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Grubic N, Hill B, Allan KS, Maximova K, Banack HR, Del Rios M, Johri AM. Mediators of the Association Between Socioeconomic Status and Survival After Out-of-Hospital Cardiac Arrest: A Systematic Review. Can J Cardiol 2024; 40:1088-1101. [PMID: 38211888 DOI: 10.1016/j.cjca.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/21/2023] [Accepted: 01/01/2024] [Indexed: 01/13/2024] Open
Abstract
Low socioeconomic status (SES) is associated with poor outcomes after out-of-hospital cardiac arrest (OHCA). Patient characteristics, care processes, and other contextual factors may mediate the association between SES and survival after OHCA. Interventions that target these mediating factors may reduce disparities in OHCA outcomes across the socioeconomic spectrum. This systematic review identified and quantified mediators of the SES-survival after OHCA association. Electronic databases (MEDLINE, Embase, PubMed, Web of Science) and grey literature sources were searched from inception to July or August 2023. Observational studies of OHCA patients that conducted mediation analyses to evaluate potential mediators of the association between SES (defined by income, education, occupation, or a composite index) and survival outcomes were included. A total of 10 studies were included in this review. Income (n = 9), education (n = 4), occupation (n = 1), and composite indices (n = 1) were used to define SES. The proportion of OHCA cases that had bystander involvement, presented with an initial shockable rhythm, and survived to hospital discharge or 30 days increased with higher SES. Common mediators of the SES-survival association that were evaluated included initial rhythm (n = 6), emergency medical services response time (n = 5), and bystander cardiopulmonary resuscitation (n = 4). Initial rhythm was the most important mediator of this association, with a median percent excess risk explained of 37.4% (range 28.6%-40.0%; n = 5; 1 study reported no mediation) and mediation proportion of 41.8% (n = 1). To mitigate socioeconomic disparities in outcomes after OHCA, interventions should target potentially modifiable mediators, such as initial rhythm, which may involve improving bystander awareness of OHCA and the need for prompt resuscitation.
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Affiliation(s)
- Nicholas Grubic
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Queen's University, Kingston, Ontario, Canada.
| | - Braeden Hill
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Katherine S Allan
- Division of Cardiology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Katerina Maximova
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; MAP Centre for Urban Health Solutions, St Michael's Hospital, Toronto, Ontario, Canada
| | - Hailey R Banack
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Marina Del Rios
- Carver College of Medicine, University of Iowa, Iowa City, Iowa, United States
| | - Amer M Johri
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
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2
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Liebregts M. Trans-Atlantic Differences in Approach to Sudden Death Prevention in Patients With Hypertrophic Cardiomyopathy. Can J Cardiol 2024; 40:869-875. [PMID: 38522619 DOI: 10.1016/j.cjca.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 03/19/2024] [Accepted: 03/19/2024] [Indexed: 03/26/2024] Open
Abstract
The American approach to predicting sudden cardiac death (SCD) in patients with hypertrophic cardiomyopathy diverges from the European method in that it relies on major risk factors independently justifying the implantation of an implantable cardioverter-defibrillator for primary prevention, whereas the European approach uses a mathematical equation to estimate a 5-year risk percentage. The aim of this review is to outline the differences between the American and European guidelines and to show how they have arisen. Furthermore, it will provide insight into the future of SCD risk prediction in patients with hypertrophic cardiomyopathy. The American SCD risk prediction method has high sensitivity but limited specificity, whereas the European method has the opposite. These differences in sensitivity and specificity likely contribute to the fact that primary prevention implantable cardioverter-defibrillator utilization is twofold higher in the United States. It is highly likely that new insights and new imaging modalities will enhance prediction models in the near future. Genotyping could potentially assume a significant role. Left ventricular global longitudinal strain was recently shown to be an independent predictor of SCD. Furthermore, after late gadolinium enhancement, additional cardiac magnetic resonance techniques such as T1 mapping and diffusion tensor imaging are showing encouraging outcomes in predicting SCD. Ultimately, it is conceivable that integrating diverse morphological and genetic characteristics through deep learning will yield novel insights and enhance SCD prediction methods.
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MESH Headings
- Humans
- Cardiomyopathy, Hypertrophic/complications
- Cardiomyopathy, Hypertrophic/diagnosis
- Cardiomyopathy, Hypertrophic/therapy
- Death, Sudden, Cardiac/prevention & control
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/epidemiology
- Europe/epidemiology
- Primary Prevention/methods
- United States/epidemiology
- Risk Assessment/methods
- Defibrillators, Implantable
- Risk Factors
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Affiliation(s)
- Max Liebregts
- Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands.
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3
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van den Heuvel L, Do J, Yeates L, Burns C, Semsarian C, Ingles J. Sudden cardiac death in the young: A qualitative study of experiences of family members with cardiogenetic evaluation. J Genet Couns 2024; 33:361-369. [PMID: 37246620 DOI: 10.1002/jgc4.1733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 05/02/2023] [Accepted: 05/07/2023] [Indexed: 05/30/2023]
Abstract
Sudden cardiac death (SCD) is a devastating event for the family and the community, especially when it occurs in a young person (<45 years). Genetic heart diseases, including cardiomyopathies and primary arrhythmia syndromes, are an important cause of SCD in the young. Although cardiogenetic evaluation, that is, clinical evaluation, genetic testing, and psychological support, is increasingly performed after SCD, it is unknown how suddenly bereaved family members experience the process. We aimed to explore the experiences of family members with cardiogenetic evaluation after SCD, and their perception of the process and care received. In-depth interviews were conducted with 18 family members of young people (<45 years old) who died suddenly, including parents, siblings, and partners. The interviews were thematically analyzed by two researchers independently. In total, 18 interviews were conducted from 17 families. The following themes were identified: (1) Experiences with postmortem genetic testing including managing expectations and psychological impact, (2) appreciation of care such as access to genetic counseling and relief following cardiac evaluation of relatives, and (3) need for support including unmet psychological support needs and better coordination of care immediately after the death. Although participants appreciated the opportunity for cardiogenetic evaluation, they also experienced a lack of coordination of cardiogenetic and psychological care. Our findings stress the importance of access to expert multidisciplinary teams, including psychological care, to adequately support these families after a SCD in a young family member.
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Affiliation(s)
- Lieke van den Heuvel
- Cardio Genomics Program at Centenary Institute, The University of Sydney, Sydney, New South Wales, Australia
- Department of Clinical Genetics, Amsterdam UMC (Location AMC), Amsterdam, The Netherlands
- Department of Genetics, University Medical Centre Utrecht, Utrecht, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
| | - Judy Do
- Cardio Genomics Program at Centenary Institute, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Population Genomics, Garvan Institute of Medical Research, and UNSW Sydney, Sydney, New South Wales, Australia
- Centre for Population Genomics, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Laura Yeates
- Cardio Genomics Program at Centenary Institute, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Population Genomics, Garvan Institute of Medical Research, and UNSW Sydney, Sydney, New South Wales, Australia
- Centre for Population Genomics, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Charlotte Burns
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, New South Wales, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Chris Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Jodie Ingles
- Cardio Genomics Program at Centenary Institute, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Population Genomics, Garvan Institute of Medical Research, and UNSW Sydney, Sydney, New South Wales, Australia
- Centre for Population Genomics, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Obeagu EI, Obeagu GU. Implications of climatic change on sickle cell anemia: A review. Medicine (Baltimore) 2024; 103:e37127. [PMID: 38335412 PMCID: PMC10860944 DOI: 10.1097/md.0000000000037127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/02/2024] [Accepted: 01/10/2024] [Indexed: 02/12/2024] Open
Abstract
Sickle cell anemia (SCA) is a hereditary blood disorder characterized by abnormal hemoglobin, causing red blood cells to assume a sickle shape, leading to various complications. Climate change has emerged as a significant global challenge, influencing environmental conditions worldwide. This paper explores the implications of climatic variations on the prevalence, management, and outcomes of SCA. Climate change affects weather patterns, leading to altered temperatures, increased frequency of extreme weather events, and variations in humidity levels. These changes can have a profound impact on individuals living with SCA. High temperatures exacerbate the symptoms of SCA, potentially triggering painful vaso-occlusive crises due to dehydration and increased blood viscosity. Conversely, cold temperatures may induce vaso-occlusion by causing blood vessels to constrict. Changes in rainfall patterns might also affect water accessibility, which is crucial for maintaining adequate hydration, particularly in regions prone to droughts. The management of SCA is multifaceted, involving regular medical care, hydration, and avoiding triggers that could precipitate a crisis. Adverse weather events and natural disasters can disrupt healthcare infrastructure and access to essential medications and resources for SCA patients, especially in vulnerable communities. To mitigate the implications of climatic change on SCA, interdisciplinary strategies are essential. These strategies may include enhancing healthcare systems' resilience to climate-related disruptions, implementing adaptive measures to address changing environmental conditions, and promoting public awareness and education on managing SCA amidst climate variability. In conclusion, climatic variations pose significant challenges for individuals with SCA, affecting the prevalence, management, and outcomes of the disease.
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Williamson MD, Grubic N, Moulson N, Johri AM. Comparative evaluation of an electrocardiogram workflow model for athletic cardiovascular screening: Primary care network versus sports cardiology interpretation. J Electrocardiol 2023; 81:36-40. [PMID: 37517199 DOI: 10.1016/j.jelectrocard.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 07/09/2023] [Accepted: 07/18/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Electrocardiogram (ECG) testing in pre-participation screening (PPS) remains controversial due to its cost, resource dependency, and the potential for inaccurate interpretations. At most centres, ECGs are conducted internally by providers trained in athletic ECG interpretation. Outsourcing ECG requisitions to an athlete's primary care network (PCN) may reduce institutional demands. This study compared PCN-conducted athletic ECG interpretation to expert sports cardiology interpretation. METHODS This was a retrospective, single-centre chart-review study of all athletes who underwent cardiovascular PPS between 2017 and 2021. All athletes submitted an ECG with their screening package, which was conducted and interpreted within their PCN. All ECGs were reinterpreted by a sports cardiologist using the International Criteria (IC) for electrocardiographic interpretation in athletes. Overall, positive, and negative percent agreement were used to compare PCN-conducted ECG interpretation with IC interpretation. RESULTS A total of 740 athletes submitted a screening package with a valid ECG (mean age: 18.5 years, 39.6% female). PCN-conducted ECGs were interpreted by 181 unique physicians. Among 41 (5.5%) PCN-conducted ECGs that were initially interpreted as abnormal, only 5 (0.7%) were classified as abnormal according to the IC. All PCN-conducted ECGs reported as normal were also classified as normal according to the IC. The overall agreement between PCN-conducted and IC ECG interpretation was 95.1% (positive percent agreement: 100%, negative percent agreement: 95.1%). CONCLUSIONS Normal PCN-conducted athletic ECGs are interpreted with high agreement to the IC. Majority of PCN-conducted ECGs interpreted as abnormal are indeed normal as per the IC. These findings suggest that a PPS workflow model that outsources ECG requisitions to a PCN may be a reliable approach to PPS, all while reducing screening-related institutional costs and resource requirements.
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Affiliation(s)
| | - Nicholas Grubic
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Nathaniel Moulson
- Division of Cardiology and Sports Cardiology BC, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amer M Johri
- Department of Medicine, Queen's University, Kingston, Ontario, Canada.
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6
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Corneil H, Liblik K, Varghese SS, Masotti B, Moulson N, McKinney J, Allan KS, Phelan D, Thakrar A, Johri AM, Grubic N. Shared Decision-Making in Athletes Diagnosed With a Cardiovascular Condition: A Scoping Review. Curr Probl Cardiol 2023; 48:101815. [PMID: 37211302 DOI: 10.1016/j.cpcardiol.2023.101815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 05/13/2023] [Indexed: 05/23/2023]
Abstract
This scoping review summarizes existing approaches, benefits, and barriers to shared decision-making (SDM) in the context of sports cardiology. Among 6,058 records screened, 37 articles were included in this review. Most included articles defined SDM as an open dialogue between the athlete, healthcare team, and other stakeholders. The benefits and risks of management strategies, treatment options, and return-to-play were the focus of this dialogue. Key components of SDM were described through various themes, such as emphasizing patient values, considering nonphysical factors, and informed consent. Benefits of SDM included enhancing patient understanding, implementing a personalized management plan, and considering a holistic approach to care. Barriers to SDM included pressure from institutions, consideration of multiple perspectives in decision-making, and the potential liability of healthcare providers. The use of SDM when discussing management, treatment, and lifestyle modification for athletes diagnosed with a cardiovascular condition is necessary to ensure patient autonomy and engagement.
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Affiliation(s)
- Heidi Corneil
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Kiera Liblik
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Sonu S Varghese
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Bruce Masotti
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Nathaniel Moulson
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - James McKinney
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Katherine S Allan
- Division of Cardiology, Unity Health Toronto - St Michael's Hospital, Toronto, Ontario, Canada
| | - Dermot Phelan
- The Gragg Center for Cardiovascular Performance, Sanger Heart & Vascular Institute, Atrium Health, Charlotte, North Carolina, United States
| | - Amar Thakrar
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Amer M Johri
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Nicholas Grubic
- Department of Medicine, Queen's University, Kingston, Ontario, Canada.
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7
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Christian S, Dzwiniel T. Principles of Genetic Counseling in Inherited Heart Conditions. Card Electrophysiol Clin 2023; 15:229-239. [PMID: 37558294 DOI: 10.1016/j.ccep.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
Cardiac genetic counseling is the process of helping individuals adapt to a personal diagnosis or family history of an inherited heart condition. The process is shown to benefit patients and includes specialized skills, such as counseling children and interpreting complex genetic results. Emerging areas include: evolving service delivery models for caring for patients and communicating risk to relatives, new areas of need including postmortem molecular autopsy, and new populations of individuals found to carry a likely pathogenic/pathogenic cardiac variant identified through genomic screening. This article provides an overview of the cardiac genetic counseling process and evolving areas in the field.
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Affiliation(s)
- Susan Christian
- Department of Medical Genetics, University of Alberta, Edmonton, Alberta, Canada.
| | - Tara Dzwiniel
- Department of Medical Genetics, University of Alberta, Edmonton, Alberta, Canada
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8
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Public emotions and opinions following the sudden cardiac arrest of a young athlete: A sentiment analysis. Am J Emerg Med 2023; 67:179-181. [PMID: 36925351 DOI: 10.1016/j.ajem.2023.03.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 03/07/2023] [Accepted: 03/07/2023] [Indexed: 03/11/2023] Open
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9
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Hill B, Grubic N, Williamson M, Phelan DM, Baggish AL, Dorian P, Drezner JA, Johri AM. Does cardiovascular preparticipation screening cause psychological distress in athletes? A systematic review. Br J Sports Med 2023; 57:172-178. [PMID: 36418151 DOI: 10.1136/bjsports-2022-105918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the psychological implications of cardiovascular preparticipation screening (PPS) in athletes. DESIGN Systematic review. DATA SOURCES MEDLINE, EMBASE, PubMed, CINAHL, SPORTDiscus, APA PsycInfo, Cochrane Library and grey literature sources. STUDY ELIGIBILITY CRITERIA Observational and experimental studies assessing a population of athletes who participated in a cardiovascular PPS protocol, where psychological outcomes before, during and/or after PPS were reported. METHODS Results of included studies were synthesised by consolidating similar study-reported measures for key psychological outcomes before, during and/or after screening. Summary measures (medians, ranges) were computed across studies for each psychological outcome. RESULTS A total of eight studies were included in this review (median sample size: 479). Study cohorts consisted of high school, collegiate, professional and recreational athletes (medians: 59% male, 20.5 years). Most athletes reported positive reactions to screening and would recommend it to others (range 88%-100%, five studies). Increased psychological distress was mainly reported among athletes detected with pathological cardiac conditions and true-positive screening results. In comparison, athletes with false-positive screening results still reported an increased feeling of safety while participating in sport and were satisfied with PPS. A universal conclusion across all studies was that most athletes did not experience psychological distress before, during or after PPS, regardless of the screening modality used or accuracy of results. CONCLUSION Psychological distress associated with PPS in athletes is rare and limited to athletes with true-positive findings. To mitigate downstream consequences in athletes who experience psychological distress, appropriate interventions and resources should be accessible prior to the screening procedure. PROSPERO REGISTRATION NUMBER CRD42021272887.
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Affiliation(s)
- Braeden Hill
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Nicholas Grubic
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | | | - Dermot M Phelan
- Sports Cardiology Center, Atrium Health Sanger Heart and Vascular Institute, Charlotte, North Carolina, USA
| | - Aaron L Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Paul Dorian
- Department of Medicine, Division of Cardiology, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan A Drezner
- Center for Sports Cardiology, University of Washington, Seattle, Washington, USA
| | - Amer M Johri
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
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10
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Grubic N, Smith BT, Randhawa VK, Blewer AL, Allan KS. Removing the "Man" in "Mannikin": The Importance of Sociodemographic Diversity in Resuscitation Training. Can J Cardiol 2022; 38:1907-1910. [PMID: 36424233 DOI: 10.1016/j.cjca.2022.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 10/16/2022] [Indexed: 11/22/2022] Open
Affiliation(s)
- Nicholas Grubic
- Department of Medicine, Queen's University, Kingston, Ontario, Canada.
| | - Brendan T Smith
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, Ontario, Canada
| | - Varinder K Randhawa
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Audrey L Blewer
- Department of Family Medicine and Community Health, Duke University, Durham, North Carolina, United States; Department of Population Health Sciences, Duke University, Durham, North Carolina, United States
| | - Katherine S Allan
- Division of Cardiology, St Michael's Hospital, Toronto, Ontario, Canada
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11
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Grubic N, Hill B, Phelan D, Baggish A, Dorian P, Johri AM. Bystander interventions and survival after exercise-related sudden cardiac arrest: a systematic review. Br J Sports Med 2021; 56:410-416. [PMID: 34853034 DOI: 10.1136/bjsports-2021-104623] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate the provision of bystander interventions and rates of survival after exercise-related sudden cardiac arrest (SCA). DESIGN Systematic review. DATA SOURCES MEDLINE, EMBASE, PubMed, CINAHL, SPORTDiscus, Cochrane Library and grey literature sources were searched from inception to November/December 2020. STUDY ELIGIBILITY CRITERIA Observational studies assessing a population of exercise-related SCA (out-of-hospital cardiac arrests that occurred during exercise or within 1 hour of cessation of activity), where bystander cardiopulmonary resuscitation (CPR) and/or automated external defibrillator (AED) use were reported, and survival outcomes were ascertained. METHODS Among all included studies, the median (IQR) proportions of bystander CPR and bystander AED use, as well as median (IQR) rate of survival to hospital discharge, were calculated. RESULTS A total of 29 studies were included in this review, with a median study duration of 78.7 months and a median sample size of 91. Most exercise-related SCA patients were male (median: 92%, IQR: 86%-96%), middle-aged (median: 51, IQR: 39-56 years), and presented with a shockable arrest rhythm (median: 78%, IQR: 62%-86%). Bystander CPR was initiated in a median of 71% (IQR: 59%-87%) of arrests, whereas bystander AED use occurred in a median of 31% (IQR: 19%-42%) of arrests. Among the 19 studies that reported survival to hospital discharge, the median rate of survival was 32% (IQR: 24%-49%). Studies which evaluated the relationship between bystander interventions and survival outcomes reported that both bystander CPR and AED use were associated with survival after exercise-related SCA. CONCLUSION Exercise-related SCA occurs predominantly in males and presents with a shockable ventricular arrhythmia in most cases, emphasising the importance of rapid access to defibrillation. Further efforts are needed to promote early recognition and a rapid bystander response to exercise-related SCA.
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Affiliation(s)
- Nicholas Grubic
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada .,Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Braeden Hill
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Dermot Phelan
- Sports Cardiology Center, Atrium Health Sanger Heart and Vascular Institute, Charlotte, North Carolina, USA
| | - Aaron Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Paul Dorian
- Department of Medicine, Division of Cardiology, University of Toronto, Toronto, Ontario, Canada
| | - Amer M Johri
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
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12
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Tong TK, Baker JS, Henriquez FL, Shi Q, Zhang H, Kong Z, Nie J. A Combined Approach for Health Assessment in Adolescent Endurance Runners. Healthcare (Basel) 2021; 9:healthcare9020163. [PMID: 33546247 PMCID: PMC7913343 DOI: 10.3390/healthcare9020163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/14/2021] [Accepted: 01/26/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND It has been shown that prolonged exhaustive exercise, such as half-marathon running, could lead to transient post-exercise elevation of cardiac troponins, increase in oxidative stress, and mild decline in renal function in adolescent athletes. With increases in sports participation involving young people, there has been much interest in pre and post health evaluations following exercise. Evaluations can be used to identify pre-existing health confounders and to examine any detrimental responses that may occur post exercise. Study purpose & Methods: The purpose of this study was to evaluate pre and post exercise measures of cardiac function, serum albumin, systemic immunoglobulin (Serum IgA and IgG), cortisol and testosterone in adolescent (age: 16.2 ± 0.6) male endurance runners performing in 21-km maximal run. RESULTS Results revealed that cortisol, IgA and IgG levels significantly decreased 2, 4, and 24 h post exercise compared to pre-exercise levels (p < 0.05). Testosterone levels reduced 4 h post exercise (p < 0.05) but were restored to baseline values following 24 h. There were no changes recorded for albumin levels post exercise (p > 0.05). ECG assessments did not show any abnormalities at the T wave axis, ST segments and Q wave pre or post exercise. CONCLUSIONS The findings from this study suggest that a single bout of prolonged maximum running is not likely to induce abnormal electrical activity in the heart, but does decrease serum immunoglobulin, and homeostasis of anabolic and catabolic hormones in trained adolescent endurance runners.
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Affiliation(s)
- Tomas K. Tong
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong 999077, China; (T.K.T.); (J.S.B.)
| | - Julien S. Baker
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong 999077, China; (T.K.T.); (J.S.B.)
| | - Fiona L. Henriquez
- Institute of Biomedical and Environmental Health, School of Science and Sport, University of the West of Scotland, Paisley PA1 2BE, UK;
| | - Qingde Shi
- School of Health Sciences and Sports, Macao Polytechnic Institute, Rua de Luis Gonzaga Gomes, Macao 999078, China;
| | - Haifeng Zhang
- College of Physical Education, Hebei Normal University, Shijiazhuang 050024, China;
| | - Zhaowei Kong
- Faculty of Education, University of Macau, Macao 999078, China;
| | - Jinlei Nie
- School of Health Sciences and Sports, Macao Polytechnic Institute, Rua de Luis Gonzaga Gomes, Macao 999078, China;
- Correspondence: ; Tel.: +853-8559-6832; Fax: +853-2851-8538
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