Effect of Age on Outcome on Patients Hospitalized With Heart Failure: From a 20-Year Registry in a Middle-Eastern Country (1991-2010)

Out-of-Hospital Cardiac Arrest in the Young: A 23-Year Middle Eastern Experience

Background:

Worldwide, limited data are available about young patients (≤40 years) who present with out-of-hospital cardiac arrest (OHCA). We compared demographic characteristics, clinical presentation, and outcome in younger patients (≤40 years) versus older patients (>40 years) with OHCA.

Materials and Methods:

This was a retrospective analysis of a registry of patients hospitalized with OHCA over a 23-year period (1991–2013) in Hamad Medical Corporation, Doha, Qatar.

Results:

Of 1146 patients admitted to our institution with OHCA, 159 patients (13.9%) were 40 years of age or younger. Compared to the older group (>40 years), younger group patients were more likely to be males (84.9% vs. 71.5%; P = 0.001) and to be smokers (27.7% vs. 19.7%; P = 0.012). They are less likely to have diabetes (6.3% vs. 49.2%; P = 0.001), hypertension (8.3% vs. 49.9%; P = 0.001), prior myocardial infarction (3.1% vs. 23.4%; P = 0.001), or chronic renal disease (0% vs. 8.5%; P = 0.001). There was no significant difference in ejection fraction, ST-elevation myocardial infarction (13.2% vs. 15.7%; P = 0.41), utilization of inotropes (36.5% vs. 44%; P = 0.08), or utilization of reperfusion therapy (thrombolytic: 16.4% vs. 12.2%, P = 0.14, and percutaneous intervention: 6.3% vs. 5.3%, P = 0.60, for the younger and older groups, respectively); on the other hand, younger patients were more likely to receive antiarrhythmic medications (33.3% vs. 21.2%; P = 0.001). Inhospital mortality was lower in the younger group (52.1% vs. 68.3%; P = 0.001) even after adjustment for baseline variables.

Conclusion:

In the Middle East it is not uncommon to present with OHCA in young age. These patients are predominantly males, more likely to present with arrhythmia and they have a better survival rate.

Clinical Presentations and Outcomes in Patients Presenting With Acute Cardiac Events and Right Bundle Branch Block

We conducted a retrospective analysis of 50 974 patients admitted with acute cardiac events with and without right bundle branch block (RBBB) over 23 years. Compared to non-RBBB, patients with RBBB (n = 386; 0.8%) were 3 years older ( P = .001), more likely to present with breathlessness rather than chest pain ( P = .001), and had more diabetes mellitus ( P = .001). Patients with RBBB had significantly higher cardiac enzymes ( P = .001); however, there were no significant differences in the presentation with ST-segment elevation myocardial infarction (24.6% vs 22.2%), non-ST-segment elevation myocardial infarction (23.7% vs 22.4%), and unstable angina (51.7% vs 55.4%). Patients with RBBB were more likely to have congestive heart failure (CHF; 9.6% vs 3.2%, P = .001), cardiogenic shock (10.6% vs 1.7%, P = .001), and ventricular tachyarrhythmias (7.3% vs 2.2%, P = .001). Left ventricular ejection fraction and hospital length of stay were comparable between the groups. All-cause mortality was 5 times greater in patients with RBBB (21% vs 4.2%, P = .001). Right bundle branch block was independent predictor of mortality (adjusted odd ratio 5.14; 95% confidence interval: 3.90-6.70). Subanalysis comparing normal QRS, RBBB, and left BBB showed that RBBB was associated with the worst outcomes except for CHF. Although RBBB presents in only about 1% of patients with cardiac disease, it was found to be an independent predictor of hospital mortality.

Clinical Profile, Management, and Outcome in Patients With Out-of-Hospital Cardiac Arrest and ST Segment Elevation Myocardial Infarction: Insights From a 20-Year Registry

AIM OF THE STUDY

We studied the clinical profile, management, and outcomes of patients with out-of-hospital cardiac arrest (OHCA) with and without ST-elevation myocardial infarction (STEMI).

METHODS

Retrospective analysis of the 20-year registry data (January 1991- June 2010) was conducted on patients with cardiac disease hospitalized at Hamad General Hospital and Qatar Heart Hospital, Doha, Qatar.

RESULTS

A total of 987 patients with OHCA were admitted to the cardiology department during the study period; among them, 296 (30%) patients had STEMI. Compared to the patients with OHCA without STEMI, the patients who had OHCA with STEMI were younger (53 ± 13 vs 58 ± 16 years; P = .001), more likely to be male (78% vs 34%; P = .001), smokers (35% vs 14%) but less likely to have hypertension (30% vs 48%; P = .001), diabetes (32% vs 47%, P = .001), and chronic renal failure (3.4% vs 9%; P = .002). The use of thrombolytic treatment in patients with STEMI increased from 21.6% (period 1991-1095) to 44.4% (period 2006-2010); P = .04.

CONCLUSION

Percutaneous coronary intervention had increased significantly during the last quarter of the study. There was a decline in the in-hospital mortality among patients with STEMI during the last quarter of the study.

Left Bundle Branch Block in Acute Cardiac Events: Insights From a 23-Year Registry

Between 1991 and 2013, we evaluated the demographics, presentations, and final diagnosis of patients hospitalized with acute cardiac events and left bundle branch block (LBBB). Of 50 992 patients, 768 (1.5%) had LBBB. Compared with non-LBBB patients, patients with LBBB were mostly older, female, diabetic, and had hypertension and chronic kidney failure (CKF; P < .001 for all). Dyspnea (P < .001) and dizziness (P = .037) were more frequent in patients with LBBB. The most frequent cause of admission with LBBB was congestive heart failure (CHF; 54.2%), followed by ST-elevation myocardial infarction (STEMI; 13.3%), valvular heart disease (9.4%), unstable angina (8.3%) and Non-STEMI (7.7%). On multivariate analysis, CKF (odds ratio [OR]: 2.02, 95% confidence interval [CI]: 1.09-3.70) and LBBB (OR: 2.96, 95% CI: 2.01-4.42) were predictors of in-hospital mortality in the entire study population. Further analysis of patients with LBBB showed that CKF (OR: 2.93, 95% CI: 1.40-6.12) was the only predictor of in-hospital mortality. Regardless the presenting symptoms, CHF was the final diagnosis in most cases with LBBB.

Effect of cardiovascular drugs on mortality in atrial fibrillation and chronic heart failure

OBJECTIVES

To study mortality rates among men and women with atrial fibrillation (AF) and concomitant chronic heart failure (CHF) prescribed different classes of cardiovascular drugs in primary health care.

DESIGN

A cohort of men (n = 1159) and women (n = 1155) aged 45 years or above and diagnosed with both AF and CHF from patient records from 75 primary care centers in Sweden were included in the study. Regression models with mortality as the outcome were used, with adjustment for a propensity score comprising age, cardiovascular co-morbidities, education, marital status, and pharmacotherapy. We analysed using Cox regression with hazard ratio (HR), and Laplace regression with years until 10% of the patients had died, with 95% confidence intervals (95% CI). Independent variables were prescribed cardiovascular drugs.

RESULTS

Individuals prescribed anticoagulants versus no treatment gained 1.95 years (95% CI 0.47-3.43), anticoagulants versus antiplatelets 1.26 years (95% CI 0.42-2.10), calcium channel blockers 1.17 years (95% CI 0.21-2.14), and statins 1.49 years (95% CI 0.39-2.59). Among patients 80 years or above no significant effect by anticoagulants was seen, HR 0.73 (95% CI 0.43-1.23).

CONCLUSIONS

Our findings suggest that life may be prolonged in patients with AF and concomitant CHF in primary care prescribed anticoagulants, calcium channel blockers, and statins.