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McGuigan PJ, Edwards J, Blackwood B, Dark P, Doidge JC, Harrison DA, Kitchen G, Lawson I, Nichol AD, Rowan KM, Shankar-Hari M, McAuley DF, McGuigan PJ. The association between time of in hospital cardiac arrest and mortality; a retrospective analysis of two UK databases. Resuscitation 2023; 186:109750. [PMID: 36842674 DOI: 10.1016/j.resuscitation.2023.109750] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/02/2023] [Accepted: 02/18/2023] [Indexed: 02/26/2023]
Abstract
AIMS The incidence of in hospital cardiac arrest (IHCA) varies throughout the day. This study aimed to report the variation in incidence of IHCA, presenting rhythm and outcome based on the hour in which IHCA occurred. METHODS We conducted a retrospective analysis of the National Cardiac Arrest Audit (NCAA) including patients who suffered an IHCA from 1st April 2011 to 31st December 2019. We then linked the NCAA and intensive care Case Mix Programme databases to explore the effect of time of IHCA on hospital survival in the subgroup of patients admitted to intensive care following IHCA. RESULTS We identified 115,690 eligible patients in the NCAA database. Pulseless electrical activity was the commonest presenting rhythm (54.8%). 66,885 patients died in the immediate post resuscitation period. Overall, hospital survival in the NCAA cohort was 21.3%. We identified 13,858 patients with linked ICU admissions in the Case Mix Programme database; 37.0% survived to hospital discharge. The incidence of IHCA peaked at 06.00. Rates of return of spontaneous circulation, survival to hospital discharge and good neurological outcome were lowest between 05.00 and 07.00. Among those admitted to ICU, no clear diurnal variation in hospital survival was seen in the unadjusted or adjusted analysis. This pattern was consistent across all presenting rhythms. CONCLUSIONS We observed higher rates of IHCA, and poorer outcomes at night. However, in those admitted to ICU, this variation was absent. This suggests patient factors and processes of care issues contribute to the variation in IHCA seen throughout the day.
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Affiliation(s)
- Peter J McGuigan
- Regional Intensive Care Unit, Royal Victoria Hospital, Belfast, UK; Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, UK.
| | - Julia Edwards
- Intensive Care National Audit & Research Centre, Napier House, 24 High Holborn, London, UK
| | - Bronagh Blackwood
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, UK
| | - Paul Dark
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
| | - James C Doidge
- Intensive Care National Audit & Research Centre, Napier House, 24 High Holborn, London, UK
| | - David A Harrison
- Intensive Care National Audit & Research Centre, Napier House, 24 High Holborn, London, UK
| | - Gareth Kitchen
- Faculty of Biology, Medicine, and Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK; Manchester Foundation Trust, Manchester, UK
| | - Izabella Lawson
- Intensive Care National Audit & Research Centre, Napier House, 24 High Holborn, London, UK
| | - Alistair D Nichol
- University College Dublin Clinical Research Centre, St Vincent's University Hospital, Dublin, Ireland; The Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia; The Alfred Hospital, Melbourne, Australia
| | - Kathryn M Rowan
- Intensive Care National Audit & Research Centre, Napier House, 24 High Holborn, London, UK
| | - Manu Shankar-Hari
- Centre for Inflammation Research, Institute of Regeneration and Repair, University of Edinburgh, UK; Royal Infirmary of Edinburgh, NHS Lothian, UK
| | - Danny F McAuley
- Regional Intensive Care Unit, Royal Victoria Hospital, Belfast, UK; Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, UK
| | - Peter J McGuigan
- Regional Intensive Care Unit, Royal Victoria Hospital, Belfast, UK; Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, UK.
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Effect of Temporal Difference on Clinical Outcomes of Patients with Out-of-Hospital Cardiac Arrest: A Retrospective Study from an Urban City of Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111020. [PMID: 34769541 PMCID: PMC8582961 DOI: 10.3390/ijerph182111020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 10/15/2021] [Accepted: 10/17/2021] [Indexed: 11/17/2022]
Abstract
Circadian pattern influence on the incidence of out-of-hospital cardiac arrest (OHCA) has been demonstrated. However, the effect of temporal difference on the clinical outcomes of OHCA remains inconclusive. Therefore, we conducted a retrospective study in an urban city of Taiwan between January 2018 and December 2020 in order to investigate the relationship between temporal differences and the return of spontaneous circulation (ROSC), sustained (≥24 h) ROSC, and survival to discharge in patients with OHCA. Of the 842 patients with OHCA, 371 occurred in the daytime, 250 in the evening, and 221 at night. During nighttime, there was a decreased incidence of OHCA, but the outcomes of OHCA were significant poor compared to the incidents during the daytime and evening. After multivariate adjustment for influencing factors, OHCAs occurring at night were independently associated with lower probabilities of achieving sustained ROSC (aOR = 0.489, 95% CI: 0.285–0.840, p = 0.009) and survival to discharge (aOR = 0.147, 95% CI: 0.03–0.714, p = 0.017). Subgroup analyses revealed significant temporal differences in male patients, older adult patients, those with longer response times (≥5 min), and witnessed OHCA. The effects of temporal difference on the outcome of OHCA may be a result of physiological factors, underlying etiology of arrest, resuscitative efforts in prehospital and in-hospital stages, or a combination of factors.
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Szczerbiński S, Ratajczak J, Jasiewicz M, Kubica A. Observational analysiS of out-of-hospital Cardiac Arrest occurRence and temporal variability patterns in subpopulation of southern POLand from 2006 to 2018: OSCAR-POL registry. Cardiol J 2021; 30:567-575. [PMID: 34312830 PMCID: PMC10508077 DOI: 10.5603/cj.a2021.0060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/02/2021] [Accepted: 06/05/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Temporal variability of out-of-hospital cardiac arrest (OHCA) occurrence was presented in previous studies, however, the data regarding long-term observation is scarce. The aim of this study was to investigate the temporal variability of OHCA occurrence during a long-time period and analyze the circadian pattern within particular timeframes. METHODS The retrospective analysis of 5058 OHCA cases was made covering the period from January 1st, 2006 to December 31st, 2018. Circadian, weekly, monthly and seasonal variabilities were investigated. The circadian variability of OHCA occurrence was assessed within particular years, seasons of the year, and days of the week. RESULTS The highest OHCA incidence was observed between 08:00 and 08:59 and the lowest between 01:00 and 01:59 (7.1% vs. 1.6%, p < 0.001). After division into 6-h intervals, a significantly lower number of OHCA cases occurred between 00:00 and 05:59 (12.3%) in comparison to the highest number observed in between 06:00 and 11:59 (12.3% vs. 33.5%, p < 0.001). The highest OHCA occurrence was observed on Monday (14.9%), however, no weekly variability was found (p = 0.557). The highest OHCA occurrence was observed in the winter and lowest in the summer (27.4% vs. 22.8%, p < 0.001). Significant circadian variability was observed for every day of the week, every season and year during the observation period (p < 0.001). CONCLUSIONS Circadian, monthly and seasonal variability of OHCA occurrence was confirmed in the long-term observation with no differences between particular days of the week. Significant circadian variability was observed within days of the week, seasons of the year, and particular years.
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Affiliation(s)
| | - Jakub Ratajczak
- Department of Health Promotion, Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz, Poland.
- Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz, Poland.
| | - Małgorzata Jasiewicz
- Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz, Poland
| | - Aldona Kubica
- Department of Health Promotion, Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz, Poland
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Abstract
BACKGROUND Sudden cardiac arrest (SCA) is a serious public health issue caused by the cessation of cardiac electrical and mechanical activity. Despite advances in pedestrian lifesaving technologies like defibrillators, the SCA mortality rate remains high, and survivors are at risk of suffering ischemic injury to various organs. Understanding the contributing factors for SCA is essential for improving morbidity and mortality. One factor capable of influencing SCA incidence and survival is the time of day at which SCA occurs. OBJECTIVES This review focused on the effect of time of day on SCA incidence, survival rate, and survival to discharge over the past 30 years and the role of age, sex, and SCA location in modulating the timing of SCA. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews criteria guided this review. Four databases (PubMed, Cochrane Libraries, Scopus, and Cumulative Index to Nursing and Allied Health Literature) were queried for research reports or articles addressing time of day and cardiac arrest, which were subsequently screened by the authors for inclusion in this analysis. RESULTS A total of 48 articles were included in the final analysis. This analysis showed a bimodal SCA distribution with a primary peak in the morning and a secondary peak in the afternoon; these peaks were dependent on age (older persons), sex (more frequent in males), and the location of occurrence (out-of-hospital cardiac arrest vs. in-hospital cardiac rest). Survival following SCA was lowest between midnight and 06:00 a.m. DISCUSSION The circadian rhythm likely plays an important role in the time-of-day-dependent pattern that is evident in both the incidence of and survival following SCA. There is a renewed call for nursing research to examine or address circadian rhythm as an element in studies involving older adults and activities affecting cardiovascular or respiratory parameters.
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Baert V, Vilhelm C, Escutnaire J, Marc JB, Wiel E, Tazarourte K, Goldstein P, Khoury CE, Hubert H, Génin M. Identification of a morning out-of-hospital cardiac arrest cluster of high-incidence: towards a chrono-preventive care strategy. J Eval Clin Pract 2021; 27:84-92. [PMID: 32212234 DOI: 10.1111/jep.13390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 03/05/2020] [Accepted: 03/06/2020] [Indexed: 11/30/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES The human body is regulated by intrinsic factors which follow a 24-hour biological clock. Implications of a circadian rhythm in the out-of-hospital cardiac arrest (OHCA) are studied but the literature is not consistent. The main objective of our study was to identify temporal cluster of high or low incidence of OHCA occurrence during a day. METHODS Multicentre comparative study based on the French national OHCA registry data between 2013 and 2017. After describing the population, the detection of significant temporal clusters of OHCA incidence was achieved using temporal scan statistics based on a Poisson model adjusted for age and gender. Then, comparisons between identified patients clusters and the rest of the population were performed. RESULTS During the study, 37 163 medical OHCA victims were included. The temporal scan revealed a significant 3-hour high incidence temporal cluster between 8:00 am and 10:59 am (Relative R = 1.76, P < .001). In the identified cluster, OHCA occurred more out of the home with fewer witnesses, and advanced life support was less attempted in the cluster. No difference was observed on the return of spontaneous circulation, survival at hospital admission, and survival 30 days after the OHCA or at hospital discharge. CONCLUSIONS We observed a three-hour morning high incidence peak of OHCA. This high incidence could be explained by different physiological changes in the morning. These changes are well known and the evidence of a morning peak of cardiovascular disease should enable medical teams to adapt care strategy and hospital organization.
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Affiliation(s)
- Valentine Baert
- Univ. Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et despratiques médicales, F-59000 Lille, France.,French National Out-of-Hospital Cardiac Arrest Registry, RéAC, 59000 Lille, France
| | - Christian Vilhelm
- Univ. Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et despratiques médicales, F-59000 Lille, France.,French National Out-of-Hospital Cardiac Arrest Registry, RéAC, 59000 Lille, France
| | - Joséphine Escutnaire
- Univ. Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et despratiques médicales, F-59000 Lille, France.,French National Out-of-Hospital Cardiac Arrest Registry, RéAC, 59000 Lille, France
| | - Jean-Baptiste Marc
- SAMU du Nord and Emergency Department for Adults, Lille University Hospital, Lille, France
| | - Eric Wiel
- Univ. Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et despratiques médicales, F-59000 Lille, France.,French National Out-of-Hospital Cardiac Arrest Registry, RéAC, 59000 Lille, France.,SAMU du Nord and Emergency Department for Adults, Lille University Hospital, Lille, France
| | - Karim Tazarourte
- Hospices Civils de Lyon, Emergency Department, Hôpital Edouard Herriot, Lyon, France.,Health Services and Performance Research, HESPER, EA7425, Claude Bernard University Lyon 1, Villeurbanne, France
| | - Patrick Goldstein
- SAMU du Nord and Emergency Department for Adults, Lille University Hospital, Lille, France
| | - Carlos El Khoury
- Health Services and Performance Research, HESPER, EA7425, Claude Bernard University Lyon 1, Villeurbanne, France.,Emergency Department and RESCUe Network, Lucien Hussel Hospital, Vienne, France
| | - Hervé Hubert
- Univ. Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et despratiques médicales, F-59000 Lille, France.,French National Out-of-Hospital Cardiac Arrest Registry, RéAC, 59000 Lille, France
| | - Michaël Génin
- Univ. Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et despratiques médicales, F-59000 Lille, France
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- French National Out-of-Hospital Cardiac Arrest Registry, RéAC, 59000 Lille, France
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Manfredini R, Cappadona R, Fabbian F. Letter by Manfredini et al Regarding Article, "Ambulance Density and Outcomes After Out-of-Hospital Cardiac Arrest: Insights From the Paris Sudden Death Expertise Center Registry". Circulation 2019; 140:e547-e548. [PMID: 31479322 DOI: 10.1161/circulationaha.118.039241] [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: 11/16/2022]
Affiliation(s)
- Roberto Manfredini
- Faculty of Medicine, Pharmacy and Prevention, University of Ferrara, Italy
| | - Rosaria Cappadona
- Faculty of Medicine, Pharmacy and Prevention, University of Ferrara, Italy
| | - Fabio Fabbian
- Faculty of Medicine, Pharmacy and Prevention, University of Ferrara, Italy
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Szczerbinski S, Ratajczak J, Lach P, Rzeszuto J, Paciorek P, Karlowska-Pik J, Ziemkiewicz B, Jasiewicz M, Kubica A. Epidemiology and chronobiology of out-of-hospital cardiac arrest in a subpopulation of southern Poland: A two-year observation. Cardiol J 2018; 27:16-24. [PMID: 29611174 DOI: 10.5603/cj.a2018.0025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 01/31/2018] [Accepted: 03/01/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Although recent studies indicate temporal variations in the incidence of out-of-hospital cardiac arrest (OHCA), the Polish experience in this research is scarce to date. We evaluated the epidemiology of OHCA and circadian, weekly and seasonal variations of OHCA frequency among the adult population of the Opole district, Poland. METHODS The retrospective analysis of 815 OHCA cases with presumed cardiac etiology was made based on dispatch cards from the Emergency Medical Center in Opole registered during a 2 year period (2006-2007). RESULTS The incidence of OHCA in the studied population was 1.56/1000 inhabitants per year. Mean age of the group was 69.2 ± 14.2 years, with the majority of men (63%), younger than women (66.1 vs. 74 years, p = 0.0001). The OHCA occurrence increased with age reaching a peak between 71 and 75 years. The incidence of OHCA stayed at stable low levels between 22:00 and 4:59 and started to increase at 5:00, with trimodal peaks: 8:00-10:59, 14:00-15:59 and 18.00-21.59. The lowest number of OHCA occurred from 00:00 to 5:59, the highest from 6:00 to 11:59 (13% vs. 32.4%, p < 0.001). The day with the lowest occurrence of OHCA was Friday, the highest Saturday (10.9% vs. 16%, p = 0.01). Summer was the season of the lowest incidence of OHCA, while winter - the highest (22.6% vs. 26%, p = 0.04). These seasons were the warmest and the coldest one, respectively (average temperature 18.5°C vs. 0°C, p < 0.001). CONCLUSIONS Circadian and less marked, weekly variability in OHCA occurrence were confirmed. Existing seasonal differences may be affected by temperature. This is the first Polish analysis of a large subpopulation, which also includes seasonal temperature data.
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Affiliation(s)
| | - Jakub Ratajczak
- Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz, Poland
| | - Piotr Lach
- Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz, Poland
| | - Jakub Rzeszuto
- Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz, Poland
| | - Przemyslaw Paciorek
- Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz, Poland
| | - Joanna Karlowska-Pik
- Department of Probability Theory and Stochastic Analysis, Nicolaus Copernicus University, Torun, Poland
| | - Bartosz Ziemkiewicz
- Department of Probability Theory and Stochastic Analysis, Nicolaus Copernicus University, Torun, Poland
| | - Malgorzata Jasiewicz
- Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz, Poland.
| | - Aldona Kubica
- Department of Health Promotion, Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz,Bydgoszcz, Poland
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Oh TK, Park YM, Do SH, Hwang JW, Jo YH, Kim JH, Jeon YT, Song IA. A comparative study of the incidence of in-hospital cardiopulmonary resuscitation on Monday-Wednesday and Thursday-Sunday: Retrospective analysis in a tertiary care hospital. Medicine (Baltimore) 2018; 97:e9741. [PMID: 29419666 PMCID: PMC5944682 DOI: 10.1097/md.0000000000009741] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Because most medical staff work from Monday-Friday, it is possible that they are relatively more fatigued and less capable of providing emergency supportive services on Thursday-Sunday (Thu-Sun) than on Monday-Wednesday (Mon-Wed). In this study, we aimed to analyze the incidence of in-hospital cardiopulmonary resuscitation (CPR) to determine if it differed between Thu-Sun and Mon-Wed.This retrospective observational study of in-hospital CPR was performed during 2012 to 2016 among inpatients at the Seoul National University Bundang Hospital. The primary outcome was the incidence of in-hospital CPR per 1000 inpatients in the Mon-Wed and Thu-Sun periods. Secondary outcomes included differences in the CPR incidence by time of day and season.In the study, 1195 cases of in-hospital CPR were included. The incidence of in-hospital CPR per 1000 inpatients was significantly higher on Thu-Sun (mean: 0.595, 95% confidence interval [CI]: 0.564-0.626) than on Mon-Wed (mean: 0.505, 95% CI: 0.474-0.536, P < .001). There were no seasonal variations in the incidence of in-hospital CPR. However, in-hospital CPR was most frequently performed between 16:00 and 24:00, and the return of spontaneous circulation (ROSC) rate was the lowest among cases that occurred between 0:00 and 8:00. In addition, the ROSC rate was lowest among female patients, patients with cardiac arrest, and after in-hospital CPR performed on a Sunday.The incidence of in-hospital CPR per 1000 inpatients was significantly higher on Thu-Sun than on Mon-Wed. No seasonal variations were observed in the incidence of in-hospital CPR, but the data suggest circadian variations and differences in ROSC rates.
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Affiliation(s)
- Tak Kyu Oh
- Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital
| | - Young Mi Park
- Medical Research Collaborating Center, Seoul National University Bundang Hospital
| | - Sang-Hwan Do
- Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital
| | - Jung-Won Hwang
- Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital
| | - You Hwan Jo
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jin Hee Kim
- Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital
| | - Young-Tae Jeon
- Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital
| | - In-Ae Song
- Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital
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10
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Impact of in or out of office hours at admission time on outcome in out-of-hospital cardiac arrest patients. Eur J Emerg Med 2017; 24:249-254. [DOI: 10.1097/mej.0000000000000343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Diurnal variations in incidence and outcome of out-of-hospital cardiac arrest including prior comorbidity and pharmacotherapy: A nationwide study in Denmark. Resuscitation 2014; 85:1161-8. [DOI: 10.1016/j.resuscitation.2014.06.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 05/21/2014] [Accepted: 06/13/2014] [Indexed: 11/19/2022]
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12
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Manfredini R, Boari B, Salmi R, Fabbian F, Pala M, Tiseo R, Portaluppi F. Twenty-four-hour patterns in occurrence and pathophysiology of acute cardiovascular events and ischemic heart disease. Chronobiol Int 2012; 30:6-16. [PMID: 23002808 DOI: 10.3109/07420528.2012.715843] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The scientific literature clearly establishes the occurrence of cardiovascular (CV) accidents and myocardial ischemic episodes is unevenly distributed during the 24 h. Such temporal patterns result from corresponding temporal variation in pathophysiologic mechanisms and cyclic environmental triggers that elicit the onset of clinical events. Moreover, both the pharmacokinetics and pharmacodynamics of many, though not all, CV medications have been shown to be influenced by the circadian time of their administration, even though further studies are necessary to better clarify the mechanisms of such influence on different drug classes, drug molecules, and pharmaceutical preparations. Twenty-four-hour rhythmic organization of CV functions is such that defense mechanisms against acute events are incapable of providing the same degree of protection during the day and night. Instead, temporal gates of excessive susceptibility exist, particularly in the morning and to a lesser extent evening (in diurnally active persons), to aggressive mechanisms through which overt clinical manifestations may be triggered. When peak levels of critical physiologic variables, such as blood pressure (BP), heart rate (HR), rate pressure product (systolic BP × HR, surrogate measure of myocardial oxygen demand), sympathetic activation, and plasma levels of endogenous vasoconstricting substances, are aligned together at the same circadian time, the risk of acute events becomes significantly elevated such that even relatively minor and usually harmless physical and mental stress and environmental phenomena can precipitate dramatic life-threatening clinical manifestations. Hence, the delivery of CV medications needs to be synchronized in time, i.e., circadian time, in proportion to need as determined by established temporal patterns in risk of CV events, and in a manner that averts or minimizes undesired side effects.
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Affiliation(s)
- Roberto Manfredini
- Section of Clinica Medica, Department of Clinical and Experimental Medicine, University of Ferrara, Via Savonarola 9, Ferrara, Italy
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Cardiac arrest patients in the emergency department—National Hospital Ambulatory Medical Care Survey, 2001–2007. Resuscitation 2011; 82:1298-301. [DOI: 10.1016/j.resuscitation.2011.05.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Revised: 04/15/2011] [Accepted: 05/18/2011] [Indexed: 11/17/2022]
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Koike S, Tanabe S, Ogawa T, Akahane M, Yasunaga H, Horiguchi H, Matsumoto S, Imamura T. Effect of time and day of admission on 1-month survival and neurologically favourable 1-month survival in out-of-hospital cardiopulmonary arrest patients. Resuscitation 2011; 82:863-8. [DOI: 10.1016/j.resuscitation.2011.02.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2010] [Revised: 02/05/2011] [Accepted: 02/06/2011] [Indexed: 02/05/2023]
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Portaluppi F, Tiseo R, Smolensky MH, Hermida RC, Ayala DE, Fabbian F. Circadian rhythms and cardiovascular health. Sleep Med Rev 2011; 16:151-66. [PMID: 21641838 DOI: 10.1016/j.smrv.2011.04.003] [Citation(s) in RCA: 194] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Accepted: 04/27/2011] [Indexed: 11/30/2022]
Abstract
The functional organization of the cardiovascular system shows clear circadian rhythmicity. These and other circadian rhythms at all levels of organization are orchestrated by a central biological clock, the suprachiasmatic nuclei of the hypothalamus. Preservation of the normal circadian time structure from the level of the cardiomyocyte to the organ system appears to be essential for cardiovascular health and cardiovascular disease prevention. Myocardial ischemia, acute myocardial infarct, and sudden cardiac death are much greater in incidence than expected in the morning. Moreover, supraventricular and ventricular cardiac arrhythmias of various types show specific day-night patterns, with atrial arrhythmias--premature beats, tachycardias, atrial fibrillation, and flutter - generally being of higher frequency during the day than night--and ventricular fibrillation and ventricular premature beats more common, respectively, in the morning and during the daytime activity than sleep span. Furthermore, different circadian patterns of blood pressure are found in arterial hypertension, in relation to different cardiovascular morbidity and mortality risk. Such temporal patterns result from circadian periodicity in pathophysiological mechanisms that give rise to predictable-in-time differences in susceptibility-resistance to cyclic environmental stressors that trigger these clinical events. Circadian rhythms also may affect the pharmacokinetics and pharmacodynamics of cardiovascular and other medications. Knowledge of 24-h patterns in the risk of cardiac arrhythmias and cardiovascular disease morbidity and mortality plus circadian rhythm-dependencies of underlying pathophysiologic mechanisms suggests the requirement for preventive and therapeutic interventions is not the same throughout the day and night, and should be tailored accordingly to improve outcomes.
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Nakanishi N, Nishizawa S, Kitamura Y, Nakamura T, Matsumuro A, Sawada T, Matsubara H. Circadian, weekly, and seasonal mortality variations in out-of-hospital cardiac arrest in Japan: analysis from AMI-Kyoto Multicenter Risk Study database. Am J Emerg Med 2010; 29:1037-43. [PMID: 20708890 DOI: 10.1016/j.ajem.2010.06.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Revised: 06/04/2010] [Accepted: 06/20/2010] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Several studies have reported circadian, weekly, and seasonal variations in the rates of out-of-hospital cardiac arrest (OHCA). However, variations in the mortality of OHCA are not well known. METHODS AND RESULTS We investigated the 1396 consecutive cases of OHCA with cardiac etiology between October 2004 and September 2008. There were 2 peaks in the occurrence of OHCA in early morning and late evening. There was a weekly pattern with an increased incidence on Mondays. We found a significant seasonal variation in the frequency of events, with a maximum during winter. There was a trend of reduced mortality in warmest 3 months, especially among a subgroup of ventricular fibrillation/pulseless ventricular tachycardia with arrest witnessed. CONCLUSION The present analyses demonstrated circadian, weekly and seasonal variations in the occurrence, and a seasonal variation in mortality in OHCA. Changes in temperature might influence the severity of OHCA and change the rate of success of cardiopulmonary resuscitation.
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Affiliation(s)
- Naohiko Nakanishi
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.
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17
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Tsukada T, Ikeda T, Ishiguro H, Abe A, Miyakoshi M, Miwa Y, Mera H, Yusu S, Yamaguchi Y, Yoshino H. Circadian Variation in Out-of-Hospital Cardiac Arrests due to Cardiac Cause in a Japanese Patient Population. Circ J 2010; 74:1880-7. [DOI: 10.1253/circj.cj-10-0008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Takehiro Tsukada
- Second Department of Internal Medicine, Kyorin University School of Medicine
| | - Takanori Ikeda
- Second Department of Internal Medicine, Kyorin University School of Medicine
| | - Haruhisa Ishiguro
- Second Department of Internal Medicine, Kyorin University School of Medicine
| | - Atsuko Abe
- Second Department of Internal Medicine, Kyorin University School of Medicine
| | - Mutsumi Miyakoshi
- Second Department of Internal Medicine, Kyorin University School of Medicine
| | - Yosuke Miwa
- Second Department of Internal Medicine, Kyorin University School of Medicine
| | - Hisaaki Mera
- Second Department of Internal Medicine, Kyorin University School of Medicine
| | - Satoru Yusu
- Second Department of Internal Medicine, Kyorin University School of Medicine
| | - Yoshihiro Yamaguchi
- Department of Traumatology and Critical Care Medicine, Kyorin University School of Medicine
| | - Hideaki Yoshino
- Second Department of Internal Medicine, Kyorin University School of Medicine
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18
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Pleskot M, Hazukova R, Stritecka IH, Cermakova E. The Highest Incidence of Out-of-Hospital Cardiac Arrest During a Circadian Period in Survivors. Int Heart J 2008; 49:183-92. [DOI: 10.1536/ihj.49.183] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Miloslav Pleskot
- 1st Department of Internal Medicine, Faculty of Medicine in Hradec Kralove, Charles University in Prague, University Hospital
| | - Radka Hazukova
- 1st Department of Internal Medicine, Faculty of Medicine in Hradec Kralove, Charles University in Prague, University Hospital
| | - Ing. Hana Stritecka
- Faculty of Military Health Sciences, University of Defence in Hradec Kralove
| | - Eva Cermakova
- Computer Technology Center, Department of Medical Biophysics, Faculty of Medicine in Hradec Kralove, Charles University in Prague
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19
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Portaluppi F, Hermida RC. Circadian rhythms in cardiac arrhythmias and opportunities for their chronotherapy. Adv Drug Deliv Rev 2007; 59:940-51. [PMID: 17659808 DOI: 10.1016/j.addr.2006.10.011] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2006] [Accepted: 10/01/2006] [Indexed: 11/15/2022]
Abstract
It is now well established that nearly all functions of the body, including those that influence the pharmacokinetics and pharmacodynamics of medications, exhibit significant 24-hour variation. The electrical properties of the heart as well as cardiac arrhythmias also vary as circadian rhythms, even though the suboptimal methods initially used for their investigation slowed their identification and thorough characterization. The application of continuous Holter monitoring of the electrical properties of the heart has revealed 24-hour variation in the occurrence of ventricular premature beats with the peak in events, in diurnally active persons, between 6 a.m. and noon. After the introduction of implantable cardioverter-defibrillators, ventricular tachycardia or fibrillation were also found to peak in the same period of the day. Even defibrillator energy requirements show circadian variation, thus supporting the need for a temporal awareness in the therapeutic approach to arrhythmias. Imbalanced autonomic tone, circulating levels of catecholamines, increased heart rate and blood pressure, all established determinants of cardiac arrhythmias, show circadian variations and underlie the genesis of the circadian pattern of cardiac arrhythmias. Arrhythmogenesis appears to be suppressed during nighttime sleep, and this can influence the evaluation of the efficacy of antiarrhythmic medications in relation to their administration time. Unfortunately, very few studies have been undertaken to assess the proper timing (chronotherapy) of antiarrhythmic medications as means to maximize efficacy and possibly reduce side effects. Further research in this field is warranted and could bring new insight and clinical advantage.
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Affiliation(s)
- Francesco Portaluppi
- Hypertension Center, Department of Clinical and Experimental Medicine, University of Ferrara, via Savonarola 9, I-44100 Ferrara, Italy.
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20
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Matot I, Shleifer A, Hersch M, Lotan C, Weiniger CF, Dror Y, Einav S. In-hospital cardiac arrest: Is outcome related to the time of arrest? Resuscitation 2006; 71:56-64. [PMID: 16945469 DOI: 10.1016/j.resuscitation.2006.03.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2006] [Accepted: 03/03/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Whether outcome from in-hospital cardiopulmonary resuscitation (CPR) is poorer when it occurs during the night remains controversial. This study examined the relationship between CPR during the various hospital shifts and survival to discharge. METHODS CPR attempts occurring in a tertiary hospital with a dedicated, certified resuscitation team were recorded prospectively (Utstein template guidelines) over 24 months. Medical records and patient characteristics were retrieved from patient admission files. RESULTS Included were 174 in-hospital cardiac arrests; 43%, 32% and 25% in morning evening and night shifts, respectively. Shift populations were comparable in demographic and treatment related variables. Asystole (p < 0.01) and unwitnessed arrests (p = 0.05) were more common during the night. Survival to discharge was poorer following night shift CPR than following morning and evening shift CPR (p = 0.04). When asystole (being synonymous with death) was excluded from the analysis, the odds of survival to discharge was not higher for witnessed compared to unwitnessed arrest but was 4.9 times higher if the cardiac arrest did not occur during the night shift (p = 0.05, logistic regression). The relative risk of eventual in-hospital death for patients with return of spontaneous circulation (ROSC) following night shift resuscitation was 1.9 that of those with ROSC following morning or evening resuscitation (Cox regression). CONCLUSIONS Although unwitnessed arrest is more prevalent during night shift, resuscitation during this shift is associated with poorer outcomes independently of witnessed status. Further research is required into the causes for the increased mortality observed after night shift resuscitation.
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Affiliation(s)
- Idit Matot
- Department of Anaesthesia and Intensive Care Medicine of the Hadassah Medical Centre, Jerusalem, Israel
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21
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Jones D, Bellomo R, Bates S, Warrillow S, Goldsmith D, Hart G, Opdam H. Patient monitoring and the timing of cardiac arrests and medical emergency team calls in a teaching hospital. Intensive Care Med 2006; 32:1352-6. [PMID: 16826391 DOI: 10.1007/s00134-006-0263-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2006] [Accepted: 06/06/2006] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the timing of cardiac arrest detection in relation to episodes of Medical Emergency Team (MET) review and routine nursing observations. DESIGN AND SETTING Retrospective observational study in a university-affiliated hospital. PATIENTS 279 cardiac arrests involving ward patients MEASUREMENTS AND RESULTS Cardiac arrests were allocated to one of 24 1-h intervals (24:00-00:59, 01:00-01:59, etc.). The actual hourly rate of cardiac arrests was related to the expected average hourly rate. Peak levels of cardiac arrest detection occurred during times of routine overnight nursing clinical observations between 02:00 and 03:00 (OR 3.06) and 06:00-07:00 (OR 1.95). The lowest level of cardiac arrest detection occurred between 20:00 and 21:00 (OR 0.42). After introduction of the MET there were 162 cardiac arrests, 28% of which occurred shortly after an initial MET call. The odds ratio for risk of cardiac arrest during periods of lowest MET activation (24:00-08:00) when compared with periods of highest MET activation (16:00-24:00) was 2.26. CONCLUSIONS Cardiac arrest detection in our hospital is episodic with peak levels corresponding to periods of overnight routine nursing observations following a period when patient review is likely to be low. After the introduction of the MET there was an inverse link between detection of cardiac arrests and levels of MET activation over the 24-h period. Increased overnight utilization and earlier MET activation may further reduce the incidence of cardiac arrests at our hospital.
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Affiliation(s)
- Daryl Jones
- Intensive Care, Alfred Hospital, Monash University, Melbourne, Australia
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22
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Sredniawa B, Musialik-Lydka A, Jarski P, Sliwinska A, Kalarus Z. Methods of assessment and clinical relevance of QT dynamics. Indian Pacing Electrophysiol J 2005; 5:221-32. [PMID: 16943870 PMCID: PMC1431595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The dependence on heart rate of the QT interval has been investigated for many years and several mathematical formulae have been proposed to describe the QT interval/heart rate (or QT interval/RR interval) relationship. While the most popular is Bazett's formula, it overcorrects the QT interval at high heart rates and under-corrects it at slow heart rates. This formulae and many others similar ones, do not accurately describe the natural behaviour of the QT interval. The QT interval/RR interval relationship is generally described as QT dynamics. In recent years, several methods of its assessment have been proposed, the most popular of which is linear regression. An increased steepness of the linear QT/RR slope correlates with the risk of arrhythmic death following myocardial infarction. It has also been demonstrated that the QT interval adapts to heart rate changes with a delay (QT hysteresis) and that QT dynamics parameters vary over time. New methods of QT dynamics assessment that take into account these phenomena have been proposed. Using these methods, changes in QT dynamics have been observed in patients with advanced heart failure, and during morning hours in patients with ischemic heart disease and history of cardiac arrest. The assessment of QT dynamics is a new and promising tool for identifying patients at increased risk of arrhythmic events and for studying the effect of drugs on ventricular repolarisation.
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Affiliation(s)
- Beata Sredniawa
- First Department of Cardiology, Silesian Medical School, Silesian Center for Heart Diseases, Zabrze, Poland.
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23
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Kida M, Kawamura T, Fukuoka T, Tamakoshi A, Wakai K, Ohno Y, Toyama J. Out-of-hospital cardiac arrest and survival: an epidemiological analysis of emergency service reports in a large city in Japan. Circ J 2005; 68:603-9. [PMID: 15226622 DOI: 10.1253/circj.68.603] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The factors that influence survival of out-of-hospital cardiac arrest in Japan have not been fully investigated. METHODS AND RESULTS The official emergency service record was used to investigate 1,600 patients for whom cardiopulmonary resuscitation was attempted by the city's emergency personnel. Only 45 (2.8%) patients survived for 1 month. The survival rate was 9.8% in the patients under 20 years of age, with a marked decreasing trend to 0.8% in the patients aged 80 years or older. The rate peaked at 4.8% on Sunday and bottomed out at 0.5% on Thursday, forming a distinct sine curve. The survival rate was 9.9% when an ambulance arrived at the scene within 4 min, with a steep drop to 2.5% when 4-7 min elapsed. However, the rate was not significantly different by the interval to hospital. Although bystander resuscitation did not significantly affect the survival, paramedics on board significantly improved the rate (3.5% vs 1.6%). Multivariate analysis confirmed that age, day of the week, place, interval to ambulance's arrival, and personnel on board were independently associated with the probability of survival. CONCLUSIONS Quick arrival of a paramedic team would improve the survival after out-of-hospital cardiac arrest. General education of lifesaving techniques would be another key factor.
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Affiliation(s)
- Maki Kida
- Department of Preventive Medicine/Biostatistics and Medical Decision Making, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Reed MJ, Robertson CE, Addison PS. Heart rate variability measurements and the prediction of ventricular arrhythmias. QJM 2005; 98:87-95. [PMID: 15671474 DOI: 10.1093/qjmed/hci018] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Affiliation(s)
- M J Reed
- Emergency Department, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK.
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25
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Manfredini R, Boari B, Bressan S, Gallerani M, Salmi R, Portaluppi F, Mehta RH. Influence of circadian rhythm on mortality after myocardial infarction: Data from a prospective cohort of emergency calls. Am J Emerg Med 2004; 22:555-9. [PMID: 15666260 DOI: 10.1016/j.ajem.2004.08.014] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Myocardial infarction (MI) occurs more frequently in the morning as a result of the concomitant unfavorable timing of several physiological parameters and/or biochemical conditions. However, little is known about the possible influence of this circadian pattern on prognosis. To evaluate whether the time of symptom onset could potentially influence mortality from acute MI, this prospective study considered all consecutive MIs admitted to the ED of Ferrara, Italy, after a call to the Emergency Coordinating Unit from January 1, 1998, to December 31, 2001. The total sample consisted of 442 MIs (mean age, 68.7 years; males, 72%). Eighty patients (males, 82.5%) died in the ED; the remaining 362 were admitted to the hospital. Of these, 50 (males, 60%) died during their hospital stay. Based on the timing of their symptom onset, cases were categorized both into 24 1-hour intervals and four 6-hour intervals (midnight to 5:59 am, 6:00 am to 11:59 am, noon to 5:59 pm, and 6:00 pm to 11:59 pm), and the circadian distributions of fatal versus nonfatal MIs were compared. The circadian variation of MI peaked between 6:00 am and noon (P < .001), and in this period, there was a trend toward a higher frequency of fatal cases (41.5% vs. 35.2%; chi(2) = 1.911, P = .167). To verify whether this higher frequency of fatal events in the morning hours could be related to possible higher severity of cases observed in that hours, a further separate analysis considering age, infarct site, and peak levels of MB was made. Again, no significant temporal differences among the four 6-hour intervals were found between fatal and nonfatal Mis, although a trend toward older age was observed in morning MIs. Not only the frequency, but also the mortality, of acute MI could be increased in the morning hours. This could be of practical interest for emergency doctors and could have significant implications for acute treatment, because several studies have reported a lowered efficacy of thrombolytic drugs in the morning hours.
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Affiliation(s)
- Roberto Manfredini
- Section of Internal Medicine, Department of Clinical and Experimental Medicine, University of Ferrara, via Savonarola 9, I-14400 Ferrara, Italy.
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Hashimoto J, Chonan K, Aoki Y, Ugajin T, Yamaguchi J, Nishimura T, Kikuya M, Michimata M, Matsubara M, Araki T, Hozawa A, Ohkubo T, Imai Y. Therapeutic effects of evening administration of guanabenz and clonidine on morning hypertension: evaluation using home-based blood pressure measurements. J Hypertens 2003; 21:805-11. [PMID: 12658028 DOI: 10.1097/00004872-200304000-00025] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To clarify the effects of bedtime administration of the centrally acting alpha(2)-agonists, guanabenz and clonidine, on morning hypertension. METHODS Patients with morning hypertension were assigned to receive once-daily evening administration of guanabenz (2 mg/day, n = 81; 4 mg/day, n = 2) or clonidine (75 microg/day, n = 40; 150 microg/day, n = 10) for 4 weeks, and the blood pressure (BP)-lowering effects of these drugs in the morning and evening were evaluated by assessing self-monitored BP in the home environment. The subjects were then subdivided into different groups according to their evening BP, and the effects of guanabenz and clonidine on evening BP were evaluated further for each group. In addition, as a substitute for the trough/peak ratio, the evening/morning (E/M) ratio was calculated to assess the duration of action of the two alpha(2)-agonists. RESULTS Evening dosing with guanabenz or clonidine lowered morning BP significantly. Both drugs decreased evening BP in the subgroup of subjects with a high evening BP, but not in those with a normal evening BP. The individual E/M ratios for guanabenz, but not for clonidine, were significantly greater in those with a high evening BP than in those with a normal evening BP. In the early treatment period, treatment with guanabenz resulted in a higher diastolic E/M ratio in those subjects with a high evening diastolic BP than did treatment with clonidine. CONCLUSION The results suggest that evening administration of the central alpha(2)-agonists guanabenz and clonidine effectively suppresses the morning BP elevation in treated hypertensive patients.
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Affiliation(s)
- Junichiro Hashimoto
- Department of Clinical Pharmacology and Therapeutics, Tohoku University Graduate School of Medicine and Pharmaceutical Science, Sendai, Japan
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27
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Eisenburger P, Schreiber W, Vergeiner G, Sterz F, Holzer M, Herkner H, Havel C, Laggner AN. Lunar phases are not related to the occurrence of acute myocardial infarction and sudden cardiac death. Resuscitation 2003; 56:187-9. [PMID: 12589993 DOI: 10.1016/s0300-9572(02)00298-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Mass media deliver pertinacious rumours that lunar phases influence the progress and long-term results in several medical procedures. Peer reviewed studies support this, e.g. in myocardial infarction, others do not. METHODS We looked retrospectively at the dates of cardiac arrests (CA; n=368) of cardiac origin and of acute myocardial infarctions (AMI) with consecutive thrombolytic therapy or acute PTCA (n=872) and at the lunar phases at the corresponding dates. Medical data had been collected prospectively on the patient's admission. The lunar phases were defined as full moon+/-1 day, new moon+/-1 day and the days in between as waning and waxing moon. The incidence of these cardiac events at each phase was calculated as days with a case divided by the total number of days of the specific moon phase in the observation period (1992-1998). Wilcoxon Rank Test was used for statistical analysis. RESULTS AMI and CA occurred on equal percentages of days within each lunar phase: AMI on 35% of all days with new moon, on 38% of full moon days, on 39% waning, and on 41% of the waxing moon days; CA on 19, 17, 16 and 16% of all days of the respective lunar phase. This difference was not significant. CONCLUSION Lunar phases do not appear to correlate with acute coronary events leading to myocardial infarction or sudden cardiac death.
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Affiliation(s)
- Philip Eisenburger
- Department of Emergency Medicine, University Clinics, General Hospital Vienna, Waehringer Guertel 18-20/6/D, A-1090 Vienna, Austria
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28
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Manfredini R, Gallerani M, Boari B, Maraldi C, la Cecilia O, Rafael Ferreira AB, Smolensky MH, Portaluppi F. Morning preference in onset of symptomatic third-degree atrioventricular heart block. Chronobiol Int 2002; 19:785-91. [PMID: 12182503 DOI: 10.1081/cbi-120006082] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The aim of this study was to examine 24h patterning in the symptoms indicative of third-degree atrio-ventricular (AV) heart block. We found a total of 227 cases (126 men and 101 women) of third-degree AV block that had been diagnosed by the Emergency Medical Department of the St. Anna Hospital in Ferrara, Italy between 1990 and 2001. Determination of the hour of onset of symptomatic third-degree AV block, however, was possible and listed in the records of only 161 or 70.9% of the cases (92 men and 69 women). The onset time of every event was categorized into one of four 6h spans of the 24h: night (00:00-05:59h), morning (06:00-11:59h), afternoon (12:00-17:59h), and evening (18:00-23:59h). The onset of the symptoms of third-degree AV block in the sample of 161 cases was significantly greater in the morning between 06:00 and 11:59h than any other 6h span of the day and night (chi2-test; p < 0.001). The same phenomenon was substantiated in the subgroup of the 92 males (chi2; p < 0.0001), although it could not be detected for the smaller subgroup of 69 women. The 24h pattern, with morning preference, in the onset of symptomatic third-degree AV block is similar to the one in sudden cardiac death and cardiogenic cardiac arrest. The etiology of the 24h pattern in symptomatic AV block is unknown; it may be an expression of intrinsic biological rhythmicity within the heart tissue or its control system, and/or the timing of environmental triggers resulting in coronary ischemia.
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Affiliation(s)
- Roberto Manfredini
- Internal Medicine and Hypertension Center, Department of Clinical and Experimental Medicine, University of Ferrara Medical School, Italy.
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