto-Sietsma
- Department of Vascular Medicine, Amsterdam UMC, Amsterdam, The Netherlands .,Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, Amsterdam, The Netherlands
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164
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Molina P, Sanz-Sánchez J, Fenollosa M, Martínez-Matilla M, Giner J, Zorio E. Arrhythmogenic cardiomyopathy with left ventricular involvement versus ischemic heart disease: lessons learned from the family study and the reviewed autopsy of a young male. Forensic Sci Res 2019; 4:274-279. [PMID: 31489393 PMCID: PMC6713184 DOI: 10.1080/20961790.2019.1616247] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 03/31/2019] [Accepted: 04/12/2019] [Indexed: 01/16/2023] Open
Abstract
Ischemic heart disease (IHD) is the leading cause of sudden cardiac death (SCD) and often non-thrombosed severe coronary stenoses with or without myocardial scars are detected. Left dominant arrhythmogenic cardiomyopathy (LDAC) is a life-threating rare disease which has been more thoroughly studied in the last 10 years. The macroscopic study of an SCD victim was conducted and re-evaluated 9 years later. The cardiological work-up in his first-degree relatives initially comprised an electrocardiogram (ECG) and an echocardiogram. When they were re-evaluted 9 years later, a cardiac magnetic resonance, an ECG-monitoring, an exercise testing and a genetic study were performed and the pedigree was extended accordingly. In 2008, an IHD was suspected in the sports-triggered SCD of a 37-year-old man upon the postmortem (75% stenosis of the left main and circumflex coronary arteries; the subepicardial left ventricular fibrofatty infiltration with mild myocardial degeneration was assumed to be a past myocardial infarction). No cardiomyopathy was identified in any of the two proband’s sisters. Nine years thereafter, distant relatives were diagnosed with LDAC due to a pathogenic desmoplakin mutation. The reanalysis of the two sisters showed ventricular arrhythmias in one of them without structural heart involvement and the reviewed postmortem of the proband was reclassified as LDAC based on the fibrofatty infiltration; both were mutation carriers. The completion of the family study on 19 family members yielded one SCD due to LDAC (the proband), three living patients diagnosed with LDAC (two with a defibrillator), one mutation carrier without structural ventricular involvement, and 14 healthy relatives (who were discharged) with a very good co-segregation of the mutation. Although rare, LDAC exists and sometimes its differential diagnosis with IHD has to be faced. Modifying previous postmortem misdiagnoses can help family screening to further prevent SCDs.
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Affiliation(s)
- Pilar Molina
- Servicio de Patología, Instituto de Medicina Legal y Ciencias Forenses de Valencia, Valencia, España.,Unidad de Valoración del Riesgo de Muerte Súbita Familiar and Unidad de Cardiopatías Familiares, Muerte Súbita y Mecanismos de Enfermedad (CaFaMuSMe), Instituto de Investigación Sanitaria La Fe, Valencia, España
| | - Jorge Sanz-Sánchez
- Unidad de Valoración del Riesgo de Muerte Súbita Familiar and Unidad de Cardiopatías Familiares, Muerte Súbita y Mecanismos de Enfermedad (CaFaMuSMe), Instituto de Investigación Sanitaria La Fe, Valencia, España.,Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - Manuel Fenollosa
- Servicio de Patología, Instituto de Medicina Legal y Ciencias Forenses de Valencia, Valencia, España
| | | | - Juan Giner
- Servicio de Patología, Instituto de Medicina Legal y Ciencias Forenses de Valencia, Valencia, España.,Unidad de Valoración del Riesgo de Muerte Súbita Familiar and Unidad de Cardiopatías Familiares, Muerte Súbita y Mecanismos de Enfermedad (CaFaMuSMe), Instituto de Investigación Sanitaria La Fe, Valencia, España
| | - Esther Zorio
- Unidad de Valoración del Riesgo de Muerte Súbita Familiar and Unidad de Cardiopatías Familiares, Muerte Súbita y Mecanismos de Enfermedad (CaFaMuSMe), Instituto de Investigación Sanitaria La Fe, Valencia, España.,Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, España
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165
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Cunningham KS, Spears DA, Care M. Evaluation of cardiac hypertrophy in the setting of sudden cardiac death. Forensic Sci Res 2019; 4:223-240. [PMID: 31489388 PMCID: PMC6713129 DOI: 10.1080/20961790.2019.1633761] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 06/17/2019] [Accepted: 06/17/2019] [Indexed: 01/06/2023] Open
Abstract
Ventricular hypertrophy is a common pathological finding at autopsy that can act as a substrate for arrhythmogenesis. Pathologists grapple with the significance of ventricular hypertrophy when assessing the sudden and unexpected deaths of young people and what it could mean for surviving family members. The pathological spectrum of left ventricular hypertrophy (LVH) is reviewed herein. This article is oriented to the practicing autopsy pathologist to help make sense of various patterns of increased heart muscle, particularly those that are not clearly cardiomyopathic, yet present in the setting of sudden cardiac death. The article also reviews factors influencing arrhythmogenesis as well as genetic mutations most commonly associated with ventricular hypertrophy, especially those associated with hypertrophic cardiomyopathy (HCM).
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Affiliation(s)
- Kristopher S Cunningham
- Department of Laboratory Medicine and Pathobiology, Ontario Forensic Pathology Service, University of Toronto, Toronto, Canada
| | - Danna A Spears
- University Health Network, Division of Cardiology - Electrophysiology, University of Toronto, Toronto, Canada
| | - Melanie Care
- Fred A. Litwin Family Centre in Genetic Medicine and Inherited Arrhythmia Clinic, University Health Network & Mount Sinai Hospital, University of Toronto, Toronto, Canada
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166
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Patel RB, Nohria A, Butler J, Vaduganathan M. Dying is not what it used to be! Impact of evolving epidemiology and treatment on mode of death in heart failure. Eur J Heart Fail 2019; 21:1267-1269. [PMID: 31410990 DOI: 10.1002/ejhf.1587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 11/11/2022] Open
Affiliation(s)
- Ravi B Patel
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Anju Nohria
- Brigham and Women's Heart & Vascular Center and Harvard Medical School, Boston, MA, USA
| | - Javed Butler
- Department of Medicine, University of Mississippi, Jackson, MS, USA
| | - Muthiah Vaduganathan
- Brigham and Women's Heart & Vascular Center and Harvard Medical School, Boston, MA, USA
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167
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Disertori M, Masè M, Rigoni M, Nollo G, Ravelli F. Heart failure patients unresponsive to implantable cardioverter‐defibrillator therapy: a neglected problem. Eur J Heart Fail 2019; 21:1507-1509. [DOI: 10.1002/ejhf.1551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/05/2019] [Accepted: 06/09/2019] [Indexed: 11/11/2022] Open
Affiliation(s)
- Marcello Disertori
- IRCS‐HTA, Bruno Kessler Foundation – FBK Trento Italy
- Department of CardiologySanta Chiara Hospital Trento Italy
| | - Michela Masè
- IRCS‐HTA, Bruno Kessler Foundation – FBK Trento Italy
- Department of PhysicsUniversity of Trento Trento Italy
| | - Marta Rigoni
- IRCS‐HTA, Bruno Kessler Foundation – FBK Trento Italy
| | - Giandomenico Nollo
- IRCS‐HTA, Bruno Kessler Foundation – FBK Trento Italy
- Department of Industrial EngineeringUniversity of Trento Trento Italy
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168
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Affiliation(s)
- Neal A. Chatterjee
- Division of Preventive Medicine, Dept of Medicine, Brigham and Women’s Hospital, Harvard Medical School
- Cardiology Division, Dept of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Christine M. Albert
- Division of Preventive Medicine, Dept of Medicine, Brigham and Women’s Hospital, Harvard Medical School
- Division of Cardiovascular Medicine, Dept of Medicine, Brigham and Women’s Hospital, Harvard Medical School
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169
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Tseng ZH, Salazar JW, Olgin JE, Ursell PC, Kim AS, Bedigian A, Probert J, Hart AP, Moffatt E, Vittinghoff E. Refining the World Health Organization Definition: Predicting Autopsy-Defined Sudden Arrhythmic Deaths Among Presumed Sudden Cardiac Deaths in the POST SCD Study. Circ Arrhythm Electrophysiol 2019; 12:e007171. [PMID: 31248279 DOI: 10.1161/circep.119.007171] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Conventional definitions of sudden cardiac death (SCD) presume cardiac cause. We studied the World Health Organization-defined SCDs autopsied in the POST SCD study (Postmortem Systematic Investigation of SCD) to determine whether premortem characteristics could identify autopsy-defined sudden arrhythmic death (SAD) among presumed SCDs. METHODS Between January 2, 2011, and January 4, 2016, we prospectively identified all 615 World Health Organization-defined SCDs (144 witnessed) 18 to 90 years in San Francisco County for medical record review and autopsy via medical examiner surveillance. Autopsy-defined SADs had no extracardiac or acute heart failure cause of death. We used 2 nested sets of premortem predictors-an emergency medical system set and a comprehensive set adding medical record data-to develop Least Absolute Selection and Shrinkage Operator models of SAD among witnessed and unwitnessed cohorts. RESULTS Of 615 presumed SCDs, 348 (57%) were autopsy-defined SAD. For witnessed cases, the emergency medical system model (area under the receiver operator curve 0.75 [0.67-0.82]) included presenting rhythm of ventricular tachycardia/fibrillation and pulseless electrical activity, while the comprehensive (area under the receiver operator curve 0.78 [0.70-0.84]) added depression. If only ventricular tachycardia/fibrillation witnessed cases (n=48) were classified as SAD, sensitivity was 0.46 (0.36-0.57), and specificity was 0.90 (0.79-0.97). For unwitnessed cases, the emergency medical system model (area under the receiver operator curve 0.68 [0.64-0.73]) included black race, male sex, age, and time since last seen normal, while the comprehensive (area under the receiver operator curve 0.75 [0.71-0.79]) added use of β-blockers, antidepressants, QT-prolonging drugs, opiates, illicit drugs, and dyslipidemia. If only unwitnessed cases <1 hour (n=59) were classified as SAD, sensitivity was 0.18 (0.13-0.22) and specificity was 0.95 (0.90-0.97). CONCLUSIONS Our models identify premortem characteristics that can better specify autopsy-defined SAD among presumed SCDs and suggest the World Health Organization definition can be improved by restricting witnessed SCDs to ventricular tachycardia/fibrillation or nonpulseless electrical activity rhythms and unwitnessed cases to <1 hour since last normal, at the cost of sensitivity.
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Affiliation(s)
- Zian H Tseng
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine (Z.H.T., J.E.O., A.B., J.P.), University of California
| | | | - Jeffrey E Olgin
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine (Z.H.T., J.E.O., A.B., J.P.), University of California
| | | | - Anthony S Kim
- Department of Neurology (A.S.K.), University of California
| | - Annie Bedigian
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine (Z.H.T., J.E.O., A.B., J.P.), University of California
| | - Joanne Probert
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine (Z.H.T., J.E.O., A.B., J.P.), University of California
| | - Amy P Hart
- Office of the Chief Medical Examiner, City and County of San Francisco, CA (A.P.H., E.M.)
| | - Ellen Moffatt
- Office of the Chief Medical Examiner, City and County of San Francisco, CA (A.P.H., E.M.)
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics (E.V.), University of California
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170
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Buja LM, Ottaviani G, Mitchell RN. Pathobiology of cardiovascular diseases: an update. Cardiovasc Pathol 2019; 42:44-53. [PMID: 31255975 DOI: 10.1016/j.carpath.2019.06.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 06/07/2019] [Indexed: 01/10/2023] Open
Abstract
This article introduces the Second Special Issue of Cardiovascular Pathology (CVP), the official journal of the Society for Cardiovascular Pathology (SCVP). This CVP Special Issue showcases a series of commemorative review articles in celebration of the 25th anniversary of CVP originally published in 2016 and now compiled into a virtual collection with online access for the cardiovascular pathology community. This overview also provides updates on the major categories of cardiovascular diseases from the perspective of cardiovascular pathologists, highlighting publications from CVP, as well as additional important review articles and clinicopathologic references.
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Affiliation(s)
- L Maximilian Buja
- Department of Pathology and Laboratory Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA; Cardiovascular Pathology Research Laboratory, Texas Heart Institute, CHI St. Luke's Hospital, Houston, TX, USA.
| | - Giulia Ottaviani
- Department of Pathology and Laboratory Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA; "Lino Rossi" Research Center for the study and prevention of unexpected perinatal death and sudden infant death syndrome, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Richard N Mitchell
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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171
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Bob-Manuel T, Jenkins JS, Morin DP. Non-arrhythmic causes of sudden death: A comprehensive review. Prog Cardiovasc Dis 2019; 62:265-271. [PMID: 31075277 DOI: 10.1016/j.pcad.2019.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 05/04/2019] [Indexed: 10/26/2022]
Abstract
Sudden cardiac death (SCD) is a major public health issue in the United States and worldwide. It is estimated to affect between 1 and 1.5 million patients worldwide annually, with the global burden expected to rise due to the concomitant rise in coronary artery disease in the developing world. Although arrhythmic causes of SCD such as ventricular tachycardia and ventricular fibrillation are common and well-studied, non-arrhythmic causes are also important, with diverse etiologies from ischemia-related structural heart disease to non-ischemic heart diseases, non-atherosclerotic coronary pathologies, and inflammatory states. Recent research has also found that risk factors and/or demographics predispose certain individuals to a higher risk of non-arrhythmia-related SCD. This review discusses the epidemiology, mechanisms, etiologies, and management of non-arrhythmic SCD.
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Affiliation(s)
| | - J Stephen Jenkins
- John Ochsner Heart and Vascular Center, New Orleans, LA, United States of America; University of Queensland Ochsner Clinical School, New Orleans, LA, United States of America
| | - Daniel P Morin
- John Ochsner Heart and Vascular Center, New Orleans, LA, United States of America; University of Queensland Ochsner Clinical School, New Orleans, LA, United States of America.
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172
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Bricker RS, Valle JA, Plomondon ME, Armstrong EJ, Waldo SW. Causes of Mortality After Percutaneous Coronary Intervention. Circ Cardiovasc Qual Outcomes 2019; 12:e005355. [DOI: 10.1161/circoutcomes.118.005355] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Rory S. Bricker
- Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, Aurora (R.B., J.A.V., M.E.P., E.J.A., S.W.W.)
| | - Javier A. Valle
- Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, Aurora (R.B., J.A.V., M.E.P., E.J.A., S.W.W.)
- Department of Medicine, Rocky Mountain Regional VA Medical Center, Aurora, CO (J.A.V., M.E.P., E.J.A., S.W.W.)
| | - Mary E. Plomondon
- Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, Aurora (R.B., J.A.V., M.E.P., E.J.A., S.W.W.)
- Department of Medicine, Rocky Mountain Regional VA Medical Center, Aurora, CO (J.A.V., M.E.P., E.J.A., S.W.W.)
| | - Ehrin J. Armstrong
- Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, Aurora (R.B., J.A.V., M.E.P., E.J.A., S.W.W.)
- Department of Medicine, Rocky Mountain Regional VA Medical Center, Aurora, CO (J.A.V., M.E.P., E.J.A., S.W.W.)
| | - Stephen W. Waldo
- Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, Aurora (R.B., J.A.V., M.E.P., E.J.A., S.W.W.)
- Department of Medicine, Rocky Mountain Regional VA Medical Center, Aurora, CO (J.A.V., M.E.P., E.J.A., S.W.W.)
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173
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Goff ZD, Calkins H. Sudden death related cardiomyopathies - Hypertrophic cardiomyopathy. Prog Cardiovasc Dis 2019; 62:212-216. [PMID: 31004609 DOI: 10.1016/j.pcad.2019.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 04/15/2019] [Indexed: 11/15/2022]
Abstract
Hypertrophic cardiomyopathy (HCM) is a form of inherited cardiomyopathy. Most individuals with HCM experience minimal symptoms throughout their lifetime. However, those with HCM are at risk of ventricular arrhythmias and sudden cardiac death (SCD), the most feared complication of HCM. Implantable cardioverter defibrillator (ICD) implantation has played a large role in transforming this disease from one with an ominous prognosis to one with mortality rates that are on par with the general public. Since the early 2000s, balance between SCD prevention and unnecessary ICD placement has been sought, this is reflected in the evolution of SCD risk stratification models for patients with HCM. This review discusses key concepts pertaining to HCM, with emphasis on prevention of SCD, and summarizes and compares the recommendations for ICD implantation in current guidelines.
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Affiliation(s)
- Zackary D Goff
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Hugh Calkins
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America; Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
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174
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Olson KA, Patel RB, Ahmad FS, Ning H, Bogle BM, Goldberger JJ, Lloyd-Jones DM. Sudden Cardiac Death Risk Distribution in the United States Population (from NHANES, 2005 to 2012). Am J Cardiol 2019; 123:1249-1254. [PMID: 30808515 DOI: 10.1016/j.amjcard.2019.01.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 01/11/2019] [Accepted: 01/15/2019] [Indexed: 01/21/2023]
Abstract
Sudden cardiac death (SCD) accounts for more than half of all deaths from cardiovascular disease and is the first manifestation of heart disease in 50% of these subjects. We aimed to describe the distribution of predicted SCD risk in the general US population using a recently developed risk score. We previously developed a population-based, 10-year risk score for SCD using data from the multiracial Atherosclerosis Risk in Communities cohort, validated in the Framingham Study. We now estimate 10-year predicted SCD risk in National Health and Nutrition Examination Survey participants (pooled from cycles in 2005 to 2012) and evaluate the clinical profile of participants in lower risk (0 to 80th percentile of risk) or high risk (81st to 100th percentile of risk) strata. A total of 10,811 participants were included; the mean age of participants was 48 years, and 50% were women. The average predicted 10-year risk of SCD was 3.6% in high-risk participants (81st to 100th percentile), and 0.37% in low-risk participants (0 to 80th percentile). High-risk participants were older, had higher blood pressure, total cholesterol and body mass index, lower high-density lipoprotein, and were more likely to be men, black, smokers, and diabetic. In US adults free of cardiovascular disease, the majority of SCD risk appears confined to 10% to 20% of the population. This risk score, comprised of readily available clinical variables, identifies a subset of individuals in the population who are at an appreciably higher risk of SCD. This enriched cohort represents candidates for additional nuanced and selective screening techniques to further quantify SCD risk.
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Affiliation(s)
- Kristoff A Olson
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine/Northwestern University, Chicago, Illinois
| | - Ravi B Patel
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine/Northwestern University, Chicago, Illinois; Department of Preventive Medicine, Feinberg School of Medicine/Northwestern University, Chicago, Illinois
| | - Faraz S Ahmad
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine/Northwestern University, Chicago, Illinois; Department of Preventive Medicine, Feinberg School of Medicine/Northwestern University, Chicago, Illinois
| | - Hongyan Ning
- Department of Preventive Medicine, Feinberg School of Medicine/Northwestern University, Chicago, Illinois
| | - Brittany M Bogle
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jeffrey J Goldberger
- Division of Cardiology, Department of Medicine, Miller School of Medicine, University of Miami, Miami, Florida
| | - Donald M Lloyd-Jones
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine/Northwestern University, Chicago, Illinois; Department of Preventive Medicine, Feinberg School of Medicine/Northwestern University, Chicago, Illinois.
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175
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Tzou WS, Hussein AA, Madhavan M, Viswanathan MN, Steinberg BA, Ceresnak SR, Davis DR, Park DS, Wang PJ, Kapa S. Year in Review in Cardiac Electrophysiology. Circ Arrhythm Electrophysiol 2019; 12:e007142. [PMID: 30744401 DOI: 10.1161/circep.118.007142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Wendy S Tzou
- Department of Medicine, University of Colorado, Aurora (W.S.T.)
| | - Ayman A Hussein
- Department of Cardiovascular Medicine, Cleveland Clinic, OH (A.A.H.)
| | - Malini Madhavan
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN (M.M., S.K.)
| | - Mohan N Viswanathan
- Department of Medicine, Stanford University Medical Center, Palo Alto, CA (M.N.V., P.J.W.)
| | | | - Scott R Ceresnak
- Department of Medicine, Stanford Children's Health, Palo Alto, CA (S.R.C.)
| | - Darryl R Davis
- Division of Cardiology, University of Ottawa Heart Institute, Ontario, Canada (D.R.D.)
| | - David S Park
- Department of Medicine, New York University Langone Health, NY (D.S.P.)
| | - Paul J Wang
- Department of Medicine, Stanford University Medical Center, Palo Alto, CA (M.N.V., P.J.W.)
| | - Suraj Kapa
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN (M.M., S.K.)
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176
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Sullivan K, Van Spall HG. A wearable cardioverter-defibrillator did not reduce arrhythmic death in MI with reduced ejection fraction. Ann Intern Med 2019; 170:JC5. [PMID: 30641556 DOI: 10.7326/acpjc-2019-170-2-005] [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: 11/22/2022] Open
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177
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Narayan SM, Wang PJ, Daubert JP. New Concepts in Sudden Cardiac Arrest to Address an Intractable Epidemic: JACC State-of-the-Art Review. J Am Coll Cardiol 2019; 73:70-88. [PMID: 30621954 PMCID: PMC6398445 DOI: 10.1016/j.jacc.2018.09.083] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 08/28/2018] [Accepted: 09/22/2018] [Indexed: 12/11/2022]
Abstract
Sudden cardiac arrest (SCA) is one of the largest causes of mortality globally, with an out-of-hospital survival below 10% despite intense research. This document outlines challenges in addressing the epidemic of SCA, along the framework of respond, understand and predict, and prevent. Response could be improved by technology-assisted orchestration of community responder systems, access to automated external defibrillators, and innovations to match resuscitation resources to victims in place and time. Efforts to understand and predict SCA may be enhanced by refining taxonomy along phenotypical and pathophysiological "axes of risk," extending beyond cardiovascular pathology to identify less heterogeneous cohorts, facilitated by open-data platforms and analytics including machine learning to integrate discoveries across disciplines. Prevention of SCA must integrate these concepts, recognizing that all members of society are stakeholders. Ultimately, solutions to the public health challenge of SCA will require greater awareness, societal debate and focused public policy.
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Affiliation(s)
- Sanjiv M Narayan
- Department of Medicine, Division of Cardiology, Stanford University, Stanford, California.
| | - Paul J Wang
- Department of Medicine, Division of Cardiology, Stanford University, Stanford, California
| | - James P Daubert
- Department of Medicine, Division of Cardiology, Duke University, Durham, North Carolina
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178
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Pollack RA, Weisfeldt ML. Response by Pollack and Weisfeldt to Letter Regarding Article, "Impact of Bystander Automated External Defibrillator Use on Survival and Functional Outcomes in Shockable Observed Public Cardiac Arrests". Circulation 2018; 138:2732-2733. [PMID: 30571269 DOI: 10.1161/circulationaha.118.036946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ross A Pollack
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Myron L Weisfeldt
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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179
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Patel RB, Vaduganathan M. Targeting sudden death in heart failure with preserved ejection fraction: promise or pipedream? Expert Rev Cardiovasc Ther 2018; 16:875-877. [DOI: 10.1080/14779072.2018.1540302] [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: 10/28/2022]
Affiliation(s)
- Ravi B. Patel
- Division of Cardiology, Bluhm Cardiovascular Institute at Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Muthiah Vaduganathan
- Brigham and Women’s Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA, USA
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Aagaard R, Løfgren B, Caap P, Mygind-Klausen T, Bøtker MT, Granfeldt A. A low end-tidal CO 2/arterial CO 2 ratio during cardiopulmonary resuscitation suggests pulmonary embolism. Resuscitation 2018; 133:137-140. [PMID: 30321625 DOI: 10.1016/j.resuscitation.2018.10.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 10/04/2018] [Accepted: 10/09/2018] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Identifying reversible causes of cardiac arrest is challenging. The diagnosis of pulmonary embolism is often missed. Pulmonary embolism increases alveolar dead space resulting in low end-tidal CO2 (EtCO2) relative to arterial CO2 (PaCO2) tension. Thus, a low EtCO2/PaCO2 ratio during resuscitation may be a sign of pulmonary embolism. METHODS Post hoc analysis of data from two porcine studies comparing ultrasonographic measurements of right ventricular diameter during resuscitation from cardiac arrest of different causes. Pigs were grouped according to cause of arrest (pulmonary embolism, hypovolemia, primary arrhythmia, hypoxia, or hyperkalaemia) and EtCO2/PaCO2 ratios were compared. RESULTS Data from 54 pigs were analysed. EtCO2 levels at the third rhythm analysis were significantly lower when cardiac arrest was caused by pulmonary embolism than by primary arrhythmia, hypoxia and hyperkalaemia, but there was no significant difference between pulmonary embolism and hypovolemia. In contrast, PaCO2 levels were higher in cardiac arrest caused by pulmonary embolism than in the other causes of cardiac arrest. Consequently, the EtCO2/PaCO2 ratio was lower in pulmonary embolism 0.2 (95%CI 0.1-0.4), than in hypovolaemia 0.5 (95%CI 0.3-0.6), primary arrhythmia 0.7 (95%CI 0.7-0.8), hypoxia 0.5 (95%CI 0.4-0.6), and hyperkalaemia 0.6 (95%CI 0.6-0.7). CONCLUSION A low EtCO2/PaCO2 ratio during cardiopulmonary resuscitation suggests pulmonary embolism.
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Affiliation(s)
- Rasmus Aagaard
- Research Center for Emergency Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark; Department of Internal Medicine, Randers Regional Hospital, Skovlyvej 15, 8930 Randers NE, Denmark.
| | - Bo Løfgren
- Research Center for Emergency Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark; Department of Internal Medicine, Randers Regional Hospital, Skovlyvej 15, 8930 Randers NE, Denmark; Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Philip Caap
- Research Center for Emergency Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark; Department of Cardiology, Hospital Unit Vest, Gl. Landevej 61, 7400 Herning, Denmark
| | - Troels Mygind-Klausen
- Research Center for Emergency Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark; Department of Internal Medicine, Randers Regional Hospital, Skovlyvej 15, 8930 Randers NE, Denmark
| | - Morten T Bøtker
- Department of Intensive Care Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark; Research & Development, Prehospital Emergency Medical Services, Central Denmark Region, Olof Palmes Allé 34, 1(st) floor, 8200 Aarhus N, Denmark
| | - Asger Granfeldt
- Department of Intensive Care Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
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181
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Sabra M, Refaat MM. The Sudden Cardiac Arrest-mortality score (SCA-MS): A novel score to predict long-term survival after sudden cardiac arrest. Pacing Clin Electrophysiol 2018; 41:1591-1592. [DOI: 10.1111/pace.13531] [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: 10/15/2018] [Accepted: 10/15/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Mohammad Sabra
- Division of Cardiology; American University of Beirut Medical Center; Beirut Lebanon
| | - Marwan M. Refaat
- Division of Cardiology; American University of Beirut Medical Center; Beirut Lebanon
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Abstract
PURPOSE OF REVIEW Treatment with a defibrillator can reduce the risk of sudden death by terminating ventricular arrhythmias. The identification of patient groups in whom this function reduces overall mortality is challenging. In this review, we summarise the evidence for who benefits from a defibrillator. RECENT FINDINGS Recent evidence suggests that contemporary pharmacologic and non-defibrillator device therapies are altering the potential risks and benefits of a defibrillator. Who benefits from a defibrillator is determined by both the risk of sudden death and the competing risk of other, non-sudden causes of death. The balance of these risks is changing, which calls into question whether historic evidence for the use of defibrillators remains robust in the modern era.
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Affiliation(s)
- Simon A S Beggs
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland
| | - Roy S Gardner
- Golden Jubilee National Hospital, Clydebank, Scotland
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland.
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183
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Deo R, Safford MM, Khodneva YA, Jannat-Khah DP, Brown TM, Judd SE, McClellan WM, Rhodes JD, Shlipak MG, Soliman EZ, Albert CM. Differences in Risk of Sudden Cardiac Death Between Blacks and Whites. J Am Coll Cardiol 2018; 72:2431-2439. [PMID: 30442286 PMCID: PMC9704756 DOI: 10.1016/j.jacc.2018.08.2173] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 08/13/2018] [Accepted: 08/14/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Prior studies have consistently demonstrated that blacks have an approximate 2-fold higher incidence of sudden cardiac death (SCD) than whites; however, these analyses have lacked individual-level sociodemographic, medical comorbidity, and behavioral health data. OBJECTIVES The purpose of this study was to evaluate whether racial differences in SCD incidence are attributable to differences in the prevalence of risk factors or rather to underlying susceptibility to fatal arrhythmias. METHODS The Reasons for Geographic and Racial Differences in Stroke study is a prospective, population-based cohort of adults from across the United States. Associations between race and SCD defined per National Heart, Lung, and Blood Institute criteria were assessed. RESULTS Among 22,507 participants (9,416 blacks and 13,091 whites) without a history of clinical cardiovascular disease, there were 174 SCD events (67 whites and 107 blacks) over a median follow-up of 6.1 years (interquartile range: 4.6 to 7.3 years). The age-adjusted SCD incidence rate (per 1,000 person-years) was higher in blacks (1.8; 95% confidence interval [CI]: 1.4 to 2.2) compared with whites (0.7; 95% CI: 0.6 to 0.9), with an unadjusted hazard ratio of 2.35; 95% CI: 1.74 to 3.20. The association of black race with SCD risk remained significant after adjustment for sociodemographics, comorbidities, behavioral measures of health, intervening cardiovascular events, and competing risks of non-SCD mortality (hazard ratio: 1.97; 95% CI: 1.39 to 2.77). CONCLUSIONS In a large biracial population of adults without a history of cardiovascular disease, SCD rates were significantly higher in blacks as compared with whites. These racial differences were not fully explained by demographics, adverse socioeconomic measures, cardiovascular risk factors, and behavioral measures of health.
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Affiliation(s)
- Rajat Deo
- Electrophysiology Section, Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Monika M Safford
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Yulia A Khodneva
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Deanna P Jannat-Khah
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Todd M Brown
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Suzanne E Judd
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama; Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - William M McClellan
- Departments of Medicine and Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - J David Rhodes
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Michael G Shlipak
- Department of Epidemiology, Biostatistics, and Medicine, University of California San Francisco, San Francisco, California; Department of General Internal Medicine, San Francisco VA Medical Center, San Francisco, California
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, and Department of Internal Medicine, Cardiology Section, Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - Christine M Albert
- Center for Arrhythmia Prevention, Division of Preventive Medicine, and Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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184
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Olgin JE, Pletcher MJ, Vittinghoff E, Wranicz J, Malik R, Morin DP, Zweibel S, Buxton AE, Elayi CS, Chung EH, Rashba E, Borggrefe M, Hue TF, Maguire C, Lin F, Simon JA, Hulley S, Lee BK. Wearable Cardioverter-Defibrillator after Myocardial Infarction. N Engl J Med 2018; 379:1205-1215. [PMID: 30280654 PMCID: PMC6276371 DOI: 10.1056/nejmoa1800781] [Citation(s) in RCA: 183] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Despite the high rate of sudden death after myocardial infarction among patients with a low ejection fraction, implantable cardioverter-defibrillators are contraindicated until 40 to 90 days after myocardial infarction. Whether a wearable cardioverter-defibrillator would reduce the incidence of sudden death during this high-risk period is unclear. METHODS We randomly assigned (in a 2:1 ratio) patients with acute myocardial infarction and an ejection fraction of 35% or less to receive a wearable cardioverter-defibrillator plus guideline-directed therapy (the device group) or to receive only guideline-directed therapy (the control group). The primary outcome was the composite of sudden death or death from ventricular tachyarrhythmia at 90 days (arrhythmic death). Secondary outcomes included death from any cause and nonarrhythmic death. RESULTS Of 2302 participants, 1524 were randomly assigned to the device group and 778 to the control group. Participants in the device group wore the device for a median of 18.0 hours per day (interquartile range, 3.8 to 22.7). Arrhythmic death occurred in 1.6% of the participants in the device group and in 2.4% of those in the control group (relative risk, 0.67; 95% confidence interval [CI], 0.37 to 1.21; P=0.18). Death from any cause occurred in 3.1% of the participants in the device group and in 4.9% of those in the control group (relative risk, 0.64; 95% CI, 0.43 to 0.98; uncorrected P=0.04), and nonarrhythmic death in 1.4% and 2.2%, respectively (relative risk, 0.63; 95% CI, 0.33 to 1.19; uncorrected P=0.15). Of the 48 participants in the device group who died, 12 were wearing the device at the time of death. A total of 20 participants in the device group (1.3%) received an appropriate shock, and 9 (0.6%) received an inappropriate shock. CONCLUSIONS Among patients with a recent myocardial infarction and an ejection fraction of 35% or less, the wearable cardioverter-defibrillator did not lead to a significantly lower rate of the primary outcome of arrhythmic death than control. (Funded by the National Institutes of Health and Zoll Medical; VEST ClinicalTrials.gov number, NCT01446965 .).
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Affiliation(s)
- Jeffrey E Olgin
- From the Division of Cardiology, Department of Medicine, the UCSF Center for the Prevention of Sudden Death (J.E.O., C.M., B.K.L.) and the Department of Epidemiology and Biostatistics (M.J.P., E.V., T.F.H., F.L., J.A.S., S.H.), University of California, San Francisco, San Francisco; the Department of Electrocardiology, Medical University of Lodz, Lodz, Poland (J.W.); McLeod Regional Medical Center, Florence, SC (R.M.); Ochsner Medical Center and Ochsner Clinical School, University of Queensland School of Medicine, New Orleans (D.P.M.); Hartford Healthcare Heart and Vascular Institute and University of Connecticut School of Medicine, Hartford (S.Z.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston (A.E.B.); Gill Heart Institute, University of Kentucky, and Veterans Affairs Medical Center, Lexington (C.S.E.); the Department of Internal Medicine, University of Michigan, Michigan Medicine, Ann Arbor (E.H.C.); Stony Brook Medicine, Stony Brook, NY (E.R.); and First Department of Medicine-Cardiology, University Medical Center Mannheim, Mannheim, and DZHK (German Center for Cardiovascular Research), Heidelberg - both in Germany (M.B.)
| | - Mark J Pletcher
- From the Division of Cardiology, Department of Medicine, the UCSF Center for the Prevention of Sudden Death (J.E.O., C.M., B.K.L.) and the Department of Epidemiology and Biostatistics (M.J.P., E.V., T.F.H., F.L., J.A.S., S.H.), University of California, San Francisco, San Francisco; the Department of Electrocardiology, Medical University of Lodz, Lodz, Poland (J.W.); McLeod Regional Medical Center, Florence, SC (R.M.); Ochsner Medical Center and Ochsner Clinical School, University of Queensland School of Medicine, New Orleans (D.P.M.); Hartford Healthcare Heart and Vascular Institute and University of Connecticut School of Medicine, Hartford (S.Z.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston (A.E.B.); Gill Heart Institute, University of Kentucky, and Veterans Affairs Medical Center, Lexington (C.S.E.); the Department of Internal Medicine, University of Michigan, Michigan Medicine, Ann Arbor (E.H.C.); Stony Brook Medicine, Stony Brook, NY (E.R.); and First Department of Medicine-Cardiology, University Medical Center Mannheim, Mannheim, and DZHK (German Center for Cardiovascular Research), Heidelberg - both in Germany (M.B.)
| | - Eric Vittinghoff
- From the Division of Cardiology, Department of Medicine, the UCSF Center for the Prevention of Sudden Death (J.E.O., C.M., B.K.L.) and the Department of Epidemiology and Biostatistics (M.J.P., E.V., T.F.H., F.L., J.A.S., S.H.), University of California, San Francisco, San Francisco; the Department of Electrocardiology, Medical University of Lodz, Lodz, Poland (J.W.); McLeod Regional Medical Center, Florence, SC (R.M.); Ochsner Medical Center and Ochsner Clinical School, University of Queensland School of Medicine, New Orleans (D.P.M.); Hartford Healthcare Heart and Vascular Institute and University of Connecticut School of Medicine, Hartford (S.Z.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston (A.E.B.); Gill Heart Institute, University of Kentucky, and Veterans Affairs Medical Center, Lexington (C.S.E.); the Department of Internal Medicine, University of Michigan, Michigan Medicine, Ann Arbor (E.H.C.); Stony Brook Medicine, Stony Brook, NY (E.R.); and First Department of Medicine-Cardiology, University Medical Center Mannheim, Mannheim, and DZHK (German Center for Cardiovascular Research), Heidelberg - both in Germany (M.B.)
| | - Jerzy Wranicz
- From the Division of Cardiology, Department of Medicine, the UCSF Center for the Prevention of Sudden Death (J.E.O., C.M., B.K.L.) and the Department of Epidemiology and Biostatistics (M.J.P., E.V., T.F.H., F.L., J.A.S., S.H.), University of California, San Francisco, San Francisco; the Department of Electrocardiology, Medical University of Lodz, Lodz, Poland (J.W.); McLeod Regional Medical Center, Florence, SC (R.M.); Ochsner Medical Center and Ochsner Clinical School, University of Queensland School of Medicine, New Orleans (D.P.M.); Hartford Healthcare Heart and Vascular Institute and University of Connecticut School of Medicine, Hartford (S.Z.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston (A.E.B.); Gill Heart Institute, University of Kentucky, and Veterans Affairs Medical Center, Lexington (C.S.E.); the Department of Internal Medicine, University of Michigan, Michigan Medicine, Ann Arbor (E.H.C.); Stony Brook Medicine, Stony Brook, NY (E.R.); and First Department of Medicine-Cardiology, University Medical Center Mannheim, Mannheim, and DZHK (German Center for Cardiovascular Research), Heidelberg - both in Germany (M.B.)
| | - Rajesh Malik
- From the Division of Cardiology, Department of Medicine, the UCSF Center for the Prevention of Sudden Death (J.E.O., C.M., B.K.L.) and the Department of Epidemiology and Biostatistics (M.J.P., E.V., T.F.H., F.L., J.A.S., S.H.), University of California, San Francisco, San Francisco; the Department of Electrocardiology, Medical University of Lodz, Lodz, Poland (J.W.); McLeod Regional Medical Center, Florence, SC (R.M.); Ochsner Medical Center and Ochsner Clinical School, University of Queensland School of Medicine, New Orleans (D.P.M.); Hartford Healthcare Heart and Vascular Institute and University of Connecticut School of Medicine, Hartford (S.Z.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston (A.E.B.); Gill Heart Institute, University of Kentucky, and Veterans Affairs Medical Center, Lexington (C.S.E.); the Department of Internal Medicine, University of Michigan, Michigan Medicine, Ann Arbor (E.H.C.); Stony Brook Medicine, Stony Brook, NY (E.R.); and First Department of Medicine-Cardiology, University Medical Center Mannheim, Mannheim, and DZHK (German Center for Cardiovascular Research), Heidelberg - both in Germany (M.B.)
| | - Daniel P Morin
- From the Division of Cardiology, Department of Medicine, the UCSF Center for the Prevention of Sudden Death (J.E.O., C.M., B.K.L.) and the Department of Epidemiology and Biostatistics (M.J.P., E.V., T.F.H., F.L., J.A.S., S.H.), University of California, San Francisco, San Francisco; the Department of Electrocardiology, Medical University of Lodz, Lodz, Poland (J.W.); McLeod Regional Medical Center, Florence, SC (R.M.); Ochsner Medical Center and Ochsner Clinical School, University of Queensland School of Medicine, New Orleans (D.P.M.); Hartford Healthcare Heart and Vascular Institute and University of Connecticut School of Medicine, Hartford (S.Z.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston (A.E.B.); Gill Heart Institute, University of Kentucky, and Veterans Affairs Medical Center, Lexington (C.S.E.); the Department of Internal Medicine, University of Michigan, Michigan Medicine, Ann Arbor (E.H.C.); Stony Brook Medicine, Stony Brook, NY (E.R.); and First Department of Medicine-Cardiology, University Medical Center Mannheim, Mannheim, and DZHK (German Center for Cardiovascular Research), Heidelberg - both in Germany (M.B.)
| | - Steven Zweibel
- From the Division of Cardiology, Department of Medicine, the UCSF Center for the Prevention of Sudden Death (J.E.O., C.M., B.K.L.) and the Department of Epidemiology and Biostatistics (M.J.P., E.V., T.F.H., F.L., J.A.S., S.H.), University of California, San Francisco, San Francisco; the Department of Electrocardiology, Medical University of Lodz, Lodz, Poland (J.W.); McLeod Regional Medical Center, Florence, SC (R.M.); Ochsner Medical Center and Ochsner Clinical School, University of Queensland School of Medicine, New Orleans (D.P.M.); Hartford Healthcare Heart and Vascular Institute and University of Connecticut School of Medicine, Hartford (S.Z.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston (A.E.B.); Gill Heart Institute, University of Kentucky, and Veterans Affairs Medical Center, Lexington (C.S.E.); the Department of Internal Medicine, University of Michigan, Michigan Medicine, Ann Arbor (E.H.C.); Stony Brook Medicine, Stony Brook, NY (E.R.); and First Department of Medicine-Cardiology, University Medical Center Mannheim, Mannheim, and DZHK (German Center for Cardiovascular Research), Heidelberg - both in Germany (M.B.)
| | - Alfred E Buxton
- From the Division of Cardiology, Department of Medicine, the UCSF Center for the Prevention of Sudden Death (J.E.O., C.M., B.K.L.) and the Department of Epidemiology and Biostatistics (M.J.P., E.V., T.F.H., F.L., J.A.S., S.H.), University of California, San Francisco, San Francisco; the Department of Electrocardiology, Medical University of Lodz, Lodz, Poland (J.W.); McLeod Regional Medical Center, Florence, SC (R.M.); Ochsner Medical Center and Ochsner Clinical School, University of Queensland School of Medicine, New Orleans (D.P.M.); Hartford Healthcare Heart and Vascular Institute and University of Connecticut School of Medicine, Hartford (S.Z.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston (A.E.B.); Gill Heart Institute, University of Kentucky, and Veterans Affairs Medical Center, Lexington (C.S.E.); the Department of Internal Medicine, University of Michigan, Michigan Medicine, Ann Arbor (E.H.C.); Stony Brook Medicine, Stony Brook, NY (E.R.); and First Department of Medicine-Cardiology, University Medical Center Mannheim, Mannheim, and DZHK (German Center for Cardiovascular Research), Heidelberg - both in Germany (M.B.)
| | - Claude S Elayi
- From the Division of Cardiology, Department of Medicine, the UCSF Center for the Prevention of Sudden Death (J.E.O., C.M., B.K.L.) and the Department of Epidemiology and Biostatistics (M.J.P., E.V., T.F.H., F.L., J.A.S., S.H.), University of California, San Francisco, San Francisco; the Department of Electrocardiology, Medical University of Lodz, Lodz, Poland (J.W.); McLeod Regional Medical Center, Florence, SC (R.M.); Ochsner Medical Center and Ochsner Clinical School, University of Queensland School of Medicine, New Orleans (D.P.M.); Hartford Healthcare Heart and Vascular Institute and University of Connecticut School of Medicine, Hartford (S.Z.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston (A.E.B.); Gill Heart Institute, University of Kentucky, and Veterans Affairs Medical Center, Lexington (C.S.E.); the Department of Internal Medicine, University of Michigan, Michigan Medicine, Ann Arbor (E.H.C.); Stony Brook Medicine, Stony Brook, NY (E.R.); and First Department of Medicine-Cardiology, University Medical Center Mannheim, Mannheim, and DZHK (German Center for Cardiovascular Research), Heidelberg - both in Germany (M.B.)
| | - Eugene H Chung
- From the Division of Cardiology, Department of Medicine, the UCSF Center for the Prevention of Sudden Death (J.E.O., C.M., B.K.L.) and the Department of Epidemiology and Biostatistics (M.J.P., E.V., T.F.H., F.L., J.A.S., S.H.), University of California, San Francisco, San Francisco; the Department of Electrocardiology, Medical University of Lodz, Lodz, Poland (J.W.); McLeod Regional Medical Center, Florence, SC (R.M.); Ochsner Medical Center and Ochsner Clinical School, University of Queensland School of Medicine, New Orleans (D.P.M.); Hartford Healthcare Heart and Vascular Institute and University of Connecticut School of Medicine, Hartford (S.Z.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston (A.E.B.); Gill Heart Institute, University of Kentucky, and Veterans Affairs Medical Center, Lexington (C.S.E.); the Department of Internal Medicine, University of Michigan, Michigan Medicine, Ann Arbor (E.H.C.); Stony Brook Medicine, Stony Brook, NY (E.R.); and First Department of Medicine-Cardiology, University Medical Center Mannheim, Mannheim, and DZHK (German Center for Cardiovascular Research), Heidelberg - both in Germany (M.B.)
| | - Eric Rashba
- From the Division of Cardiology, Department of Medicine, the UCSF Center for the Prevention of Sudden Death (J.E.O., C.M., B.K.L.) and the Department of Epidemiology and Biostatistics (M.J.P., E.V., T.F.H., F.L., J.A.S., S.H.), University of California, San Francisco, San Francisco; the Department of Electrocardiology, Medical University of Lodz, Lodz, Poland (J.W.); McLeod Regional Medical Center, Florence, SC (R.M.); Ochsner Medical Center and Ochsner Clinical School, University of Queensland School of Medicine, New Orleans (D.P.M.); Hartford Healthcare Heart and Vascular Institute and University of Connecticut School of Medicine, Hartford (S.Z.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston (A.E.B.); Gill Heart Institute, University of Kentucky, and Veterans Affairs Medical Center, Lexington (C.S.E.); the Department of Internal Medicine, University of Michigan, Michigan Medicine, Ann Arbor (E.H.C.); Stony Brook Medicine, Stony Brook, NY (E.R.); and First Department of Medicine-Cardiology, University Medical Center Mannheim, Mannheim, and DZHK (German Center for Cardiovascular Research), Heidelberg - both in Germany (M.B.)
| | - Martin Borggrefe
- From the Division of Cardiology, Department of Medicine, the UCSF Center for the Prevention of Sudden Death (J.E.O., C.M., B.K.L.) and the Department of Epidemiology and Biostatistics (M.J.P., E.V., T.F.H., F.L., J.A.S., S.H.), University of California, San Francisco, San Francisco; the Department of Electrocardiology, Medical University of Lodz, Lodz, Poland (J.W.); McLeod Regional Medical Center, Florence, SC (R.M.); Ochsner Medical Center and Ochsner Clinical School, University of Queensland School of Medicine, New Orleans (D.P.M.); Hartford Healthcare Heart and Vascular Institute and University of Connecticut School of Medicine, Hartford (S.Z.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston (A.E.B.); Gill Heart Institute, University of Kentucky, and Veterans Affairs Medical Center, Lexington (C.S.E.); the Department of Internal Medicine, University of Michigan, Michigan Medicine, Ann Arbor (E.H.C.); Stony Brook Medicine, Stony Brook, NY (E.R.); and First Department of Medicine-Cardiology, University Medical Center Mannheim, Mannheim, and DZHK (German Center for Cardiovascular Research), Heidelberg - both in Germany (M.B.)
| | - Trisha F Hue
- From the Division of Cardiology, Department of Medicine, the UCSF Center for the Prevention of Sudden Death (J.E.O., C.M., B.K.L.) and the Department of Epidemiology and Biostatistics (M.J.P., E.V., T.F.H., F.L., J.A.S., S.H.), University of California, San Francisco, San Francisco; the Department of Electrocardiology, Medical University of Lodz, Lodz, Poland (J.W.); McLeod Regional Medical Center, Florence, SC (R.M.); Ochsner Medical Center and Ochsner Clinical School, University of Queensland School of Medicine, New Orleans (D.P.M.); Hartford Healthcare Heart and Vascular Institute and University of Connecticut School of Medicine, Hartford (S.Z.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston (A.E.B.); Gill Heart Institute, University of Kentucky, and Veterans Affairs Medical Center, Lexington (C.S.E.); the Department of Internal Medicine, University of Michigan, Michigan Medicine, Ann Arbor (E.H.C.); Stony Brook Medicine, Stony Brook, NY (E.R.); and First Department of Medicine-Cardiology, University Medical Center Mannheim, Mannheim, and DZHK (German Center for Cardiovascular Research), Heidelberg - both in Germany (M.B.)
| | - Carol Maguire
- From the Division of Cardiology, Department of Medicine, the UCSF Center for the Prevention of Sudden Death (J.E.O., C.M., B.K.L.) and the Department of Epidemiology and Biostatistics (M.J.P., E.V., T.F.H., F.L., J.A.S., S.H.), University of California, San Francisco, San Francisco; the Department of Electrocardiology, Medical University of Lodz, Lodz, Poland (J.W.); McLeod Regional Medical Center, Florence, SC (R.M.); Ochsner Medical Center and Ochsner Clinical School, University of Queensland School of Medicine, New Orleans (D.P.M.); Hartford Healthcare Heart and Vascular Institute and University of Connecticut School of Medicine, Hartford (S.Z.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston (A.E.B.); Gill Heart Institute, University of Kentucky, and Veterans Affairs Medical Center, Lexington (C.S.E.); the Department of Internal Medicine, University of Michigan, Michigan Medicine, Ann Arbor (E.H.C.); Stony Brook Medicine, Stony Brook, NY (E.R.); and First Department of Medicine-Cardiology, University Medical Center Mannheim, Mannheim, and DZHK (German Center for Cardiovascular Research), Heidelberg - both in Germany (M.B.)
| | - Feng Lin
- From the Division of Cardiology, Department of Medicine, the UCSF Center for the Prevention of Sudden Death (J.E.O., C.M., B.K.L.) and the Department of Epidemiology and Biostatistics (M.J.P., E.V., T.F.H., F.L., J.A.S., S.H.), University of California, San Francisco, San Francisco; the Department of Electrocardiology, Medical University of Lodz, Lodz, Poland (J.W.); McLeod Regional Medical Center, Florence, SC (R.M.); Ochsner Medical Center and Ochsner Clinical School, University of Queensland School of Medicine, New Orleans (D.P.M.); Hartford Healthcare Heart and Vascular Institute and University of Connecticut School of Medicine, Hartford (S.Z.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston (A.E.B.); Gill Heart Institute, University of Kentucky, and Veterans Affairs Medical Center, Lexington (C.S.E.); the Department of Internal Medicine, University of Michigan, Michigan Medicine, Ann Arbor (E.H.C.); Stony Brook Medicine, Stony Brook, NY (E.R.); and First Department of Medicine-Cardiology, University Medical Center Mannheim, Mannheim, and DZHK (German Center for Cardiovascular Research), Heidelberg - both in Germany (M.B.)
| | - Joel A Simon
- From the Division of Cardiology, Department of Medicine, the UCSF Center for the Prevention of Sudden Death (J.E.O., C.M., B.K.L.) and the Department of Epidemiology and Biostatistics (M.J.P., E.V., T.F.H., F.L., J.A.S., S.H.), University of California, San Francisco, San Francisco; the Department of Electrocardiology, Medical University of Lodz, Lodz, Poland (J.W.); McLeod Regional Medical Center, Florence, SC (R.M.); Ochsner Medical Center and Ochsner Clinical School, University of Queensland School of Medicine, New Orleans (D.P.M.); Hartford Healthcare Heart and Vascular Institute and University of Connecticut School of Medicine, Hartford (S.Z.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston (A.E.B.); Gill Heart Institute, University of Kentucky, and Veterans Affairs Medical Center, Lexington (C.S.E.); the Department of Internal Medicine, University of Michigan, Michigan Medicine, Ann Arbor (E.H.C.); Stony Brook Medicine, Stony Brook, NY (E.R.); and First Department of Medicine-Cardiology, University Medical Center Mannheim, Mannheim, and DZHK (German Center for Cardiovascular Research), Heidelberg - both in Germany (M.B.)
| | - Stephen Hulley
- From the Division of Cardiology, Department of Medicine, the UCSF Center for the Prevention of Sudden Death (J.E.O., C.M., B.K.L.) and the Department of Epidemiology and Biostatistics (M.J.P., E.V., T.F.H., F.L., J.A.S., S.H.), University of California, San Francisco, San Francisco; the Department of Electrocardiology, Medical University of Lodz, Lodz, Poland (J.W.); McLeod Regional Medical Center, Florence, SC (R.M.); Ochsner Medical Center and Ochsner Clinical School, University of Queensland School of Medicine, New Orleans (D.P.M.); Hartford Healthcare Heart and Vascular Institute and University of Connecticut School of Medicine, Hartford (S.Z.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston (A.E.B.); Gill Heart Institute, University of Kentucky, and Veterans Affairs Medical Center, Lexington (C.S.E.); the Department of Internal Medicine, University of Michigan, Michigan Medicine, Ann Arbor (E.H.C.); Stony Brook Medicine, Stony Brook, NY (E.R.); and First Department of Medicine-Cardiology, University Medical Center Mannheim, Mannheim, and DZHK (German Center for Cardiovascular Research), Heidelberg - both in Germany (M.B.)
| | - Byron K Lee
- From the Division of Cardiology, Department of Medicine, the UCSF Center for the Prevention of Sudden Death (J.E.O., C.M., B.K.L.) and the Department of Epidemiology and Biostatistics (M.J.P., E.V., T.F.H., F.L., J.A.S., S.H.), University of California, San Francisco, San Francisco; the Department of Electrocardiology, Medical University of Lodz, Lodz, Poland (J.W.); McLeod Regional Medical Center, Florence, SC (R.M.); Ochsner Medical Center and Ochsner Clinical School, University of Queensland School of Medicine, New Orleans (D.P.M.); Hartford Healthcare Heart and Vascular Institute and University of Connecticut School of Medicine, Hartford (S.Z.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston (A.E.B.); Gill Heart Institute, University of Kentucky, and Veterans Affairs Medical Center, Lexington (C.S.E.); the Department of Internal Medicine, University of Michigan, Michigan Medicine, Ann Arbor (E.H.C.); Stony Brook Medicine, Stony Brook, NY (E.R.); and First Department of Medicine-Cardiology, University Medical Center Mannheim, Mannheim, and DZHK (German Center for Cardiovascular Research), Heidelberg - both in Germany (M.B.)
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