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Fahy L, Rowe S, Nehme Z, Stub D, Zentner D, James P, Pflaumer A, Connell V, Semsarian C, Ingles J, La Gerche A, Paratz ED. Prevalence of atrial septal defects and patent foramen ovale in a cohort of sudden cardiac death patients undergoing autopsy. J Cardiol 2024; 83:390-393. [PMID: 37734655 DOI: 10.1016/j.jjcc.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 09/08/2023] [Accepted: 09/13/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Patent foramen ovale (PFO) and atrial septal defects (ASD) have been described in up to 30 % of subjects in autopsy series but contemporary data are scarce. It is important to confirm the prevalence of ASD/PFO in the general population given the potential associated stroke risk and the increasing availability of intervention via PFO closure. METHODS A state-wide prospective out-of-hospital cardiac arrest registry (OHCA) identified all patients aged 1 to 50 years who experienced OHCA in Victoria, Australia from April 2019 to April 2022 and subsequently underwent autopsy with a cardiac cause of death identified. Autopsy was performed including visual description of any ASD and identification of probe patency of foramen ovale. RESULTS A total of 517 patients underwent autopsy in the setting of sudden cardiac death; 36 patients (6.9 %) had a probe-patent foramen ovale, 2 patients (0.4 %) had secundum ASD, and 2 patients (0.4 %) had both a PFO and ASD (1 of whom had undergone percutaneous repair of both lesions). Twelve patients (2.3 %) had a prior history of cerebrovascular accident either recorded on medical history or detected on neuropathological examination; however none of these patients had a PFO or ASD. CONCLUSIONS The combined rate of PFO and ASD in a cohort of 517 patients undergoing autopsy was 7.9 %. None of these patients had experienced a cerebrovascular accident. This rate of PFOs appears lower than earlier reports and raises the possibility that the relative risk of an associated stroke could be higher than previously estimated.
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Affiliation(s)
- Louise Fahy
- Baker Heart and Diabetes Institute, Prahran, VIC, Australia; Department of Cardiology, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia.
| | - Stephanie Rowe
- Baker Heart and Diabetes Institute, Prahran, VIC, Australia; Department of Cardiology, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Ziad Nehme
- Ambulance Victoria, Doncaster, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Dion Stub
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Cardiology, Alfred Hospital, Prahran, VIC, Australia
| | - Dominica Zentner
- Department of Cardiology, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Paul James
- Department of Cardiology, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Andreas Pflaumer
- Department of Cardiology, Royal Children's Hospital, Parkville, VIC, Australia; Murdoch Children's Research Institute and University of Melbourne, Parkville, VIC, Australia; Department of Population Genomics, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
| | - Vanessa Connell
- Department of Cardiology, Royal Children's Hospital, Parkville, VIC, Australia
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute and University of Sydney, Sydney, NSW, Australia
| | - Jodie Ingles
- Department of Population Genomics, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
| | - Andre La Gerche
- Baker Heart and Diabetes Institute, Prahran, VIC, Australia; Department of Cardiology, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia; Faculty of Medicine, Dentistry and Health Sciences, Melbourne University, Parkville, VIC, Australia
| | - Elizabeth D Paratz
- Baker Heart and Diabetes Institute, Prahran, VIC, Australia; Department of Cardiology, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia; Faculty of Medicine, Dentistry and Health Sciences, Melbourne University, Parkville, VIC, Australia
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Paratz ED, Stub D, Sutherland N, Gutman S, La Gerche A, Mariani J, Taylor A, Ellims A. Response to: Regard to assessing agreement between two raters with kappa statistics. Int J Cardiol 2024; 404:131978. [PMID: 38513734 DOI: 10.1016/j.ijcard.2024.131978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 03/15/2024] [Indexed: 03/23/2024]
Affiliation(s)
- Elizabeth D Paratz
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC 3181, Australia; Alfred Hospital, 55 Commercial Rd, Prahran, VIC 3181, Australia; St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC 3065, Australia; Ambulance Victoria, 375 Manningham Rd, Doncaster, VIC 3108, Australia.
| | - Dion Stub
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC 3181, Australia; Alfred Hospital, 55 Commercial Rd, Prahran, VIC 3181, Australia; Ambulance Victoria, 375 Manningham Rd, Doncaster, VIC 3108, Australia; Department of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne 3004, Australia
| | | | - Sarah Gutman
- Alfred Hospital, 55 Commercial Rd, Prahran, VIC 3181, Australia
| | - Andre La Gerche
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC 3181, Australia; Alfred Hospital, 55 Commercial Rd, Prahran, VIC 3181, Australia; St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC 3065, Australia
| | - Justin Mariani
- Alfred Hospital, 55 Commercial Rd, Prahran, VIC 3181, Australia
| | - Andrew Taylor
- Alfred Hospital, 55 Commercial Rd, Prahran, VIC 3181, Australia
| | - Andris Ellims
- Alfred Hospital, 55 Commercial Rd, Prahran, VIC 3181, Australia
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Paratz ED, Fahy L, Stub D, Nehme Z, Connell V, Pflaumer A, La Gerche A. Diversity of ICD-10 coding for sudden arrhythmic death syndrome is likely to create a spurious rise in cases under new ICD-11 nomenclature. Heart Rhythm 2024:S1547-5271(24)02513-X. [PMID: 38670248 DOI: 10.1016/j.hrthm.2024.04.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024]
Affiliation(s)
- Elizabeth D Paratz
- Department of Cardiology, St Vincent's Hospital Melbourne, 41 Victoria Parade Fitzroy VIC 3065 Australia; St Vincent's Institute of Medical Research, 9 Princes St Fitzroy VIC 3065 Australia; Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Grattan St Parkville VIC 3000 Australia; Department of Cardiology, Alfred Hospital, 55 Commercial Rd Prahran VIC 3181 Australia.
| | - Louise Fahy
- Department of Cardiology, St Vincent's Hospital Melbourne, 41 Victoria Parade Fitzroy VIC 3065 Australia; St Vincent's Institute of Medical Research, 9 Princes St Fitzroy VIC 3065 Australia
| | - Dion Stub
- Department of Cardiology, Alfred Hospital, 55 Commercial Rd Prahran VIC 3181 Australia; Department of Public Health and Preventive Medicine, Monash University 553 St Kilda Rd Melbourne VIC 3004 Australia
| | - Ziad Nehme
- Department of Public Health and Preventive Medicine, Monash University 553 St Kilda Rd Melbourne VIC 3004 Australia; Centre for Research & Evaluation, Ambulance Victoria, 31 Joseph St Blackburn North VIC 3130 Australia
| | - Vanessa Connell
- Department of Cardiology, Royal Children's Hospital, 50 Flemington Rd Parkville VIC 3052
| | - Andreas Pflaumer
- Department of Cardiology, Royal Children's Hospital, 50 Flemington Rd Parkville VIC 3052; Murdoch Children's Research Institute, 50 Flemington Rd Parkville VIC 3052 Australia
| | - Andre La Gerche
- Department of Cardiology, St Vincent's Hospital Melbourne, 41 Victoria Parade Fitzroy VIC 3065 Australia; St Vincent's Institute of Medical Research, 9 Princes St Fitzroy VIC 3065 Australia; Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Grattan St Parkville VIC 3000 Australia
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Paratz ED, Nehme E, Heriot N, Sundararajan V, Page G, Fahy L, Rowe S, Anderson D, Stub D, La Gerche A, Nehme Z. Sex disparities in bystander defibrillation for out-of-hospital cardiac arrest. Resusc Plus 2024; 17:100532. [PMID: 38188595 PMCID: PMC10770583 DOI: 10.1016/j.resplu.2023.100532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 12/01/2023] [Indexed: 01/09/2024] Open
Abstract
Background Previous studies have suggested that females experiencing out-of-hospital cardiac arrest (OHCA) receive lower rates of both bystander cardiopulmonary resuscitation (CPR) and defibrillation compared to males. Whether this disparity has improved over time is unknown. Methods A state-wide OHCA registry in Victoria, Australia collected data over twenty years (2002-2021) regarding rates of bystander interventions in OHCA. Characteristics and outcomes of each OHCA were compared with logistic regression according to sex and time (defined in two-year periods). Results 32,502 OHCAs were included (69.7% male). Both bystander CPR and defibrillation rates increased for females over time (p < 0.0001). There was no sex disparity in receipt of bystander CPR after adjustment for baseline differences. Females were less likely than males to receive bystander defibrillation, with sex disparity increasing from 2010 onwards (adjOR 0.26 (95%CI 0.09-0.80) in 2020-21 for females compared to males). Conclusion Initiatives to increase bystander CPR and defibrillation have resulted in higher overall rates of bystander interventions in the last two decades and no significant sex differences in provision of bystander CPR. However, females receive less bystander defibrillation than males, and sex disparity is increasing. Strategies to promote bystander defibrillation in females experiencing OHCA with a shockable rhythm should be a priority.
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Affiliation(s)
- Elizabeth D. Paratz
- HEART Lab, St Vincent’s Institute of Medical Research, 9 Princes St., Fitzroy, VIC 3065, Australia
- Department of Cardiology, St Vincent’s Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia
- Cardiology Department, Baker Heart & Diabetes Institute, 75 Commercial Rd., Prahran, VIC 3181, Australia
- Department of Medicine, St Vincent’s Hospital Melbourne, The University of Melbourne, 29 Regent Street, Fitzroy, VIC 3065, Australia
- Ambulance Victoria, 31 Joseph St., Blackburn North, VIC 3130, Australia
| | - Emily Nehme
- Ambulance Victoria, 31 Joseph St., Blackburn North, VIC 3130, Australia
- School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Rd., Melbourne, VIC 3004, Australia
| | - Natalie Heriot
- Ambulance Victoria, 31 Joseph St., Blackburn North, VIC 3130, Australia
| | - Vijaya Sundararajan
- Department of Medicine, St Vincent’s Hospital Melbourne, The University of Melbourne, 29 Regent Street, Fitzroy, VIC 3065, Australia
| | | | - Louise Fahy
- HEART Lab, St Vincent’s Institute of Medical Research, 9 Princes St., Fitzroy, VIC 3065, Australia
- Department of Cardiology, St Vincent’s Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia
| | - Stephanie Rowe
- HEART Lab, St Vincent’s Institute of Medical Research, 9 Princes St., Fitzroy, VIC 3065, Australia
- Department of Cardiology, St Vincent’s Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia
| | - David Anderson
- Ambulance Victoria, 31 Joseph St., Blackburn North, VIC 3130, Australia
| | - Dion Stub
- Ambulance Victoria, 31 Joseph St., Blackburn North, VIC 3130, Australia
- School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Rd., Melbourne, VIC 3004, Australia
- Department of Cardiology, Alfred Health, 55 Commercial Rd., Prahran, VIC 3181, Australia
| | - Andre La Gerche
- HEART Lab, St Vincent’s Institute of Medical Research, 9 Princes St., Fitzroy, VIC 3065, Australia
- Department of Cardiology, St Vincent’s Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia
- Cardiology Department, Baker Heart & Diabetes Institute, 75 Commercial Rd., Prahran, VIC 3181, Australia
| | - Ziad Nehme
- Ambulance Victoria, 31 Joseph St., Blackburn North, VIC 3130, Australia
- School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Rd., Melbourne, VIC 3004, Australia
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Paratz ED, Stub D, Sutherland N, Gutman S, La Gerche A, Mariani J, Taylor A, Ellims A. The challenge of risk stratification in hypertrophic cardiomyopathy: Clinical, genetic and imaging insights from a quaternary referral centre. Int J Cardiol 2024; 395:131416. [PMID: 37802298 DOI: 10.1016/j.ijcard.2023.131416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/27/2023] [Accepted: 10/02/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) is the commonest genetic cardiomyopathy and may result in sudden cardiac death (SCD). Clinical risk stratification scores are utilised to estimate SCD risk and determine potential utility of a primary prevention implantable cardioverter defibrillator (ICD). METHODS Patients with a confirmed diagnosis of HCM from a quaternary HCM service were defined according to clinical characteristics, genetic profiles and cardiac imaging results. European Risk-SCD score and American Heart Association / American College of Cardiology (AHA/ACC) Score were calculated. The primary outcome was cardiac arrest. RESULTS 380 patients with HCM were followed up for a median of 6.4 years. 18 patients (4.7%) experienced cardiac arrest, with predictive factors being younger age (37.2 vs 54.4 years, p = 0.0041), unexplained syncope (33.3% vs 9.4%, p = 0.007), non-sustained ventricular tachycardia (50.0% vs 12.7%, p < 0.0001), increased septal thickness (21.5 vs 17.5 mm, p = 0.0003), and presence of a sarcomeric gene mutation (100.0% vs 65.8%, p = 0.038). The Risk-SCD and AHA/ACC scores had poor agreement (kappa coefficient 0.38). Risk-SCD score had poor sensitivity (44.4%), classifying 55.6% of patients with cardiac arrest as low-risk but was highly specific (93.7%). AHA/ACC risk score did not discriminate between groups significantly. 20 patients (5.3%) died, with most >60-year-olds having a non-cardiac cause of death (p = 0.0223). CONCLUSION This study highlights limited (38%) agreement between the Risk-SCD and AHA/ACC scores. Most cardiac arrests occurred in ostensibly low or medium-risk patients under both scores. Appropriate ICD selection remains challenging. Incorporating newer risk markers such as HCM genotyping and myocardial fibrosis quantification by cardiac MRI may assist future risk refinement.
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Affiliation(s)
- Elizabeth D Paratz
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC 3181, Australia; Alfred Hospital, 55 Commercial Rd, Prahran, VIC 3181, Australia; St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC 3065, Australia; Ambulance Victoria, 375 Manningham Rd, Doncaster, VIC 3108, Australia.
| | - Dion Stub
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC 3181, Australia; Alfred Hospital, 55 Commercial Rd, Prahran, VIC 3181, Australia; Ambulance Victoria, 375 Manningham Rd, Doncaster, VIC 3108, Australia; Department of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne 3004, Australia
| | | | - Sarah Gutman
- Alfred Hospital, 55 Commercial Rd, Prahran, VIC 3181, Australia
| | - Andre La Gerche
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC 3181, Australia; Alfred Hospital, 55 Commercial Rd, Prahran, VIC 3181, Australia; St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC 3065, Australia
| | - Justin Mariani
- Alfred Hospital, 55 Commercial Rd, Prahran, VIC 3181, Australia
| | - Andrew Taylor
- Alfred Hospital, 55 Commercial Rd, Prahran, VIC 3181, Australia
| | - Andris Ellims
- Alfred Hospital, 55 Commercial Rd, Prahran, VIC 3181, Australia
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Paratz ED, Spanos C, Rowe S, Fahy L, Nehme Z, Stub D, Zentner D, James P, Pflaumer A, Connell V, Semsarian C, Ingles J, La Gerche A. Prevalence of Multiple Causes of Death Within Young and Middle-Aged People Experiencing Sudden Cardiac Arrest. Heart Lung Circ 2023; 32:1451-1456. [PMID: 38036374 DOI: 10.1016/j.hlc.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/28/2023] [Accepted: 10/08/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Multiple causes of death are increasingly reported, particularly in older populations. Rates of multiple causes of young sudden death have not been quantified. METHOD The End Unexplained Cardiac Death (EndUCD) registry was utilised to identify cases of young sudden death (aged 1-50 years) referred for forensic assessment from April 2019 to April 2022. Causes of death were coded according to whether one or more underlying causes of death were identified. Patients were compared according to the number of causes of death, with significant predictors assessed using logistic regression analysis. RESULTS 1,085 cases of sudden death were identified. 263 (24.2%) cases had more than one competing cause of their sudden death. The most common multi-causal associations identified were dual non-cardiac causes of the sudden death (n=68), cardiomyopathy with non-cardiac event (n=64) and coronary artery disease with non-cardiac cause (n=63). Multi-causal death was more common in those undergoing comprehensive autopsy examination (95.8% vs 77.6%, p<0.0001), and in the setting of higher body mass index (median 31.3 kg/m2 vs 29.9 kg/m2, p=0.01), older age (44.3 years vs 41.4 years, p<0.0001), non-ventricular cardiac arrest rhythm (93.2% vs 87.3%, p=0.009), and smoking (22.8% vs 14.2%, p=0.001). The strongest predictor of multiple pathologies was comprehensive autopsy examination compared with external inspection, full-body post-mortem computed tomography and review of ancillary documentation and investigations (odds ratio 6.49, 95% confidence interval 3.47-12.14). CONCLUSIONS One-quarter of young sudden deaths have more than one underlying cause, highlighting the value of comprehensive investigations including autopsy. Awareness of the complexity of young sudden death is important, along with multidisciplinary involvement to ensure all contributors to death are identified.
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Affiliation(s)
- Elizabeth D Paratz
- Department of Cardiology, Baker Heart and Diabetes Institute, Melbourne, Vic, Australia; Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Vic, Australia; Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Vic, Australia.
| | - Cassandra Spanos
- Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Vic, Australia
| | - Stephanie Rowe
- Department of Cardiology, Baker Heart and Diabetes Institute, Melbourne, Vic, Australia; Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Vic, Australia
| | - Louise Fahy
- Department of Cardiology, Baker Heart and Diabetes Institute, Melbourne, Vic, Australia; Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Vic, Australia
| | - Ziad Nehme
- Department of Research and Evaluation, Ambulance Victoria, Melbourne, Vic, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Dion Stub
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia
| | - Dominica Zentner
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Vic, Australia; Department of Cardiology, Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - Paul James
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - Andreas Pflaumer
- Department of Cardiology, Royal Children's Hospital, Parkville, Vic, Australia; Murdoch Children's Research Institute and The University of Melbourne, Melbourne, Vic, Australia
| | - Vanessa Connell
- Department of Cardiology, Royal Children's Hospital, Parkville, Vic, Australia
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute and University of Sydney, Camperdown, NSW, Australia
| | - Jodie Ingles
- Department of Population Genomics, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
| | - Andre La Gerche
- Department of Cardiology, Baker Heart and Diabetes Institute, Melbourne, Vic, Australia; Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Vic, Australia; Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Vic, Australia
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Paratz ED, Mundisugih J, Rowe SJ, Kizana E, Semsarian C. Gene Therapy in Cardiology: Is a Cure for Hypertrophic Cardiomyopathy on the Horizon? Can J Cardiol 2023:S0828-282X(23)01951-7. [PMID: 38013066 DOI: 10.1016/j.cjca.2023.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/07/2023] [Accepted: 11/22/2023] [Indexed: 11/29/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiomyopathy worldwide, affecting approximately 1 in 500 individuals. Current therapeutic interventions include lifestyle optimisation, medications, septal reduction therapies, and, rarely, cardiac transplantation. Advances in our understanding of disease-causing genetic variants in HCM and their associated molecular mechanisms have led to the potential for targeted therapeutics and implementation of precision and personalised medicine. Results from preclinical research are promising and raise the question of whether cure of some subtypes of HCM may be possible in the future. This review provides an overview of current genetic therapy platforms, including 1) genome editing, 2) gene replacement, 3) allelic-specific silencing, and 4) signalling pathway modulation. The current applicability of each of these platforms within the paradigm of HCM is examined, with updates on current and emerging trials in each domain. Barriers and limitations within the current landscape are also highlighted. Despite recent advances, translation of genetic therapy for HCM to clinical practice is still in early development. In realising the promises of genetic HCM therapies, ethical and equitable access to safe gene therapy must be prioritised.
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Affiliation(s)
- Elizabeth D Paratz
- Baker Heart and Diabetes Institute, Prahran, Victoria, Australia; St Vincent's Institute of Medical Research, Fitzroy, Victoria, Australia; Faculty of Medicine, Dentistry and Health Sciences, Melbourne University, Parkville, Victoria, Australia.
| | - Juan Mundisugih
- Centre for Heart Research, Westmead Institute for Medical Research, Westmead Clinical School, University of Sydney, Westmead, New South Wales, Australia; Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Stephanie J Rowe
- Baker Heart and Diabetes Institute, Prahran, Victoria, Australia; St Vincent's Institute of Medical Research, Fitzroy, Victoria, Australia; Faculty of Medicine, Dentistry and Health Sciences, Melbourne University, Parkville, Victoria, Australia
| | - Eddy Kizana
- Centre for Heart Research, Westmead Institute for Medical Research, Westmead Clinical School, University of Sydney, Westmead, New South Wales, Australia
| | - Christopher Semsarian
- Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia; Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, University of Sydney, Camperdown, New South Wales, Australia
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Somma V, Pflaumer A, Connell V, Rowe S, Fahy L, Zentner D, James P, Ingles J, Semsarian C, Stub D, Nehme Z, La Gerche A, Paratz ED. Epidemiology of pediatric out-of-hospital cardiac arrest compared with adults. Heart Rhythm 2023; 20:1525-1531. [PMID: 37331677 DOI: 10.1016/j.hrthm.2023.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 05/30/2023] [Accepted: 06/12/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) is associated with ∼90% mortality rate. In the pediatric population, this would equate to a large number of years of life lost, posing a heavy medical and economic burden to society. OBJECTIVE The purpose of this study was to outline the characteristics and causes of pediatric OHCA (pOHCA) and associations with survival until discharge in patients enrolled in the End Unexplained Cardiac Death Registry. METHODS A prospective statewide multisource registry identified all pOHCAs cases in patients aged 1-18 years in Victoria, Australia (population 6.5 million), from April 2019 to April 2021. Cases were adjudicated using ambulance, hospital, and forensic records; clinic assessments; and interviews of survivors and family members. RESULTS The analysis included 106 cases after adjudication (62, 58.5% male), 45 (42.5%) of which were due to cardiac causes of OHCA, with unascertained (n = 33 [31.1%]) being the most common cardiac cause reported. Respiratory events (n = 28 [26.4%]) were the most common noncardiac cause of pOHCA. Noncardiac causes were more likely to present with asystole or pulseless electrical activity (P = .007). The overall survival to hospital discharge rate was 11.3% and associated with increasing age, witnessed cardiac arrest, and initial ventricular arrhythmias (P < .05). CONCLUSION The incidence of pOHCA in the study population was 3.69 per 100,000 child-years. In contrast to young adults with OHCA, the most common etiology was noncardiac in pediatric patients. Prognostic factors associated with survival to discharge included increasing age, witnessed arrest, and initial ventricular arrhythmias. Rates of cardiopulmonary resuscitation and defibrillation were suboptimal.
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Affiliation(s)
- Vincenzo Somma
- St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Andreas Pflaumer
- Royal Children's Hospital, Parkville, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia; Melbourne University, Parkville, Victoria, Australia
| | | | - Stephanie Rowe
- St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Baker Heart and Diabetes Institute, Prahran, Victoria, Australia
| | - Louise Fahy
- St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Baker Heart and Diabetes Institute, Prahran, Victoria, Australia
| | - Dominica Zentner
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Royal Melbourne Hospital, St Parkville, Victoria, Australia
| | - Paul James
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Royal Melbourne Hospital, St Parkville, Victoria, Australia
| | - Jodie Ingles
- Garvan Institute of Medical Research, St Darlinghurst, New South Wales, Australia
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, The University of Sydney, Camperdown, New South Wales, Australia
| | - Dion Stub
- Alfred Hospital, Prahran, Victoria, Australia
| | - Ziad Nehme
- Ambulance Victoria, Blackburn North, Victoria, Australia
| | - Andre La Gerche
- St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Melbourne University, Parkville, Victoria, Australia; Baker Heart and Diabetes Institute, Prahran, Victoria, Australia
| | - Elizabeth D Paratz
- St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Melbourne University, Parkville, Victoria, Australia; Baker Heart and Diabetes Institute, Prahran, Victoria, Australia.
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Rowe SJ, Paratz ED, Foulkes SJ, Janssens K, Spencer LW, Fahy L, D'Ambrosio P, Haykowsky MJ, La Gerche A. Understanding Exercise Capacity: From Elite Athlete to HFpEF. Can J Cardiol 2023; 39:S323-S334. [PMID: 37574129 DOI: 10.1016/j.cjca.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/27/2023] [Accepted: 08/08/2023] [Indexed: 08/15/2023] Open
Abstract
Exercise capacity is a spectrum that reflects an individual's functional capacity and the dynamic nature of cardiac remodelling along with respiratory and skeletal muscle systems. The relationship of increasing physical activity, increased cardiac mass and volumes, and improved cardiorespiratory fitness (CRF) is well established in the endurance athlete. However, less emphasis has been placed on the other end of the spectrum, which includes individuals with a more sedentary lifestyle and small hearts who are at increased risk of functional disability and poor clinical outcomes. Reduced CRF is an independent predictor of all-cause mortality and cardiovascular events determined by multiple inter-related exogenous and endogenous factors. In this review, we explore the relationship of physical activity, cardiac remodelling, and CRF across the exercise spectrum, emphasising the critical role of cardiac size in determining exercise capacity. In contrast to the large compliant left ventricle of the endurance athlete, an individual with a lifetime of physical inactivity is likely to have a small, stiff heart with reduced cardiac reserve. We propose that this might contribute to the development of heart failure with preserved ejection fraction in certain individuals, and is key to understanding the link between low CRF and increased risk of heart failure.
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Affiliation(s)
- Stephanie J Rowe
- Baker Heart and Diabetes Institute, Melbourne, Australia; Cardiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Baker Department of Cardiometabolic Health, The University of Melbourne, Parkville, Victoria, Australia.
| | - Elizabeth D Paratz
- Baker Heart and Diabetes Institute, Melbourne, Australia; Cardiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Baker Department of Cardiometabolic Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Stephen J Foulkes
- Baker Heart and Diabetes Institute, Melbourne, Australia; Baker Department of Cardiometabolic Health, The University of Melbourne, Parkville, Victoria, Australia; Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Kristel Janssens
- Baker Heart and Diabetes Institute, Melbourne, Australia; Exercise and Nutrition Research Program, The Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Luke W Spencer
- Baker Heart and Diabetes Institute, Melbourne, Australia; Baker Department of Cardiometabolic Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Louise Fahy
- Baker Heart and Diabetes Institute, Melbourne, Australia; Cardiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Paolo D'Ambrosio
- Baker Heart and Diabetes Institute, Melbourne, Australia; Baker Department of Cardiometabolic Health, The University of Melbourne, Parkville, Victoria, Australia; Cardiology Department, Royal Melbourne Hospital, Parkville, Australia
| | - Mark J Haykowsky
- Baker Heart and Diabetes Institute, Melbourne, Australia; Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Andre La Gerche
- Baker Heart and Diabetes Institute, Melbourne, Australia; Cardiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Baker Department of Cardiometabolic Health, The University of Melbourne, Parkville, Victoria, Australia
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Paratz ED, van Heusden A, Ball J, Smith K, Zentner D, Morgan N, Parsons S, Thompson T, James P, Connell V, Pflaumer A, Semsarian C, Ingles J, Stub D, La Gerche A. Inconsistent discharge diagnoses for young cardiac arrest episodes: insights from a statewide registry. Intern Med J 2023; 53:1776-1782. [PMID: 36001398 DOI: 10.1111/imj.15918] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 08/18/2022] [Indexed: 10/21/2023]
Abstract
BACKGROUND Administrative coding of out-of-hospital cardiac arrest (OHCA) is heterogeneous, with the prevalence of noninformative diagnoses uncertain. AIM To characterize the prevalence and type of non-informative diagnoses in a young cardiac arrest population. METHODS Hospital discharge diagnoses provided to a statewide OHCA registry were characterised as either 'informative' or 'noninformative.' Informative diagnoses stated an OHCA had occurred or defined OHCA as occurring due to coronary artery disease, cardiomyopathy, channelopathy, definite noncardiac cause, or no known cause. Noninformative diagnoses were blank, stated presenting cardiac rhythm only, provided irrelevant information or presented a complication of the OHCA as the main diagnosis. Characteristics of patients receiving informative versus noninformative diagnoses were compared. RESULTS Of 1479 patients with OHCA aged 1 to 50 years, 290 patients were admitted to 15 hospitals. Ninety diagnoses (31.0%) were noninformative (arrest rhythm = 50, blank = 21, complication = 10 and irrelevant = 9). Two hundred diagnoses (69.0%) were informative (cardiac arrest = 84, coronary artery disease = 54, noncardiac diagnosis = 48, cardiomyopathy = 8, arrhythmia disorder = 4 and unascertained = 2). Only 10 diagnoses (3.5%) included both OHCA and an underlying cause. Patients receiving a noninformative diagnosis were more likely to have survived OHCA or been referred for forensic assessment (P = 0.011) and had longer median length of stay (9 vs 5 days, P = 0.0019). CONCLUSION Almost one third of diagnoses for young patients discharged after an OHCA included neither OHCA nor any underlying cause. Underestimating the burden of OHCA impacts ongoing patient and at-risk family care, data sampling strategies, international statistics and research funding.
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Affiliation(s)
- Elizabeth D Paratz
- Department of Sports Cardiology, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Alexander van Heusden
- Department of Sports Cardiology, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Jocasta Ball
- Department of Sports Cardiology, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Department of Research, Ambulance Victoria, Melbourne, Victoria, Australia
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Karen Smith
- Department of Research, Ambulance Victoria, Melbourne, Victoria, Australia
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Paramedicine, Monash University, Melbourne, Victoria, Australia
| | - Dominica Zentner
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Royal Melbourne Hospital Clinical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Natalie Morgan
- Victorian Institute of Forensic Medicine, Melbourne, Victoria, Australia
| | - Sarah Parsons
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Royal Melbourne Hospital Clinical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Tina Thompson
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Paul James
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Vanessa Connell
- Department of Cardiology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Andreas Pflaumer
- Department of Cardiology, Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, Melbourne University, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Jodie Ingles
- Department of Population Genomics, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | - Dion Stub
- Department of Sports Cardiology, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Research, Ambulance Victoria, Melbourne, Victoria, Australia
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andre La Gerche
- Department of Sports Cardiology, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
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Paratz ED, Nehme E, Heriot N, Bissland K, Rowe S, Fahy L, Anderson D, Stub D, La Gerche A, Nehme Z. A two-point strategy to clarify prognosis in >80 year olds experiencing out of hospital cardiac arrest. Resuscitation 2023; 191:109962. [PMID: 37683995 DOI: 10.1016/j.resuscitation.2023.109962] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND The global population is aging, with the number of ≥80-year-olds projected to triple over the next 30 years. Rates of out-of-hospital cardiac arrest (OHCA) are also increasing within this age group. METHODS The Victorian Ambulance Cardiac Arrest Registry was utilised to identify OHCAs in patients aged ≥80 years between 2002-2021. Predictors of survival to discharge were defined and a prognostic score derived from this cohort. RESULTS 77,628 patients experienced OHCA of whom 25,269 (32.6%) were ≥80 years (80-90 years = 18,956; 90-100 years = 6,148; >100 years = 209). The number of patients ≥80 years increased over time both absolutely (p = 0.002) and proportionally (p = 0.028). 619 (2.4%) patients survived to discharge without change over time. Older ages had no difference in witnessed OHCA status but were less likely to have shockable rhythm (OR 0.50 (95% CI 0.44-0.57) for 90-100-year-olds, OR 0.28 (95% CI 0.12-0.63) for 90-100-year-olds). If OHCA was witnessed and there was a shockable rhythm then survival was 14%; if one factor was present survival was 5-6% and if neither factor was present, survival was 0.09%. These survival rates enabled derivation of a simplified prognostic assessment score - the '15/5/0' score - highly comparable to a previously-published American cohort. CONCLUSIONS Elderly OHCA rates have increased to one-third of caseload. The most important factors predicting survival were whether the OHCA was witnessed and there was a shockable rhythm. We present a simple two-point '15/5/0' prognostic score defining which patients will gain most from advanced resuscitative measures.
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Affiliation(s)
- Elizabeth D Paratz
- Department of Sports Cardiology, Baker Heart & Diabetes Institute, 75 Commercial Rd, Prahran, VIC 3181, Australia; Department of Cardiology, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia; Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Parkville, VIC 3000, Australia; Ambulance Victoria, Centre for Research and Evaluation, 31 Joseph St, Blackburn, North VIC 3130, Australia. https://twitter.com/@pretzeldr
| | - Emily Nehme
- Ambulance Victoria, Centre for Research and Evaluation, 31 Joseph St, Blackburn, North VIC 3130, Australia; School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia
| | - Natalie Heriot
- Ambulance Victoria, Centre for Research and Evaluation, 31 Joseph St, Blackburn, North VIC 3130, Australia
| | - Kenneth Bissland
- Department of Geriatric Medicine, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia
| | - Stephanie Rowe
- Department of Sports Cardiology, Baker Heart & Diabetes Institute, 75 Commercial Rd, Prahran, VIC 3181, Australia; Department of Cardiology, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia; Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Parkville, VIC 3000, Australia
| | - Louise Fahy
- Department of Sports Cardiology, Baker Heart & Diabetes Institute, 75 Commercial Rd, Prahran, VIC 3181, Australia; Department of Cardiology, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia
| | - David Anderson
- Ambulance Victoria, Centre for Research and Evaluation, 31 Joseph St, Blackburn, North VIC 3130, Australia; School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia; Department of Cardiology, Alfred Health, 55 Commercial Rd, Prahran, VIC 3181, Australia
| | - Dion Stub
- Ambulance Victoria, Centre for Research and Evaluation, 31 Joseph St, Blackburn, North VIC 3130, Australia; School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia; Department of Cardiology, Alfred Health, 55 Commercial Rd, Prahran, VIC 3181, Australia
| | - Andre La Gerche
- Department of Sports Cardiology, Baker Heart & Diabetes Institute, 75 Commercial Rd, Prahran, VIC 3181, Australia; Department of Cardiology, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia; Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Parkville, VIC 3000, Australia
| | - Ziad Nehme
- Ambulance Victoria, Centre for Research and Evaluation, 31 Joseph St, Blackburn, North VIC 3130, Australia; School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia; Department of Paramedicine, Monash University, McMahons Road, Frankston, VIC 3199, Australia
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Trytell A, Osekowski M, Zentner D, Nehme Z, James P, Pflaumer A, Semsarian C, Ingles J, Stub D, La Gerche A, Paratz ED. Prevalence of illicit drug use in young patients with sudden cardiac death. Heart Rhythm 2023; 20:1349-1355. [PMID: 37295741 DOI: 10.1016/j.hrthm.2023.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/21/2023] [Accepted: 06/04/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Illicit drug use may accelerate coronary disease and cardiac hypertrophy or stimulate arrhythmias. Rates of illicit drug use in young patients with sudden cardiac death (SCD) are uncertain. OBJECTIVE The purpose of this study was to identify rates of illicit drug use in young patients with SCD. METHODS A prospective statewide registry identified out-of-hospital patients with cardiac arrest aged 18-50 years from April 2019 to April 2021. Clinical characteristics were compared between patients with and without illicit drug use (defined by toxicological results or reported regular use). Illicit drugs included amphetamine-type substances, cocaine, heroin, cannabis, and other drugs. RESULTS A total of 554 (40.2%) of 1378 patients had confirmed cardiac cause of out-of-hospital cardiac arrest, with 523 undergoing toxicological assessment. There were 170 patients (32.5%) having either positive toxicology for illicit drugs (n = 138) or negative toxicology but reported regular drug use (n = 32). Patients with SCD and illicit drug use were more commonly male (81.2% vs 72.3%; P = .028), smokers (38.8% vs 19.8%; P ≤ .0001), and excess alcohol drinkers (30.6% vs 20.6%; P = .012) and had a psychiatric diagnosis (38.8% vs 25.7%; P = .002), lower body mass index (29.4 kg/m2 vs 31.7 kg/m2; P = .0063), and lower rates of hypertension (10.6% vs 18.6%; P = .019). Death commonly occurred while sedentary (47.5%) or during sleep (45.8%). Accounting for these baseline differences, there were no differences in rates of coronary disease or cardiomyopathy. Cannabis (n = 106) was the most common illicit drug identified and polysubstance abuse occurred frequently (n = 25). CONCLUSION Approximately one-third of young patients with SCD have positive toxicology at the time of death or reported frequent use of illicit drugs, with high rates of polysubstance abuse.
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Affiliation(s)
- Adam Trytell
- Department of Cardiology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Michael Osekowski
- Department of Cardiology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Dominica Zentner
- Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Cardiology, Royal Melbourne Hospital Clinical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Ziad Nehme
- Ambulance Victoria, Doncaster, Victoria, Australia; Department of Paramedicine, Monash University, Melbourne, Victoria, Australia; Department of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Paul James
- Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Andreas Pflaumer
- Department of Cardiology, The Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Chris Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Jodie Ingles
- Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | - Dion Stub
- Ambulance Victoria, Doncaster, Victoria, Australia; Department of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Cardiology, Alfred Hospital, Prahran, Victoria, Australia
| | - Andre La Gerche
- Department of Cardiology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Department of Cardiology, Alfred Hospital, Prahran, Victoria, Australia; Baker Heart and Diabetes Institute, Prahran, Victoria, Australia; Department of Medicine, Dentistry and Health Sciences, Melbourne University, Parkville, Victoria, Australia
| | - Elizabeth D Paratz
- Department of Cardiology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Department of Cardiology, Alfred Hospital, Prahran, Victoria, Australia; Baker Heart and Diabetes Institute, Prahran, Victoria, Australia; Department of Medicine, Dentistry and Health Sciences, Melbourne University, Parkville, Victoria, Australia.
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Paratz ED, van Heusden A, Zentner D, Morgan N, Smith K, Thompson T, James P, Connell V, Pflaumer A, Semsarian C, Ingles J, Parsons S, Rauchberger I, Stub D, La Gerche A. Sudden Cardiac Death in People With Schizophrenia: Higher Risk, Poorer Resuscitation Profiles, and Differing Pathologies. JACC Clin Electrophysiol 2023; 9:1310-1318. [PMID: 37558287 DOI: 10.1016/j.jacep.2023.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 12/30/2022] [Accepted: 01/11/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND People with schizophrenia account for approximately 1.0% of the population and seem to experience increased rates of sudden cardiac death (SCD). OBJECTIVES This study sought to determine characteristics of increased SCD in people with schizophrenia. METHODS The End Unexplained Cardiac Death (EndUCD) prospective state-wide registry compared people aged 15 to 50 years with and without schizophrenia who experienced SCD within a 2-year time period and were referred for forensic evaluation. RESULTS We identified 579 individuals, of whom 65 (11.2%) had schizophrenia. Patients with schizophrenia were more commonly smokers (46.2% vs 23.0%; P < 0.0001), consumed excess alcohol (32.3% vs 21.4%; P = 0.05), and used QTc-prolonging medications (69.2% vs 17.9%; P < 0.0001). They were less likely to arrest while exercising (0.0% vs 6.4%; P = 0.04). Unfavorable arrest-related factors included lower rates of witnessed arrest (6.2% vs 23.5%; P < 0.0001), more likely to be found in asystole (92.3% vs 73.3%; P < 0.0001), and being more likely to be found as part of a welfare check after a prolonged period of time (median 42 hours vs 12 hours; P = 0.003). There was more frequent evidence of decomposition, and they more commonly underwent autopsy (41.2% vs 26.4%; P = 0.04 and 93.8% vs 82.5%; P = 0.05), with a diagnosis of nonischemic cardiomyopathy being more common (29.2% vs 18.1%; P = 0.04). CONCLUSIONS People with schizophrenia account for 11% of young SCD patients referred for forensic investigations, exceeding population rates by 11-fold. They have a higher preexisting cardiac risk factor burden, unfavorable resuscitation profiles, and higher rates of nonischemic cardiomyopathy. Strategies targeting biopsychosocial support may deliver not only psychological benefits, but also help to decrease unwitnessed cardiac arrest.
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Affiliation(s)
- Elizabeth D Paratz
- Baker Heart and Diabetes Institute, Prahran, Victoria, Australia; Alfred Hospital, Prahran, Victoria, Australia; St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.
| | | | - Dominica Zentner
- Royal Melbourne Hospital, Parkville, Victoria, Australia; Royal Melbourne Hospital Clinical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Natalie Morgan
- Victorian Institute of Forensic Medicine, Southbank, Victoria, Australia
| | - Karen Smith
- Ambulance Victoria, Doncaster, Victoria, Australia; Department of Paramedicine, Monash University, Melbourne, Victoria, Australia; Department of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Tina Thompson
- Royal Melbourne Hospital, Parkville, Victoria, Australia; Royal Melbourne Hospital Clinical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Paul James
- Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Vanessa Connell
- The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Andreas Pflaumer
- The Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, The University of Sydney, Sydney, New South Wales, Australia
| | - Jodie Ingles
- Garvan Institute of Medical Research, Darlinghurst, Sydney, New South Wales, Australia
| | - Sarah Parsons
- Victorian Institute of Forensic Medicine, Southbank, Victoria, Australia; Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia
| | - Ilan Rauchberger
- Alfred Hospital, Prahran, Victoria, Australia; Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Dion Stub
- Baker Heart and Diabetes Institute, Prahran, Victoria, Australia; Alfred Hospital, Prahran, Victoria, Australia; Ambulance Victoria, Doncaster, Victoria, Australia; Department of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andre La Gerche
- Baker Heart and Diabetes Institute, Prahran, Victoria, Australia; Alfred Hospital, Prahran, Victoria, Australia; St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
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Affiliation(s)
- Elizabeth D Paratz
- Baker Heart and Diabetes Institute, Prahran, VIC, Australia (E.D.P., A.L.G.)
- Ambulance Victoria, Doncaster, Australia (E.D.P., Z.N., D.S.)
| | - Ziad Nehme
- Ambulance Victoria, Doncaster, Australia (E.D.P., Z.N., D.S.)
| | - Dion Stub
- Ambulance Victoria, Doncaster, Australia (E.D.P., Z.N., D.S.)
- Department of Cardiology, Alfred Health, Prahran, VIC, Australia (D.S.)
| | - Andre La Gerche
- Baker Heart and Diabetes Institute, Prahran, VIC, Australia (E.D.P., A.L.G.)
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Paratz ED, La Gerche A, Thompson PL. Declining Recognition of Chest Pain as a Cardiac Symptom Should Act as a Shot in The Arm. Heart Lung Circ 2023; 32:435-437. [PMID: 37080637 DOI: 10.1016/j.hlc.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Affiliation(s)
- Elizabeth D Paratz
- Baker Heart & Diabetes Institute, Melbourne, Vic, Australia; St Vincent's Hospital Melbourne, Melbourne, Vic, Australia; Faculty of Medicine, Dentistry & Health Sciences, Melbourne University, Melbourne, Vic, Australia.
| | - Andre La Gerche
- Baker Heart & Diabetes Institute, Melbourne, Vic, Australia; St Vincent's Hospital Melbourne, Melbourne, Vic, Australia; Faculty of Medicine, Dentistry & Health Sciences, Melbourne University, Melbourne, Vic, Australia
| | - Peter L Thompson
- Sir Charles Gairdner Hospital, Perth, WA, Australia; University of Western Australia, Perth, WA, Australia; Harry Perkins Institute of Medical Research, Perth, WA, Australia
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Paratz ED, Rowe SJ, Stub D, Pflaumer A, La Gerche A. A systematic review of global autopsy rates in all-cause mortality and young sudden death. Heart Rhythm 2023; 20:607-613. [PMID: 36640854 DOI: 10.1016/j.hrthm.2023.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/03/2023] [Accepted: 01/05/2023] [Indexed: 01/13/2023]
Abstract
Autopsy is the gold standard method for determining cause of death. Young sudden death (SD) is a prototype condition in which autopsy is universally recommended. The aim of this review was to quantify real-world global rates of autopsy in either all-cause death or young SD. A systematic review was conducted. Rates of autopsy in all-cause death and in young SD were determined in each country using scientific and commercial search engines. In total, 59 of 195 countries (30.3%) reported autopsy rates in all-cause death, with rates varying from 0.01%-83.9%. Almost all of these figures derived from academic publications rather than governmental statistics. Only 16 of 195 countries (8.2%) reported autopsy rates in the context of young SD, with reported rates ranging from 5%-100%. The definition of "young" was heterogeneous. No governmental statistics reported autopsy rates in young SD. Risks of bias included inability to verify reported figures, heterogeneity in reporting of clinical vs medicolegal autopsies, and the small number of studies identified overall, resulting in the consistent exclusion of low- and middle-income countries. In conclusion, most countries globally do not report autopsy rates in either all-cause death (69.7%) or in SD (92.8%). Without transparent reporting of autopsy rates, global burdens of disease and rates of sudden cardiac death cannot be reliably calculated.
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Affiliation(s)
- Elizabeth D Paratz
- Baker Heart & Diabetes Institute, Prahran, Australia; Alfred Hospital, Prahran, Australia; St. Vincent's Hospital, Fitzroy, Australia.
| | - Stephanie J Rowe
- Baker Heart & Diabetes Institute, Prahran, Australia; Alfred Hospital, Prahran, Australia; St. Vincent's Hospital, Fitzroy, Australia
| | - Dion Stub
- Baker Heart & Diabetes Institute, Prahran, Australia; Alfred Hospital, Prahran, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Andreas Pflaumer
- Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, Melbourne University, Parkville, Australia; Murdoch Children's Research Institute, Parkville, Australia
| | - Andre La Gerche
- Baker Heart & Diabetes Institute, Prahran, Australia; Alfred Hospital, Prahran, Australia; St. Vincent's Hospital, Fitzroy, Australia
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Paratz ED, van Heusden A, Zentner D, Morgan N, Smith K, Thompson T, James P, Connell V, Pflaumer A, Semsarian C, Ingles J, Parsons S, Stub D, Gerche AL. Causes, circumstances, and potential preventability of cardiac arrest in the young: insights from a state-wide clinical and forensic registry. Europace 2022; 24:1933-1941. [PMID: 36037012 DOI: 10.1093/europace/euac141] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/21/2022] [Indexed: 12/14/2022] Open
Abstract
AIMS The causes, circumstances, and preventability of young sudden cardiac arrest remain uncertain. METHODS AND RESULTS A prospective state-wide multi-source registry identified all out-of-hospital cardiac arrests (OHCAs) in 1-50 year olds in Victoria, Australia, from 2019 to 2021. Cases were adjudicated using hospital and forensic records, clinic assessments and interviews of survivors and family members. For confirmed cardiac causes of OHCA, circumstances and cardiac history were collected. National time-use data was used to contextualize circumstances. 1319 OHCAs were included. 725 (55.0%) cases had a cardiac aetiology of OHCA, with coronary disease (n = 314, 23.8%) the most common pathology. Drug toxicity (n = 226, 17.1%) was the most common non-cardiac cause of OHCA and the second-most common cause overall. OHCAs were most likely to occur in sleep (n = 233, 41.2%). However, when compared to the typical Australian day, OHCAs occurred disproportionately more commonly during exercise (9% of patients vs. 1.3% of typical day, P = 0.018) and less commonly while sedentary (39.6 vs. 54.6%, P = 0.047). 38.2% of patients had known standard modifiable cardiovascular risk factors. 77% of patients with a cardiac cause of OHCA had not reported cardiac symptoms nor been evaluated by a cardiologist prior to their OHCA. CONCLUSION Approximately half of OHCAs in the young have a cardiac cause, with coronary disease and drug toxicity dominant aetiologies. OHCAs disproportionately occur during exercise. Of patients with cardiac cause of OHCA, almost two-thirds have no standard modifiable cardiovascular risk factors, and more than three-quarters had no prior warning symptoms or interaction with a cardiologist.
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Affiliation(s)
- Elizabeth D Paratz
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC 3181, Australia.,Alfred Hospital, 55 Commercial Rd, Prahran, VIC 3181, Australia.,St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC 3065, Australia
| | | | - Dominica Zentner
- Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC 3050, Australia.,Royal Melbourne Hospital Clinical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC 3000, Australia
| | - Natalie Morgan
- Victorian Institute of Forensic Medicine, 65 Kavanagh St, Southbank, VIC 3006, Australia
| | - Karen Smith
- Ambulance Victoria, 375 Manningham Rd, Doncaster, VIC 3108, Australia.,Department of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia.,Department of Paramedicine, Monash University, Melbourne, VIC, Australia
| | - Tina Thompson
- Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC 3050, Australia
| | - Paul James
- Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC 3050, Australia
| | - Vanessa Connell
- Royal Children's Hospital, 50 Flemington Rd, Parkville Melbourne, VIC 3052, Australia
| | - Andreas Pflaumer
- Royal Children's Hospital, 50 Flemington Rd, Parkville Melbourne, VIC 3052, Australia.,Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Rd, Parkville, VIC 3052, Australia.,Department of Paediatrics, Melbourne University, Parkville, VIC 3010, Australia
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Missenden Rd, Sydney, NSW 2050, Australia
| | - Jodie Ingles
- Centre for Population Genomics, Garvan Institute of Medical Research, and UNSW Sydney, Sydney, NSW, Australia.,Centre for Population Genomics, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Sarah Parsons
- Victorian Institute of Forensic Medicine, 65 Kavanagh St, Southbank, VIC 3006, Australia.,Department of Forensic Medicine, Monash University, 65 Kavanagh St, Southbank, VIC 3006, Australia
| | - Dion Stub
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC 3181, Australia.,Alfred Hospital, 55 Commercial Rd, Prahran, VIC 3181, Australia.,Ambulance Victoria, 375 Manningham Rd, Doncaster, VIC 3108, Australia.,Department of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia
| | - Andre La Gerche
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC 3181, Australia.,Alfred Hospital, 55 Commercial Rd, Prahran, VIC 3181, Australia.,St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC 3065, Australia
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Affiliation(s)
- Elizabeth D Paratz
- Clinical Research Domain, Baker Heart and Diabetes Institute, Commercial Road Melbourne, 3004 VIC, Australia.,Cardiology Department, St Vincent's Hospital Melbourne, Victoria Parade Fitzroy, 3065 VIC, Australia
| | - André La Gerche
- Clinical Research Domain, Baker Heart and Diabetes Institute, Commercial Road Melbourne, 3004 VIC, Australia.,Cardiology Department, St Vincent's Hospital Melbourne, Victoria Parade Fitzroy, 3065 VIC, Australia
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Trytell A, Paratz ED, Van Heusden A, Zentner D, Morgan N, Smith K, Thompson T, James P, Connell V, Pflaumer A, Semsarian C, Ingles J, Stub D, Parsons S, La Gerche A. Prevalence of illicit drug use in young sudden cardiac death patients; an Australian prospective cohort study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Illicit drug use may accelerate coronary disease and cardiac hypertrophy or stimulate arrhythmias. Rates of illicit drug use in young sudden cardiac death (SCD) patients are uncertain.
Purpose
To identify rates of illicit drug use in young SCD patients in Australia.
Methods
A prospective multi-centre registry identified out of hospital cardiac arrest (OHCA) patients aged 1–50 years between April 2019 and April 2020. Clinical characteristics were compared between patients with and without illicit drug use (defined by toxicological results or reported regular use). Illicit drugs included stimulants such as amphetamine-type substances and cocaine, or non-stimulants such as heroin, cannabis and novel psychoactive substances (cathinones and synthetic cannabinoids).
Results
770 OHCAs occurred, with 555 patients undergoing forensic assessment. 287 patients had confirmed cardiac cause of OHCA, with 274 undergoing toxicological assessment and 79 (28.8%) having positive toxicology for illicit drugs (n=60) or reported regular drug use (n=19). An additional 121 patients experienced non-cardiac SCD due to illicit drug toxicity, resulting in a total of 200 patients (36.0% of OHCAs) with illicit drug use. Patients with SCD and illicit drug use were more commonly male (86.1% vs 72.3%, p=0.015), regular smokers (36.7% vs 21.5%, p=0.009), had cardiomegaly (76.5% vs 57.5%, p=0.007), and higher rates of coronary disease and cardiomyopathy (coronary disease 44.3% vs 33.3%, cardiomyopathy 30.4% vs 18.5%, p=0.003). Methamphetamines (n=42, 53.1%) were the most common illicit drug identified and polysubstance abuse occurred frequently (n=15, 19.0%).
Conclusion
Approximately one-third of young SCD patients use illicit drugs, with high rates of polysubstance abuse. Illicit drug use in SCD patients is associated with coronary disease and cardiomyopathy.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Trytell
- St Vincent's Hospital , Melbourne , Australia
| | - E D Paratz
- St Vincent's Hospital , Melbourne , Australia
| | | | - D Zentner
- Royal Melbourne Hospital , Melbourne , Australia
| | - N Morgan
- Victorian Institute of Forensic Medicine , Melbourne , Australia
| | - K Smith
- Ambulance Victoria , Melbourne , Australia
| | - T Thompson
- Royal Melbourne Hospital , Melbourne , Australia
| | - P James
- Royal Melbourne Hospital , Melbourne , Australia
| | - V Connell
- Royal Children's Hospital , Melbourne , Australia
| | - A Pflaumer
- Royal Children's Hospital , Melbourne , Australia
| | | | - J Ingles
- Garvan Institute of Medical Research , Sydney , Australia
| | - D Stub
- The Alfred Hospital , Melbourne , Australia
| | - S Parsons
- Victorian Institute of Forensic Medicine , Melbourne , Australia
| | - A La Gerche
- St Vincent's Hospital , Melbourne , Australia
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Paratz ED, Ashokkumar S, van Heusden A, Smith K, Zentner D, Morgan N, Parsons S, Thompson T, James P, Connell V, Pflaumer A, Semsarian C, Ingles J, Stub D, Gerche AL. Obesity in young sudden cardiac death: Rates, clinical features, and insights into people with body mass index >50kg/m2. Am J Prev Cardiol 2022; 11:100369. [PMID: 35928552 PMCID: PMC9344343 DOI: 10.1016/j.ajpc.2022.100369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 07/03/2022] [Accepted: 07/24/2022] [Indexed: 11/30/2022] Open
Abstract
55.0% of young sudden cardiac death (SCD) patients in Victoria, Australia are obese. This obesity prevalence exceeds that in the age-matched general Australian population, with all classes of obesity over-represented in our SCD cohort. Patients with BMI>50 kg/m2 represented 8.5% of young SCD. Almost two thirds of patients with BMI>50 kg/m2 died from left ventricular hypertrophy, with fewer than 10% dying from coronary disease.
Objective To contextualize obesity rates in young sudden cardiac death (SCD) against the age-matched national population, and identify clinical and pathologic features in WHO class II and III obesity. Methods A prospective state-wide out-of-hospital cardiac arrest registry included all SCDs in Victoria, Australia from 2019–2021. Body mass indices (BMIs) of patients 18-50 years were compared to age-referenced general population. Characteristics of SCD patients with WHO Class II obesity (BMI ≥30kg/m2) and non-obesity (BMI<30kg/m2) were compared. Clinical characteristics of people with BMI>50kg/m2 were assessed. Results 504 patients were included. Obesity was strongly over-represented in young SCD compared to the age-matched general population (55.0% vs 28.7%, p<0.0001). Obese SCD patients more frequently had hypertension, diabetes and obstructive sleep apnoea (p<0.0001, p=0.009 and p=0.001 respectively), ventricular fibrillation as their arrest rhythm (p=0.008) and left ventricular hypertrophy (LVH) (p<0.0001). Obese patients were less likely to have toxicology positive for illicit substances (22.0% vs 32.6%, p=0.008) or history of alcohol abuse (18.8% vs 26.9%, p=0.030). Patients with BMI>50 kg/m2 represented 8.5% of young SCD. LVH (n=26, 60.5%) was their predominant cause of death and only 10 (9.3%) patients died from coronary disease. Conclusion Over half of young Australian SCD patients are obese, with all obesity classes over-represented compared to the general population. Obese patients had more cardiac risk factors. Almost two thirds of patients with BMI>50 kg/m2 died from LVH, with fewer than 10% dying from coronary disease.
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Affiliation(s)
- Elizabeth D Paratz
- Baker Heart and Diabetes Institute, 75 Commercial Rd Prahran, Melbourne, VIC 3181, Australia
- Alfred Hospital, 55 Commercial Rd Prahran, Melbourne, VIC 3181, Australia
- St Vincent's Hospital Melbourne, 41 Victoria Pde Fitzroy, Melbourne, VIC 3065, Australia
- Corresponding author at: Baker Heart and Diabetes Institute, 75 Commercial Rd Prahran, Melbourne, VIC 3181, Australia.
| | - Srikkumar Ashokkumar
- St Vincent's Hospital Melbourne, 41 Victoria Pde Fitzroy, Melbourne, VIC 3065, Australia
| | - Alexander van Heusden
- Baker Heart and Diabetes Institute, 75 Commercial Rd Prahran, Melbourne, VIC 3181, Australia
| | - Karen Smith
- Ambulance Victoria, 375 Manningham Rd, Doncaster, VIC 3108, Australia
- Department of Paramedicine, Monash University, Melbourne, VIC, Australia
| | - Dominica Zentner
- Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC 3050, Australia
- Royal Melbourne Hospital Clinical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC 3000, Australia
| | - Natalie Morgan
- Victorian Institute of Forensic Medicine, 65 Kavanagh St, Southbank, VIC 3006, Australia
| | - Sarah Parsons
- Department of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia
- Victorian Institute of Forensic Medicine, 65 Kavanagh St, Southbank, VIC 3006, Australia
| | - Tina Thompson
- Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC 3050, Australia
| | - Paul James
- Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC 3050, Australia
| | - Vanessa Connell
- Royal Children's Hospital, 50 Flemington Rd Parkville Melbourne, VIC 3052, Australia
| | - Andreas Pflaumer
- Royal Children's Hospital, 50 Flemington Rd Parkville Melbourne, VIC 3052, Australia
- Department of Paediatrics, Melbourne University, Parkville, VIC 3010, Australia
- Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Rd, Parkville, VIC 3052, Australia
| | - Chris Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Missenden Rd, Sydney, NSW 2050, Australia
| | - Jodie Ingles
- Garvan Institute of Medical Research, 384 Victoria St Darlinghurst, Sydney, NSW 2010, Australia
| | - Dion Stub
- Baker Heart and Diabetes Institute, 75 Commercial Rd Prahran, Melbourne, VIC 3181, Australia
- Alfred Hospital, 55 Commercial Rd Prahran, Melbourne, VIC 3181, Australia
- Ambulance Victoria, 375 Manningham Rd, Doncaster, VIC 3108, Australia
- Department of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia
| | - Andre La Gerche
- Baker Heart and Diabetes Institute, 75 Commercial Rd Prahran, Melbourne, VIC 3181, Australia
- Alfred Hospital, 55 Commercial Rd Prahran, Melbourne, VIC 3181, Australia
- St Vincent's Hospital Melbourne, 41 Victoria Pde Fitzroy, Melbourne, VIC 3065, Australia
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21
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Paratz ED, van Heusden A, Smith K, Brennan A, Dinh D, Ball J, Lefkovits J, Kaye DM, Nicholls S, Pflaumer A, La Gerche A, Stub D. Factors predicting cardiac arrest in acute coronary syndrome patients under 50: a state-wide angiographic and forensic evaluation of outcomes. Resuscitation 2022; 179:124-130. [PMID: 36031075 DOI: 10.1016/j.resuscitation.2022.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/16/2022] [Accepted: 08/21/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND An uncertain proportion of patients with acute coronary syndrome (ACS) also experience out-of-hospital cardiac arrest (OHCA). Predictors of OHCA in ACS remain unclear and vulnerable to selection bias as pre-hospital deceased patients are usually not included. METHODS Data on patients aged 18-50 years from a percutaneous coronary intervention (PCI) and OHCA registry were combined to identify all patients experiencing OHCA due to ACS (not including those managed medically or who proceeded to cardiac surgery). Clinical, angiographic and forensic details were collated. In-hospital and post-discharge outcomes were compared between OHCA survivors and non-OHCA ACS patients. RESULTS OHCA occurred in 6.0% of ACS patients transported to hospital and 10.0% of all ACS patients. Clinical predictors were non-diabetic status (p=0.015), non-obesity (p=0.004), ST-elevation myocardial infarction (p<0.0001) and left main (p<0.0002) or left anterior descending (LAD) coronary artery (p<0.0001) as culprit vessel. OHCA patients had poorer in-hospital clinical outcomes, including longer length of stay and higher pre-procedural intubation, cardiogenic shock, major adverse cardiovascular events, bleeding, and mortality (p<0.0001 for all). At 30 days, OHCA survivors had equivalent cardiac function and return to premorbid independence but higher rates of anxiety/depression (p=0.029). CONCLUSION OHCA complicates approximately 10% of ACS in the young. Predictors of OHCA are being non-diabetic, non-obese, having a STEMI presentation, and left main or LAD coronary culprit lesion. For OHCA patients surviving to PCI, higher rates of in-hospital complications are observed. Despite this, recovery of pre-morbid physical and cardiac function is equivalent to non-OHCA patients, apart from higher rates of anxiety/depression.
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Affiliation(s)
- Elizabeth D Paratz
- Baker Heart and Diabetes Institute, 75 Commercial Rd Prahran VIC 3181; Alfred Hospital, 55 Commercial Rd Prahran VIC 3181; St Vincent's Hospital Melbourne, 41 Victoria Pde Fitzroy VIC 3065.
| | | | - Karen Smith
- Ambulance Victoria, 375 Manningham Rd Doncaster VIC 3108; Department of Paramedicine, Monash University, Melbourne VIC; Department of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd Melbourne 3004
| | - Angela Brennan
- Department of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd Melbourne 3004
| | - Diem Dinh
- Department of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd Melbourne 3004
| | - Jocasta Ball
- Department of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd Melbourne 3004
| | - Jeff Lefkovits
- Department of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd Melbourne 3004
| | - David M Kaye
- Alfred Hospital, 55 Commercial Rd Prahran VIC 3181
| | - Steve Nicholls
- Department of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd Melbourne 3004
| | - Andreas Pflaumer
- Royal Children's Hospital, 50 Flemington Rd Parkville Melbourne VIC 3052; Department of Paediatrics, Melbourne University, Parkville VIC 3010; Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Rd Parkville VIC 3052
| | - Andre La Gerche
- Baker Heart and Diabetes Institute, 75 Commercial Rd Prahran VIC 3181; Alfred Hospital, 55 Commercial Rd Prahran VIC 3181; St Vincent's Hospital Melbourne, 41 Victoria Pde Fitzroy VIC 3065
| | - Dion Stub
- Baker Heart and Diabetes Institute, 75 Commercial Rd Prahran VIC 3181; Alfred Hospital, 55 Commercial Rd Prahran VIC 3181; Ambulance Victoria, 375 Manningham Rd Doncaster VIC 3108; Department of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd Melbourne 3004
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Paratz ED, van Heusden A, Zentner D, Morgan N, Smith K, Ball J, Thompson T, James P, Connell V, Pflaumer A, Semsarian C, Ingles J, Stub D, Parsons S, La Gerche A. Prevalence of Coronary Artery Anomalies in Young and Middle-Aged Sudden Cardiac Death Victims (from a Prospective State-Wide Registry). Am J Cardiol 2022; 175:127-130. [PMID: 35662474 DOI: 10.1016/j.amjcard.2022.03.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/10/2022] [Accepted: 03/18/2022] [Indexed: 11/01/2022]
Abstract
Coronary artery anomalies (CAAs) have been previously implicated as a major cause of young sudden cardiac death (SCD), particularly in exercise-related SCD, with a prevalence of up to 33%. A state-wide prospective out-of-hospital cardiac arrest registry identified all patients aged 1 to 50 years who experienced an SCD and underwent autopsy from April 2019 to April 2021. Rates of normal anatomy, normal variants, and CAAs were identified, and circumstances and causes of death for patients with CAAs examined. Of 1,477 patients who experienced cardiac arrest during the study period, 490 underwent autopsy and were confirmed to have experienced SCD. Of these 490 patients, 5 (1%) had a CAA identified, with 3 having anomalies of coronary origin and 2 having anomalies of coronary course. In no cases were the CAA deemed responsible for the SCD. In 2 cases, severe coronary disease and intra-coronary thrombus with histological evidence of acute myocardial infarction were identified. In the third, critical coronary disease was found, the fourth had an unrelated thoracic aortic dissection, and the fifth had cardiomegaly in the setting of illicit drug use. Of 27 patients who experienced their SCD during exercise, only 1 had a CAA identified (the patient with thoracic aortic dissection). In conclusion, in this prospective cohort of consecutive young patients with SCD who underwent autopsy, CAAs occurred in 1% of patients and did not cause any deaths. The role of CAAs in causing young and middle-aged SCD appears to be less significant than previously hypothesized.
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Paratz ED, van Heusden A, Smith K, Ball J, Zentner D, Morgan N, Thompson T, James P, Connell V, Pflaumer A, Semsarian C, Ingles J, Parsons S, Stub D, La Gerche A. Higher rates but similar causes of young out-of-hospital cardiac arrest in rural Australian patients. Aust J Rural Health 2022; 30:619-627. [PMID: 35704685 DOI: 10.1111/ajr.12890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 04/06/2022] [Accepted: 05/16/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To determine whether young rural Australians have higher rates or different underlying causes of out-of-hospital cardiac arrest (OHCA). DESIGN A case-control design identified patients experiencing an OHCA, then compared annual OHCA rates and underlying causes in rural versus metropolitan Victoria. OHCA causes were defined as either cardiac or non-cardiac, with specific aetiologies including coronary disease, cardiomyopathy, unascertained cause of arrest, drug toxicity, respiratory event, neurological event and other cardiac and non-cardiac. For OHCAs with confirmed cardiac aetiology, cardiovascular risk profiles were compared. SETTING A state-wide prospective OHCA registry (combining ambulance, hospital and forensic data) in the state of Victoria, Australia (population 6.5 million). PARTICIPANTS Victorians aged 1-50 years old experienced an OHCA between April 2019 and April 2020. MAIN OUTCOME MEASURES Rates and underlying causes of OHCA in young rural and metropolitan Victorians. RESULTS Rates of young OHCA were higher in rural areas (OHCA 22.5 per 100 000 rural residents vs. 13.4 per 100 000 metropolitan residents, standardised incidence ratio 168 (95% CI 101-235); confirmed cardiac cause of arrest 12.1 per 100 000 rural residents versus 7.5 per 100 000 metropolitan residents, standardised incidence ratio 161 (95% CI 71-251). The underlying causation of the OHCA and cardiovascular risk factor burden did not differ between rural and metropolitan areas. CONCLUSION Higher rates of OHCA occur in young rural patients, with standardised incidence ratio of 168 compared to young metropolitan residents. Rural status did not influence causes of cardiac arrest or known cardiovascular risk factor burden in young patients experiencing OHCA.
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Affiliation(s)
- Elizabeth D Paratz
- Baker Heart and Diabetes Institute, Prahran, Vic., Australia.,Alfred Hospital, Prahran, Vic., Australia.,St Vincent's Hospital Melbourne, Fitzroy, Vic., Australia
| | | | - Karen Smith
- Ambulance Victoria, Doncaster, Vic., Australia.,Department of Paramedicine, Monash University, Melbourne, Vic., Australia.,Department of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - Jocasta Ball
- Baker Heart and Diabetes Institute, Prahran, Vic., Australia.,Ambulance Victoria, Doncaster, Vic., Australia
| | - Dominica Zentner
- Royal Melbourne Hospital, Parkville, Vic., Australia.,Royal Melbourne Hospital Clinical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Vic., Australia
| | - Natalie Morgan
- Victorian Institute of Forensic Medicine, Southbank, Vic., Australia
| | - Tina Thompson
- Royal Melbourne Hospital, Parkville, Vic., Australia
| | - Paul James
- Royal Melbourne Hospital, Parkville, Vic., Australia
| | | | - Andreas Pflaumer
- Royal Children's Hospital, Melbourne, Vic., Australia.,Department of Paediatrics, Melbourne University, Parkville, Vic., Australia.,Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Vic., Australia
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, NSW, Australia
| | - Jodie Ingles
- Garvan Institute of Medical Research, Sydney, NSW, Australia
| | - Sarah Parsons
- Victorian Institute of Forensic Medicine, Southbank, Vic., Australia.,Department of Forensic Medicine, Monash University, Southbank, Vic., Australia
| | - Dion Stub
- Alfred Hospital, Prahran, Vic., Australia.,Ambulance Victoria, Doncaster, Vic., Australia.,Department of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - Andre La Gerche
- Baker Heart and Diabetes Institute, Prahran, Vic., Australia.,Alfred Hospital, Prahran, Vic., Australia.,St Vincent's Hospital Melbourne, Fitzroy, Vic., Australia
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Paratz ED, Mock N, Marques D, Wilson W, Kushwaha V, Eggleton S, Harries J, da Silva S, Dos Santos da Silva A, Saramento J, de Sousa Maurays J, Flavio R, Horton A, Gutman S, Creati L, Barlis P, Appelbe A, Bayley N. Telemedicine to Timor-Leste: implementing an international cardiac telehealth service during population dislocation, floods and COVID-19. Intern Med J 2022; 52:2076-2085. [PMID: 35319143 PMCID: PMC9111676 DOI: 10.1111/imj.15753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/20/2022] [Accepted: 03/06/2022] [Indexed: 11/30/2022]
Abstract
Background The East Timor Hearts Fund (ETHF) has provided cardiac services in Timor‐Leste since 2010, conducting three clinics yearly. With international border closures due to the COVID‐19 pandemic, development of collaborative telehealth services was required. Methods Scoping discussions identified major challenges (structural, patient‐related and medical system‐related). At two pilot clinics, patient history, investigation and management were collated. Clinic metrics were compared to an index face‐to‐face clinic in February 2019. Post‐clinic discussions identified areas of success and shortfall in the conduct of the telehealth clinics. Results 23 patients were reviewed at the online telehealth clinics held onsite at Timorese medical facilities. Compared to an index 2019 clinic,there were markedly lower numbers of new referrals (2 vs 190 patients, 8.7% vs 59.4%). Patients seen at the online clinic were predominantly female (17/23, 73.9%) and Dili‐based (18/23, 78.3%) with a mean age of 25.9 ± 7.2 years old. The majority (12/23, 52.2%) had isolated rheumatic mitral valve disease. Investigations including electrocardiography, pathology, echocardiography and 6‐minute walk tests were conducted in select patients. Medication advice was provided for 10 (43.5%) patients. 11 patients (47.8%) were deemed to require urgent intervention. Post‐clinic discussions indicated general satisfaction with telehealth clinics, although frustration at current inability to provide interventional services was highlighted. Conclusion Our pilot telehealth clinics indicate that capacity‐building telemedicine can be rapidly implemented in an emergency setting internationally. Clinic design benefits from careful identification and resolution of challenges to optimise flow. Cardiac patients in Timor‐Leste have a significant burden of disease amenable to intervention. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Elizabeth D Paratz
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, 3181, VIC, Australia.,Alfred Hospital, 55 Commercial Rd, Prahran, 3181, VIC, Australia.,St Vincent's Hospital Melbourne, 41 Victoria Pde Fitzroy, 3065, VIC, Australia
| | - Nicki Mock
- East Timor Hearts Fund, Melbourne, VIC, Australia
| | | | - Will Wilson
- Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC, 3050
| | - Virag Kushwaha
- Eastern Heart Clinic, Prince of Wales Hospital, Randwick, 2031, NSW, Australia
| | - Simon Eggleton
- Eastern Heart Clinic, Prince of Wales Hospital, Randwick, 2031, NSW, Australia
| | - Jess Harries
- Maluk Timor, Rua Aidak Nurak, Comoro, Dili, Timor-Leste
| | | | | | | | | | | | - Ari Horton
- Monash Children's Hospital, 246 Clayton Rd Clayton, 3168, VIC, Australia
| | - Sarah Gutman
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, 3181, VIC, Australia.,Alfred Hospital, 55 Commercial Rd, Prahran, 3181, VIC, Australia.,St Vincent's Hospital Melbourne, 41 Victoria Pde Fitzroy, 3065, VIC, Australia
| | - Louise Creati
- St Vincent's Hospital Melbourne, 41 Victoria Pde Fitzroy, 3065, VIC, Australia
| | - Peter Barlis
- St Vincent's Hospital Melbourne, 41 Victoria Pde Fitzroy, 3065, VIC, Australia.,Northern Hospital, 185 Cooper St Epping, 3076, VIC, Australia
| | - Alan Appelbe
- University Hospital Geelong, Bellerine St Geelong, 3220, VIC, Australia
| | - Noel Bayley
- Warrnambool Base Hospital, 25 Ryot St Warrnambool, 3280, VIC, Australia
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Paratz ED, Block TJ, Stub DA, La Gerche A, Kistler PM, Kalman JM, Strathmore N, Mond H, Woodford NWF, Burke M, Voskoboinik A. Postmortem Interrogation of Cardiac Implantable Electronic Devices: A 15-Year Experience. JACC Clin Electrophysiol 2022; 8:356-366. [PMID: 35331431 DOI: 10.1016/j.jacep.2021.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/13/2021] [Accepted: 10/25/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVES This study sought to define the feasibility and utility of postmortem cardiac implantable electronic device (CIED) interrogation. BACKGROUND The diagnostic yield of routine postmortem interrogation of CIEDs including pacemakers, defibrillators, and implantable loop recorders has not been established. METHODS The study reviewed all CIED interrogations in deceased individuals undergoing medicolegal investigation of sudden or unexplained death by the Victorian Institute of Forensic Medicine between 2005 and 2020. RESULTS A total of 260 patients (68.8% male, median age 72.8 years [interquartile range: 62.7-82.2 years]) underwent CIED interrogation (202 pacemakers, 56 defibrillators, and 2 loop recorders) for investigation of sudden (n = 162) or unexplained (n = 98) death. CIEDs were implanted for median of 2.0 years (interquartile range: 0.7-5.0 years), with 19 devices at elective replacement indicator and 5 at end of life. Interrogation was successful in 256 (98.5%) cases. Potential CIED malfunction was identified in 20 (7.7%) cases, including untreated ventricular arrhythmias (n = 13) and lead failures (n = 3, 2 resulting in untreated ventricular arrhythmia). Interrogation directly informed cause of death in 131 (50.4%) cases. A total of 72 (27.7%) patients had abnormalities recorded in 30 days preceding death: nonsustained ventricular tachycardia (n = 26), rapid atrial fibrillation (n = 17), elective replacement indicator or end-of-life status (n = 22), intrathoracic impedance alarms (n = 3), lead issues (n = 3), or therapy delivered (n = 1). In 6 cases in which the patient was found deceased after a prolonged period, interrogation determined time of death. In 1 case, CIED interrogation was the primary means of patient identification. CONCLUSIONS Postmortem CIED interrogation frequently contributes important information regarding critical device malfunction, premortem abnormalities, mechanism, and time of death or patient identity. Device interrogation should be considered for select patients with CIEDs undergoing autopsy.
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Affiliation(s)
- Elizabeth D Paratz
- Department of Cardiology, Baker Heart and Diabetes Institute, Prahran, Victoria, Australia; Department of Cardiology, Alfred Hospital, Prahran, Victoria, Australia; St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Tomasz J Block
- Department of General Medicine, Austin Hospital, Heidelberg, Victoria, Australia; Department of Diabetes, Central Clinical School, Monash University, the Alfred Centre, Melbourne, Victoria, Australia
| | - Dion A Stub
- Department of Cardiology, Alfred Hospital, Prahran, Victoria, Australia; Department of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Cardiology, Western Health, St Albans, Victoria, Australia
| | - Andre La Gerche
- Department of Cardiology, Baker Heart and Diabetes Institute, Prahran, Victoria, Australia; Department of Cardiology, Alfred Hospital, Prahran, Victoria, Australia; St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Peter M Kistler
- Department of Cardiology, Baker Heart and Diabetes Institute, Prahran, Victoria, Australia; Department of Cardiology, Alfred Hospital, Prahran, Victoria, Australia; Department of Cardiology, Western Health, St Albans, Victoria, Australia; Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Jonathan M Kalman
- Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria, Australia; Royal Melbourne Hospital Clinical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Neil Strathmore
- Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria, Australia; Royal Melbourne Hospital Clinical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Harry Mond
- Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria, Australia; Royal Melbourne Hospital Clinical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Noel W F Woodford
- Victorian Institute of Forensic Medicine, Southbank, Victoria, Australia; Department of Cardiology, Western Health, St Albans, Victoria, Australia
| | - Michael Burke
- Victorian Institute of Forensic Medicine, Southbank, Victoria, Australia; Department of Cardiology, Western Health, St Albans, Victoria, Australia
| | - Aleksandr Voskoboinik
- Department of Cardiology, Baker Heart and Diabetes Institute, Prahran, Victoria, Australia; Department of Cardiology, Alfred Hospital, Prahran, Victoria, Australia; Department of Cardiology, Western Health, St Albans, Victoria, Australia; Department of Medicine, Monash University, Clayton, Victoria, Australia.
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Paratz ED, Ross L, Zentner D, Morgan N, Bouwer H, Lynch M, Parsons S, La Gerche A. Intracoronary IgG4-related disease as an unusual cause of sudden cardiac arrest: a case series. Eur Heart J Case Rep 2022; 6:ytac050. [PMID: 35187393 PMCID: PMC8851923 DOI: 10.1093/ehjcr/ytac050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/30/2021] [Accepted: 01/19/2022] [Indexed: 01/14/2023]
Abstract
Background IgG4-related disease (IgG4-RD) is a fibro-inflammatory condition classically causing retroperitoneal fibrosis, aortitis, thyroiditis, or pancreatitis. Diagnosis includes the presence of lymphoplasmacytic infiltrate (with >40% ratio IgG4+:IgG plasma cells) and fibrosis. Cardiac involvement may include aortic, pericardial, or coronary disease. Coronary manifestations encompass obstructive intra-luminal lesions, external encasing pseudo-tumour on imaging, or lymphoplasmacytic arteritis. Case summary Case 1: A fit and healthy 50-year-old man was found deceased. His only known medical condition was treated Hashimoto’s thyroiditis. Post-mortem examination demonstrated an isolated severe stenosis of the left anterior descending (LAD) coronary artery without histopathological evidence of acute myocardial infarction. Coronary plaque histopathology showed florid IgG4-positive plasma cell infiltrate throughout all layers of the artery with dense fibrous tissue connective tissue stroma, all features consistent with coronary artery IgG4-RD. Case 2: A 48-year-old man collapsed at work. Computed tomography scan 1 week prior reported an ill-defined para-aortic retroperitoneal soft tissue density. No cardiac symptoms were reported in life. Post-mortem examination showed coronary arteritis and peri-arteritis with sclerosing peri-aortitis in the LAD. There was myocardial fibrosis of the anterior left ventricle and focal myocarditis of the right ventricle. Discussion IgG4-related disease presenting as sudden cardiac death without any preceding symptoms is very rare (six prior cases identified on literature review). Reported targeted successful interventions for intracoronary IgG4-RD diagnosed in life have included steroid therapy and B cell depleting therapy (i.e. rituximab). If cardiac symptoms are present in a patient with known IgG4-RD, cardiac investigations should be promptly arranged.
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Affiliation(s)
- Elizabeth D Paratz
- Department of Cardiology, Baker Heart and Diabetes Institute, 75 Commercial Road, Prahran, VIC 3181, Australia
- Department of Cardiology, Alfred Hospital, 55 Commercial Road, Prahran, VIC 3181, Australia
- Department of Cardiology, St Vincent’s Hospital Melbourne, 41 Victoria Pde, Fitzroy. VIC 3065, Australia
| | - Laura Ross
- Department of Cardiology, St Vincent’s Hospital Melbourne, 41 Victoria Pde, Fitzroy. VIC 3065, Australia
- Department of Rheumatology, St Vincent’s Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC 3065, Australia
- Department of Medicine, The University of Melbourne at St Vincent’s, 41 Victoria Pde, Fitzroy, VIC 3065, Australia
| | - Dominica Zentner
- Department of Cardiology, Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC 3050, Australia
- Department of Cardiology, Royal Melbourne Hospital Clinical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC 3000, Australia
| | - Natalie Morgan
- Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, VIC 3006, Australia
| | - Heinrich Bouwer
- Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, VIC 3006, Australia
- Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, VIC 3006, Australia
| | - Matthew Lynch
- Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, VIC 3006, Australia
- Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, VIC 3006, Australia
| | - Sarah Parsons
- Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, VIC 3006, Australia
- Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, VIC 3006, Australia
| | - Andre La Gerche
- Department of Cardiology, Baker Heart and Diabetes Institute, 75 Commercial Road, Prahran, VIC 3181, Australia
- Department of Cardiology, Alfred Hospital, 55 Commercial Road, Prahran, VIC 3181, Australia
- Department of Cardiology, St Vincent’s Hospital Melbourne, 41 Victoria Pde, Fitzroy. VIC 3065, Australia
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Paratz ED, van Heusden A, Zentner D, Morgan N, Smith K, Ball J, Thompson T, James P, Connell V, Pflaumer A, Semsarian C, Ingles J, Stub D, Parsons S, La Gerche A. Predictors and outcomes of in-hospital referrals for forensic investigation after young sudden cardiac death. Heart Rhythm 2022; 19:937-944. [DOI: 10.1016/j.hrthm.2022.01.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/26/2022] [Accepted: 01/27/2022] [Indexed: 11/27/2022]
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Costello BT, Climie RE, Wright L, Janssens K, Mitchell A, Wallace I, Lindqvist A, Foulkes S, Paratz ED, Flannery MD, Saner N, Griffin D, Green DJ, Cowie B, Howden EH, Garnham A, La Gerche A. Athletes with mild COVID-19 illness demonstrate subtle imaging abnormalities without exercise impairment or arrhythmias. Eur J Prev Cardiol 2021; 29:e220-e223. [PMID: 34669943 PMCID: PMC8574300 DOI: 10.1093/eurjpc/zwab166] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Ben T Costello
- Sports Cardiology Lab, Baker Heart and Diabetes Institute, Level 4, 99 Commercial Rd, Melbourne, VIC 3004, Australia
| | - Rachel E Climie
- Sports Cardiology Lab, Baker Heart and Diabetes Institute, Level 4, 99 Commercial Rd, Melbourne, VIC 3004, Australia.,Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS 7000, Australia
| | - Leah Wright
- Sports Cardiology Lab, Baker Heart and Diabetes Institute, Level 4, 99 Commercial Rd, Melbourne, VIC 3004, Australia
| | - Kristel Janssens
- Sports Cardiology Lab, Baker Heart and Diabetes Institute, Level 4, 99 Commercial Rd, Melbourne, VIC 3004, Australia
| | - Amy Mitchell
- Sports Cardiology Lab, Baker Heart and Diabetes Institute, Level 4, 99 Commercial Rd, Melbourne, VIC 3004, Australia
| | - Imogen Wallace
- Sports Cardiology Lab, Baker Heart and Diabetes Institute, Level 4, 99 Commercial Rd, Melbourne, VIC 3004, Australia
| | - Anniina Lindqvist
- Sports Cardiology Lab, Baker Heart and Diabetes Institute, Level 4, 99 Commercial Rd, Melbourne, VIC 3004, Australia
| | - Steve Foulkes
- Sports Cardiology Lab, Baker Heart and Diabetes Institute, Level 4, 99 Commercial Rd, Melbourne, VIC 3004, Australia
| | - Elizabeth D Paratz
- Sports Cardiology Lab, Baker Heart and Diabetes Institute, Level 4, 99 Commercial Rd, Melbourne, VIC 3004, Australia
| | - Michael D Flannery
- Sports Cardiology Lab, Baker Heart and Diabetes Institute, Level 4, 99 Commercial Rd, Melbourne, VIC 3004, Australia
| | - Nicholas Saner
- Sports Cardiology Lab, Baker Heart and Diabetes Institute, Level 4, 99 Commercial Rd, Melbourne, VIC 3004, Australia
| | - David Griffin
- Infectious Disease Department, Alfred Hospital, Commercial Road, Melbourne, VIC 3004, Australia
| | - Danny J Green
- School of Human Sciences, University of Western Australia, 35 Stirling Highway, Perth 6009, Australia
| | - Brian Cowie
- Sports Cardiology Lab, Baker Heart and Diabetes Institute, Level 4, 99 Commercial Rd, Melbourne, VIC 3004, Australia
| | - Erin H Howden
- Sports Cardiology Lab, Baker Heart and Diabetes Institute, Level 4, 99 Commercial Rd, Melbourne, VIC 3004, Australia
| | - Andrew Garnham
- Faculty of Health, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
| | - Andre La Gerche
- Sports Cardiology Lab, Baker Heart and Diabetes Institute, Level 4, 99 Commercial Rd, Melbourne, VIC 3004, Australia.,National Centre for Sports Cardiology, St Vincent's Hospital Melbourne, Victoria Parade, Fitzroy, VIC 3065, VIC, Australia
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Rowe SJ, Paratz ED, Fahy L, Prior DL, MacIsaac AI. Telehealth in Australian cardiology: insight into factors predicting the use of telephone versus video during the COVID-19 pandemic. Intern Med J 2021; 51:1229-1235. [PMID: 34227713 PMCID: PMC8447318 DOI: 10.1111/imj.15444] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 06/25/2021] [Accepted: 06/26/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The use of telehealth has increased dramatically in Australia in 2020 as a pragmatic response to the COVID-19 pandemic; however, differences between telehealth modalities have not been established. AIM To identify characteristics contributing to choosing telephone (TP) versus video consultation (VC) and assess patient outcomes between telehealth modalities. METHODS We conducted an observational study of cardiology outpatients at a tertiary hospital with appointments from 17 March 2020 to 12 August 2020. Demographic variables and appointment modality were compared between each group. Outcomes assessed were mortality, emergency department (ED) presentations and cross over between appointment modalities. RESULTS There were 1754 telemedicine encounters with 1188 patients seen by TP and 327 patients by VC. Consulting volume increased from previous years. Cardiac mortality was low (0.3%). There were no differences in mortality or ED presentations between telehealth modalities. Patients choosing TP over VC were older (P < 0.001), more likely to be female (P = 0.005), non-English-speaking (P = 0.041), living in metropolitan Melbourne (P < 0.0001), undertaking a first appointment (P = 0.002) and seeing particular cardiologists (P < 0.001). VC patients were more likely to have early review (P = 0.015), and this was likely to be TP (P < 0.0001). TP patients were more likely to follow up in person (P < 0.0001). CONCLUSION During COVID-19, we increased consultation volumes without adverse patient outcomes. We identified factors influencing the choice of telemedicine modality which did not translate into differences in mortality or ED presentations. Telemedicine is a growing platform with an important role of facilitating access to healthcare for diverse patient groups.
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Affiliation(s)
- Stephanie J Rowe
- Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Elizabeth D Paratz
- Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Louise Fahy
- Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - David L Prior
- Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Andrew I MacIsaac
- Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
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Parsons S, Paratz ED, van Heusden A, Zentner D, Morgan N, Thompson T, James P, Pflaumer A, Semsarian C, Ingles J, Case R, Ball J, Smith K, Stub D, La Gerche A. The formation of a cardiac arrest registry in Australia [End unexplained cardiac death (EndUCP) registry]. Pathology 2021. [DOI: 10.1016/j.pathol.2021.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Paratz ED, Wilkie BD. Carbon monoxide exposure in hospital accommodation. Intern Med J 2021; 51:625. [PMID: 33890377 DOI: 10.1111/imj.15269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 11/29/2020] [Accepted: 12/07/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Elizabeth D Paratz
- Department of Cardiology, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Bruce D Wilkie
- Department of General Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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Paratz ED, Rowsell L, van Heusden A, Zentner D, Parsons S, Morgan N, Thompson T, James P, Pflaumer A, Semsarian C, Ingles J, Case R, Ball J, Smith K, Stub D, La Gerche A. The End Unexplained Cardiac Death (EndUCD) Registry for Young Australian Sudden Cardiac Arrest. Heart Lung Circ 2021; 30:714-720. [DOI: 10.1016/j.hlc.2020.09.937] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 09/20/2020] [Indexed: 10/23/2022]
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Paratz ED, Mock N, Gutman SJ, Horton A, Creati L, Appelbe A, Eggleton S, Kushwaha V, da Silva Almeida IT, Monteiro A, Bayley N. Taking the pulse of Timor-Leste's cardiac needs: a 10-year descriptive time-trend analysis. Intern Med J 2021; 50:838-845. [PMID: 31237730 DOI: 10.1111/imj.14411] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/13/2019] [Accepted: 06/16/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Timor-Leste is one of the poorest countries in the world. The East Timor Hearts Fund is a charitable organisation involving Australian cardiologists providing outreach screening and access to cardiac interventions. AIMS To assess ten years of clinical volume, demographics and patient outcomes. Our intention was to identify existing limitations to facilitate planning for further capacity building over the next decade. METHODS The East Timor Hearts Fund database was sectioned into 2-year intervals (2009/2010, 2011/2012, 2013/2014, 2015/2016 and 2017/2018). Demographics and clinical outcomes of patients were compared, with subgroup analysis of adult (>18 years old), paediatric and interventional patients. RESULTS Over 10 years, 2050 patient encounters have occurred; 1119 (54.6%) encounters occurred in 2017/2018; 73.6% of patients were assessed in the capital Dili. Rheumatic and congenital cardiac diseases remain very common (39.1% of adult new patients and 74.2% of paediatric new patients), with 1.4% of new patients exhibiting both pathologies. The number of new patients with rheumatic or congenital heart disease tripled in 2017/2018 compared to 2009/2010 (99 vs 34 patients, P < 0.0001). Paediatric case volume increased over 10-fold over 10 years (288 new patients in 2017/2018 vs 24 in 2009/2010, P < 0.0001), with corresponding increase in proportion of paediatric interventions (59.4% in 2017/2018 vs 25.0% in 2009/2010, P = 0.027). For patients undergoing intervention (n = 87), post-procedural complications and mortality are extremely low (3.4% and 1.1%, respectively), with all eligible patients attending at least one post-procedure appointment. CONCLUSION Demand for cardiac services in Timor-Leste is rising exponentially, with inequitable geographic coverage. Rheumatic and congenital cardiac diseases remain priorities for assessment, and paediatric case volume is increasing. Patients undergoing intervention experience good medical outcomes.
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Affiliation(s)
- Elizabeth D Paratz
- East Timor Hearts Fund, Melbourne, Victoria, Australia.,Cardiology Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Cardiology Department, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Nicki Mock
- East Timor Hearts Fund, Melbourne, Victoria, Australia
| | - Sarah J Gutman
- East Timor Hearts Fund, Melbourne, Victoria, Australia.,Cardiology Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Cardiology Department, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Ari Horton
- East Timor Hearts Fund, Melbourne, Victoria, Australia.,Paediatric Cardiology, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Louise Creati
- East Timor Hearts Fund, Melbourne, Victoria, Australia.,Cardiology Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Alan Appelbe
- East Timor Hearts Fund, Melbourne, Victoria, Australia.,Cardiology Department, Geelong Hospital, Geelong, Victoria, Australia
| | - Simon Eggleton
- East Timor Hearts Fund, Melbourne, Victoria, Australia.,Cardiology Department, Eastern Heart Clinic, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Virag Kushwaha
- East Timor Hearts Fund, Melbourne, Victoria, Australia.,Cardiology Department, Eastern Heart Clinic, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Inez T da Silva Almeida
- Internal Medicine, Hospital Nacional Guido Valdares, Dili, Timor-Leste.,Valdares Cardiology, Warrnambool Base Hospital, Warrnambool, Victoria, Australia
| | - Andre Monteiro
- Internal Medicine, Hospital Nacional Guido Valdares, Dili, Timor-Leste.,Valdares Cardiology, Warrnambool Base Hospital, Warrnambool, Victoria, Australia
| | - Noel Bayley
- East Timor Hearts Fund, Melbourne, Victoria, Australia.,Valdares Cardiology, Warrnambool Base Hospital, Warrnambool, Victoria, Australia
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Paratz ED, Smith K, Ball J, van Heusden A, Zentner D, Parsons S, Morgan N, Thompson T, James P, Pflaumer A, Semsarian C, Stub D, Liew D, La Gerche A. The economic impact of sudden cardiac arrest. Resuscitation 2021; 163:49-56. [PMID: 33865963 DOI: 10.1016/j.resuscitation.2021.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 02/15/2021] [Accepted: 04/01/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND There are 20,000 sudden cardiac arrests (SCAs) in Australia annually, with 90% case-fatality. OBJECTIVE The present study calculated both the health and economic impact of SCAs in Victoria, Australia. METHODS Data on all SCAs attended by Ambulance Victoria from July 2017 to June 2018 were collected regarding age, gender, and survival to hospital, discharge and 12 months. Pre-SCA employment status of all patients was modelled using age and gender-matched Australian economic data. A Markov state-transition model with a five-year horizon calculated health and economic impact in years of life lived (YLL), productivity-adjusted life years (PALYs) and gross domestic product (GDP) lost. A counterfactual Markov state-transition model assessed outcomes of an identical cohort of patients who did not experience SCA. All values were discounted by 5%. RESULTS In 12 months, 4637 people suffered SCAs in Victoria, of whom 1516 (32.7%) were working at the time. 695 patients (15.0%) survived to hospital, 325 (7.0%) to discharge, and 303 (6.5%) to 12 months. In five years following their SCA, the cohort lost 15,922 years of life and 2327 PALYs. Reduced productivity led to GDP losses of AUD$448 million (92.8% relative reduction). Extrapolated to the 20,000 SCAs occurring across all of Australia, total GDP losses approached AUD$2 billion. CONCLUSION The health and economic burden of SCAs is high, predominantly underpinned by very high mortality. Annual national losses approach AUD$2 billion (USD$1.42 billion) and are comparable to productivity losses from all cancers combined. Prioritising research and state-of-the-art care for SCA patients appears economically sound.
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Affiliation(s)
- Elizabeth D Paratz
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC, 3181, Australia; Alfred Hospital, 55 Commercial Rd, Prahran, VIC, 3181, Australia; St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC, 3065, Australia.
| | - Karen Smith
- Ambulance Victoria, 375 Manningham Rd, Doncaster, VIC, 3108, Australia; Department of Paramedicine, Monash University, Melbourne, VIC, Australia; Department of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne 3004, Australia
| | - Jocasta Ball
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC, 3181, Australia; Ambulance Victoria, 375 Manningham Rd, Doncaster, VIC, 3108, Australia; Department of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne 3004, Australia
| | | | - Dominica Zentner
- Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC, 3050, Australia; Royal Melbourne Hospital Clinical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, 3000, Australia
| | - Sarah Parsons
- Victorian Institute of Forensic Medicine, 65 Kavanagh St, Southbank, VIC, 3006, Australia; Department of Forensic Medicine, Monash University, 65 Kavanagh St, Southbank, VIC, 3006, Australia
| | - Natalie Morgan
- Victorian Institute of Forensic Medicine, 65 Kavanagh St, Southbank, VIC, 3006, Australia
| | - Tina Thompson
- Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC, 3050, Australia
| | - Paul James
- Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC, 3050, Australia
| | - Andreas Pflaumer
- Royal Children's Hospital, 50 Flemington Rd Parkville, Melbourne, VIC, 3052, Australia; Department of Paediatrics, Melbourne University, Parkville, VIC, 3010, Australia; Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Rd, Parkville, VIC, 3052, Australia
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, The University of Sydney, Missenden Rd, Sydney, NSW, 2050, Australia
| | - Dion Stub
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC, 3181, Australia; Alfred Hospital, 55 Commercial Rd, Prahran, VIC, 3181, Australia; Ambulance Victoria, 375 Manningham Rd, Doncaster, VIC, 3108, Australia; Department of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne 3004, Australia
| | - Danny Liew
- Alfred Hospital, 55 Commercial Rd, Prahran, VIC, 3181, Australia; Department of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne 3004, Australia
| | - Andre La Gerche
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC, 3181, Australia; Alfred Hospital, 55 Commercial Rd, Prahran, VIC, 3181, Australia; St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC, 3065, Australia
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Wilkie BD, Chandra R, Chua J, Lam DCS, Paratz ED, An V, Keck JO. Efficacy of postoperative oral metronidazole for haemorrhoidectomy pain: a randomized double-blind, placebo-controlled trial. Colorectal Dis 2021; 23:274-282. [PMID: 32750730 DOI: 10.1111/codi.15291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 07/17/2020] [Indexed: 02/08/2023]
Abstract
AIM The aim of this work was to examine the efficacy of oral metronidazole in reducing posthaemorrhoidectomy pain versus placebo. METHOD Forty patients were randomized to either metronidazole and standard care or placebo and standard care (21 metronidazole, 19 placebo) in a double-blinded, randomized controlled trial. The main outcome measure was posthaemorrhoidectomy pain scores over 21 days, measured on a 10-point Likert scale. RESULTS There were no significant differences between groups with regards to age, gender, smoking status, self-reported general health or quality of life, haemorrhoid-related pain, haemorrhoid-related impact on quality of life, reported satisfaction with surgery, experience of surgery, median overall pain score or likelihood of recommending surgery to others. For reported median worst pain scores and defaecation-related pain, a trend to significance was identified between groups on days 16 and 18-21, with the metronidazole group reporting less pain. However, these differences were not significant when prespecified Bonferroni correction criteria were used. Using multilevel mixed effects modelling, the impact of time on median worst pain score was identified to be highly significant (P < 0.0001) whereas treatment allocation (placebo versus metronidazole) did not significantly affect the improvement in patients' reported pain (P = 0.8837). CONCLUSION Our data do not support the hypothesis that postoperative metronidazole has a clinically meaningful effect on posthaemorrhoidectomy pain. This study adds to the previous literature, and implies that it should not be routinely used as an adjunct to analgesia.
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Affiliation(s)
- B D Wilkie
- Department of Surgery, Eastern Health, Melbourne, Victoria, Australia.,Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - R Chandra
- Department of Surgery, Eastern Health, Melbourne, Victoria, Australia.,Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Monash University, Clayton, Victoria, Australia
| | - J Chua
- Department of Surgery, Eastern Health, Melbourne, Victoria, Australia
| | - D C S Lam
- Department of Surgery, Eastern Health, Melbourne, Victoria, Australia.,Department of Surgery, Northern Health, Melbourne, Vic, Australia
| | - E D Paratz
- St Vincent's Hospital Melbourne, Fitzroy, Melbourne, Victoria, Australia
| | - V An
- Department of Surgery, Eastern Health, Melbourne, Victoria, Australia.,Monash University, Clayton, Victoria, Australia
| | - J O Keck
- Department of Surgery, Eastern Health, Melbourne, Victoria, Australia.,St Vincent's Hospital Melbourne, Fitzroy, Melbourne, Victoria, Australia
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Paratz ED, Costello B, Rowsell L, Morgan N, Smith K, Thompson T, Semsarian C, Pflaumer A, James P, Stub D, La Gerche A, Zentner D, Parsons S. Can post-mortem coronary artery calcium scores aid diagnosis in young sudden death? Forensic Sci Med Pathol 2020; 17:27-35. [PMID: 33190173 DOI: 10.1007/s12024-020-00335-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2020] [Indexed: 12/16/2022]
Abstract
This study sought to explore the feasibility and utility of post-mortem coronary artery calcium (CAC) scoring in identifying patients with ischemic heart disease as cause of sudden death. 100 deceased patients aged 18-50 years underwent post-mortem examination in the setting of sudden death. At post-mortem, fifty cases were determined to have ischemic heart disease, and fifty had death attributed to trauma or unascertained causes. The CAC score was calculated in a blinded manner from post-mortem CTs performed on all cases. CAC scores were assessable in 97 non-decomposed cases (feasibility 97%). The median CAC score was 88 Agatston units [IQR 0-286] in patients deceased from ischemic heart disease vs 0 [IQR 0-0] in patients deceased from other causes (p < 0.0001). Presence of any coronary calcification differed significantly between ischemic heart disease and non-ischemic groups (adjusted odds ratio 10.7, 95% CI 3.2-35.5). All cases with a CAC score > 100 (n = 22) had ischemic heart disease as the cause of death. Fifteen cases had a CAC score of zero but severe coronary disease at post-mortem examination. Post-mortem CAC scoring is highly feasible. An elevated CAC score in cases 18-50 years old with sudden death predicts ischemic heart disease at post-mortem examination. However, a CAC score of zero does not exclude significant coronary artery disease. Post-mortem CAC score may be considered as a further assessment tool to help predict likely cause of death when there is an objection to or unavailability of post-mortem examination.
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Affiliation(s)
- Elizabeth D Paratz
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC, 3181, Australia. .,Alfred Hospital, 55 Commercial Rd, Prahran, VIC, 3181, Australia. .,St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC, 3065, Australia.
| | - Ben Costello
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC, 3181, Australia.,St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC, 3065, Australia
| | - Luke Rowsell
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC, 3181, Australia
| | - Natalie Morgan
- Victorian Institute of Forensic Medicine, 65 Kavanagh St, Southbank, VIC, 3006, Australia
| | - Karen Smith
- , Ambulance Victoria, 375 Manningham Rd, Doncaster, VIC, 3108, Australia.,Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Rd, Parkville, VIC, 3052, Australia
| | - Tina Thompson
- Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC, 3050, Australia
| | - Chris Semsarian
- Centenary Institute and The University of Sydney, Missenden Rd, Sydney, NSW, 2050, Australia
| | - Andreas Pflaumer
- Royal Children's Hospital, 50 Flemington Rd, Parkville Melbourne, VIC, 3052, Australia.,Department of Paediatrics, Melbourne University, Parkville, VIC, 3010, Australia.,Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Rd, Parkville, VIC, 3052, Australia
| | - Paul James
- Peter MacCallum Cancer Centre, 305 Grattan St, Parkville, VIC, 3050, Australia
| | - Dion Stub
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC, 3181, Australia.,Alfred Hospital, 55 Commercial Rd, Prahran, VIC, 3181, Australia.,Department of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, 3004, Australia
| | - André La Gerche
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC, 3181, Australia.,Alfred Hospital, 55 Commercial Rd, Prahran, VIC, 3181, Australia.,St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC, 3065, Australia
| | - Dominica Zentner
- Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC, 3050, Australia.,Royal Melbourne Hospital Clinical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, 3000, Australia
| | - Sarah Parsons
- Victorian Institute of Forensic Medicine, 65 Kavanagh St, Southbank, VIC, 3006, Australia.,Department of Forensic Medicine, Monash University, 65 Kavanagh St, Southbank, VIC, 3006, Australia
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Paratz ED, Gutman JM, Newcomb AE. The Sinister Mammary Hematoma: Extreme Pacing Lead Perforation Into the Breast. JACC Clin Electrophysiol 2018; 3:1060-1061. [PMID: 29759713 DOI: 10.1016/j.jacep.2017.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 01/09/2017] [Accepted: 01/09/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Elizabeth D Paratz
- Department of Cardiology, St. Vincent's Hospital Melbourne, Melbourne, Australia.
| | - Jack M Gutman
- Department of Cardiology, St. Vincent's Hospital Melbourne, Melbourne, Australia
| | - Andrew E Newcomb
- Department of Cardiothoracic Surgery, St. Vincent's Hospital Melbourne, Melbourne, Australia
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Paratz ED, Hare JL, Kaye DM. Double jeopardy: Competing arrhythmias in heterotopic heart transplants. J Heart Lung Transplant 2018; 37:936-938. [PMID: 29627142 DOI: 10.1016/j.healun.2018.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 02/27/2018] [Accepted: 03/14/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
- Elizabeth D Paratz
- Department of Cardiovascular Medicine, The Alfred Hospital, Melbourne, Australia.
| | - James L Hare
- Department of Cardiovascular Medicine, The Alfred Hospital, Melbourne, Australia; Baker Heart and Diabetes Institute, Melbourne, Australia
| | - David M Kaye
- Department of Cardiovascular Medicine, The Alfred Hospital, Melbourne, Australia; Baker Heart and Diabetes Institute, Melbourne, Australia
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Paratz ED, Kao C, MacIsaac AI, Somaratne J, Whitbourn R. Evolving management and improving outcomes of pregnancy-associated spontaneous coronary artery dissection (P-SCAD): a systematic review. Int J Cardiol Heart Vasc 2018; 18:1-6. [PMID: 29750179 PMCID: PMC5941240 DOI: 10.1016/j.ijcha.2017.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Accepted: 12/13/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND Pregnancy-associated spontaneous coronary artery dissection (P-SCAD) is defined as SCAD occurring during pregnancy or within 3 months post-partum. Earlier systematic reviews have suggested a high maternal and foetal mortality rate. We undertook a structured systematic review of P-SCAD demographics, management and maternal and foetal outcomes. METHODS Case study identification was conducted according to PRISMA guidelines, with screening of all published P-SCAD cases not meeting pre-defined exclusion criteria. Of two hundred and seventy-three publications screened, one hundred and thirty-eight cases met inclusion criteria. Cases were allocated to one of three time periods; 1960-85 (twenty cases) reflecting early management of P-SCAD, 1986-2005 (forty-two cases) reflecting recent management, and 2006-16 (seventy-six cases), reflecting contemporary management. RESULTS The only significant demographic change in women experiencing P-SCAD over the last 50 years was an increasing proportion of primigravidas (p = 0.02). Management and outcomes, however, have altered significantly. Emergent angiography (p < 0.0001), reduced thrombolysis (p = 0.006) and increasingly conservative or percutaneous management (p < 0.0001) are associated with dramatic reductions in maternal mortality (85% in earliest reports to 4% in the last decade, p < 0.0001) and foetal mortality (50% in earliest reports to 0.0% in the last decade, p = 0.023). CONCLUSION This systematic review of temporal changes in presentation, management and outcomes of P-SCAD represents the widest range of variables analysed in the largest cohort of P-SCAD patients to date. In the setting of earlier coronary angiography and increasingly conservative management, maternal and foetal survival rates continue to improve.
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Affiliation(s)
| | - Chien Kao
- Department of Cardiology, St Vincent's Hospital, Melbourne, Australia
| | - Andrew I MacIsaac
- Department of Cardiology, St Vincent's Hospital, Melbourne, Australia
| | | | - Robert Whitbourn
- Department of Cardiology, St Vincent's Hospital, Melbourne, Australia
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Paratz ED, Bayley N. Heart disease in East Timor: cross-sectional analysis of 474 patients attending Timor-Leste's first cardiology service. Intern Med J 2017; 47:423-428. [PMID: 28145049 DOI: 10.1111/imj.13381] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 01/09/2017] [Accepted: 01/23/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND East Timor is a developing country and is a close neighbour of Australia. The prevalence of cardiac disease is unknown. AIMS To describe the prevalence and patterns of cardiac disease in patients attending the first cardiology service of Timor-Leste. METHODS A cross-sectional retrospective analysis was performed of demographic and clinical data of 474 unique patients referred to outpatient cardiology clinics conducted in East Timor from 2003 to 2016. RESULTS Mean age was 29.9 ± 18.5 years, with females significantly younger than males (28.8 ± 16.9 vs 32.3 ± 20.6 years). Congenital cardiac disease patients were the youngest (15.5 ± 13.9 years) and cardiomyopathy patients the oldest (46.7 ± 17.8 years). Of patients with rheumatic heart disease, the majority had mitral stenosis (59.4%) and multi-valvular involvement (61.6%). Of note, 28.3% of patients with rheumatic heart disease presented with severe mitral stenosis. Amongst congenital heart disease patients, the most common diagnosis was atrial or ventricular septal defects (61% combined). A total of 19.2% of patients either required immediate referral for intervention or palliation for their cardiac disease. Patients referred to Australia for treatment were significantly younger (19.7 ± 11.7 years) than all other outcome groups. CONCLUSION Amongst young East Timorese, rheumatic heart disease and unrepaired congenital cardiac defects impose a significant burden. One-fifth of patients present to clinics with severe disease requiring urgent referral for surgery or palliation.
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Affiliation(s)
- Elizabeth D Paratz
- East Timor Hearts Fund, Melbourne, Victoria, Australia.,St Vincent's Health Melbourne, Melbourne, Victoria, Australia
| | - Noel Bayley
- East Timor Hearts Fund, Melbourne, Victoria, Australia
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Paratz ED, Nicolaides S, Layland J. Many shades of grey: seeking the optimal medical therapy of acute coronary syndrome in older people. J Pharm Pract Res 2017. [DOI: 10.1002/jppr.1365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - Jamie Layland
- Peninsula Health Heart Service; Frankston Australia
- Peninsula Clinic School; Monash University; Frankston Australia
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Paratz ED, Wilkinson LE, MacIsaac AI. Outcomes of Obese and Morbidly Obese Patients Undergoing Percutaneous Coronary Intervention. Heart Lung Circ 2017; 27:785-791. [PMID: 29428203 DOI: 10.1016/j.hlc.2017.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 06/26/2017] [Accepted: 08/06/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND The risks of percutaneous coronary intervention (PCI) in obese and particularly morbidly obese patients remain uncertain. METHODS 1082 consecutive patients were categorised as non-obese (NO, body mass index (BMI) <30kg/m2, n=688), obese (O, BMI 30-40kg/m2, n=354) or morbidly obese (MO, BMI ≥40kg/m2, n=40). Demographic and procedural information was collated. Monte Carlo simulations modelled radiation dosimetric data. RESULTS Obese and morbidly obese patients were younger (p=0.016), more frequently female (p=0.036), more frequently diabetic (p<0.0001), with better renal function (p<0.0001), and prior PCI (p=0.01). There was no difference in major adverse cardiovascular or cerebrovascular events (MACCE) (NO=1.2%, O=0.8%, MO=2.5%, p=NS), acute kidney injury, bleeding, length of stay, 30-day readmission or 30-day mortality. Obese and morbidly obese patients received increased contrast (NO=180 [150-230]mL, O=190 [160-250]mL, MO=200 [165-225]mL, p=0.016), dose area product (NO=75.56 [50.61-113.69]Gycm2, O=116.4 [76.11-157.82]Gycm2, MO=125.62 [92.22-158.81]Gycm2, p<0.0001), entrance air kerma (NO=1439.42 [977.0-2075.5]mGy, O=2111.63 [1492.0-3011.0]mGy, MO=2376.0 [1700.0-3234.42]mGy, p<0.0001), and peak skin dose (NO=1439.42 [977.0-2075.5], O=2111.63 [1492.0-3011.0], MO=2376.0 [1700.0-3234.42], p<0.0001). Effective radiation dose increased in obese patients (NO=20.9±14.9mSv, O=27.4±17.1mSv, MO=24.1±12.6mSv, p<0.0001 for NO vs O, p=0.449 for NO vs MO). CONCLUSIONS Percutaneous coronary intervention can be performed in obese and morbidly obese patients without elevated risk for most clinical outcomes. However, radiation increases above levels that could cause both transient and late effects. Strategies should be pursued to minimise radiation dose.
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Affiliation(s)
- Elizabeth D Paratz
- Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Vic, Australia.
| | - Luke E Wilkinson
- Department of Medical Engineering and Physics, St Vincent's Hospital Melbourne, Vic, Australia
| | - Andrew I MacIsaac
- Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Vic, Australia
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Paratz ED, Khav N, Burns AT. Systemic Mastocytosis, Kounis Syndrome and Coronary Intervention: Case Report and Systematic Review. Heart Lung Circ 2017; 26:772-778. [DOI: 10.1016/j.hlc.2016.12.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 11/09/2016] [Accepted: 12/13/2016] [Indexed: 12/12/2022]
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Paratz ED, Zhao J, Sherwen AK, Scarlato RM, MacIsaac AI. Is an Abnormal ECG Just the Tip of the ICE-berg? Examining the Utility of Electrocardiography in Detecting Methamphetamine-Induced Cardiac Pathology. Heart Lung Circ 2016; 26:684-689. [PMID: 28110851 DOI: 10.1016/j.hlc.2016.11.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 11/02/2016] [Accepted: 11/09/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Methamphetamine use is escalating in Australia and New Zealand, with increasing emergency department attendance and mortality. Cardiac complications play a large role in methamphetamine-related mortality, and it would be informative to assess the frequency of abnormal electrocardiograms (ECGs) amongst methamphetamine users. OBJECTIVE To determine the frequency and severity of ECG abnormalities amongst methamphetamine users compared to a control group. METHODS We conducted a retrospective cohort analysis on 212 patients admitted to a tertiary hospital (106 patients with methamphetamine use, 106 age and gender-matched control patients). Electrocardiograms were analysed according to American College of Cardiology guidelines. RESULTS Mean age was 33.4 years, with 73.6% male gender, with no significant differences between groups in smoking status, ECG indication, or coronary angiography rates. Methamphetamine users were more likely to have psychiatric admissions (22.6% vs 1.9%, p<0.0001). Overall, ECG abnormalities were significantly more common (71.7% vs 32.1%, p<0.0001) in methamphetamine users, particularly tachyarrhythmias (38.7% vs 26.4%, p<0.0001), right axis deviation (7.5% vs 0.0%, p=0.004), left ventricular hypertrophy (26.4% vs 4.7%, p<0.0001), P pulmonale pattern (7.5% vs 0.9%, p=0.017), inferior Q waves (10.4% vs 0.0%, p=0.001), lateral T wave inversion (3.8% vs 0.0%, p=0.043), and longer QTc interval (436.41±31.61ms vs 407.28±24.38ms, p<0.0001). Transthoracic echocardiogram (n=24) demonstrated left ventricular dysfunction (38%), thrombus (8%), valvular lesions (17%), infective endocarditis (17%), and pulmonary hypertension (13%). Electrocardiograms were only moderately sensitive at predicting abnormal TTE. CONCLUSION Electrocardiographic abnormalities are more common in methamphetamine users than age and gender-matched controls. Due to the high frequency of abnormalities, ECGs should be performed in all methamphetamine users who present to hospital. Methamphetamine users with abnormal ECGs should undergo further cardiac investigations.
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Affiliation(s)
- Elizabeth D Paratz
- Department of Cardiology, St Vincent's Hospital Melbourne, Vic, Australia.
| | - Jessie Zhao
- Department of Cardiology, St Vincent's Hospital Melbourne, Vic, Australia
| | - Amanda K Sherwen
- Department of Cardiology, St Vincent's Hospital Melbourne, Vic, Australia
| | | | - Andrew I MacIsaac
- Department of Cardiology, St Vincent's Hospital Melbourne, Vic, Australia
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Paratz ED, Cunningham NJ, MacIsaac AI. The Cardiac Complications of Methamphetamines. Heart Lung Circ 2015; 25:325-32. [PMID: 26706652 DOI: 10.1016/j.hlc.2015.10.019] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 10/26/2015] [Accepted: 10/31/2015] [Indexed: 11/18/2022]
Abstract
Methamphetamines are increasingly popular drugs of abuse in Australia, and are rising in purity. The rising popularity and purity of methamphetamines has notably increased demands upon Australian medical services. Methamphetamines are sympathomimetic amines with a range of adverse effects upon multiple organ systems. Cardiovascular complications are the second leading cause of death in methamphetamine abusers, and there appears to be a high prevalence of cardiac pathology. Cardiovascular pathology frequently seen in methamphetamine abusers includes hypertension, aortic dissection, acute coronary syndromes, pulmonary arterial hypertension and methamphetamine-associated cardiomyopathy. The rising prevalence of methamphetamine abuse is likely to increase the burden of cardiovascular pathology in Australians. A National Parliamentary Enquiry was opened in March 2015 to address concerns regarding the medical and social impacts of methamphetamine abuse. From April 2015, a National 'Ice Taskforce' was also created in parallel. Reversal of cardiac pathology appears to be achievable with abstinence from methamphetamines and initiation of appropriate treatment. It is key to appreciate that the pathogenesis of methamphetamine-induced cardiac complications arises as a result of the specific toxic effects of methamphetamines. Clinical management is hence individualised; suggested management approaches for methamphetamine-induced cardiac complications are detailed within this article.
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Affiliation(s)
| | - Neil J Cunningham
- Emergency Department, St Vincent's Hospital Melbourne, Vic, Australia
| | - Andrew I MacIsaac
- Cardiology Department, St Vincent's Hospital Melbourne, Vic, Australia
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Abstract
BACKGROUND Palliative care units provide non-curative treatment and support to patients with terminal illness. Brief end-of-life admissions are disruptive for patients and their families, and increase staff stress. Extremely rapid deaths (survival <24 h from admission) are particularly challenging for all involved. From 1 January 2010 to 23 August 2011, 256 patients died on the Palliative Care Unit (Caritas Christi) at St Vincent's Hospital Melbourne. Forty-two died within 24 h (16%), while 214 survived beyond 24 h (84%). AIMS A retrospective chart audit was conducted, aiming to identify factors characterising those patients who died within 24 h. METHODS Groups were compared for age, gender, country of birth, preferred language, ward of origin, primary pathology, time trends, whether an emergency code was called, Palliative Care Outcomes Collaboration (PCOC) phase, modified Karnofsky score and commencement of a syringe driver for medication. RESULTS Results showed that admission from neurosurgery (P= 0.0001), a vascular or infective pathology (P= 0.0001), PCOC phase ≥ 3 (P= 0.0001), modified Karnofsky score ≤ 20% (P= 0.0001), and commencement of a syringe driver prior to or at admission (P= 0.0001) were all significantly associated with death within 24 h of admission. On binary logistic regression, the only independent predictor of patients likely to die in <24 h from admission was PCOC phase ≥ 3 (P= 0.002).
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Abstract
In recent years, a phenomenon of "late effects of the Holocaust" has emerged, with impacts on the psychological and physical health of ageing Holocaust survivors. As Holocaust survivors age, they may experience heightened anxiety around normal processes of ageing, worsened post-traumatic stress disorder with cognitive decline, and fear of the medical system. Holocaust survivors are at increased risk of osteoporosis, cardiometabolic disease due to hypothalamic-pituitary-adrenal axis dysfunction, cancer, and sequelae of Nazi medical experiments. From existing medical literature on this topic, practical principles of management are derived to create a framework for sensitive medical management of Holocaust survivors in Australia. The issues discussed are also relevant to the wider geriatric refugee or prisoner-of-war experience.
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