Improving Ascertainment of Sudden Cardiac Death in Patients with End Stage Renal Disease

Abstract

SummaryBackground and objectives Data collected by the US Renal Data System (USRDS) identify sudden cardiac death (SCD) as the leading cause of death among hemodialysis patients. However, evidence suggests that clinical events captured on the USRDS death notification form may be inaccurate. A new method for classifying SCD was recently developed to enhance the accuracy of SCD classification. This study examined the performance characteristics of this refined definition using a cohort of hemodialysis patients who experienced a witnessed SCD as the reference standard.Design, setting, participants, & measurements This is a retrospective cohort study of 363 patients who experienced a witnessed SCD in US Gambro (DaVita) outpatient dialysis clinics. Sensitivity of SCD defined by death notification forms and SCD defined using additional administrative sources was compared. Clinical data recorded near time of death were also examined.Results Existing USRDS death notification forms reported 70.8% of witnessed SCD as "cardiac arrest/cause unknown" or "arrhythmia." The refined definition significantly improved identification to 83.8% of witnessed SCD events (P,0.001). Verified SCD cases that were not identified by either definition were more likely to be reported on the death notification form as death due to myocardial infarction, hyperkalemia, sepsis, malignancy, or unknown cause.Conclusions Compared with the death notification form alone, the refined SCD definition significantly improves the sensitivity of reporting of witnessed SCD occurring within outpatient hemodialysis clinics. More accurate reporting of cardiac events by clinicians and refinements to existing death notification forms may further improve recognition and understanding of SCD.

Heritability of Risk for Sudden Cardiac Arrest in ESRD

“…Although validation studies have shown that ESRD 2746 forms provide reasonable accuracy for the identification of fatal cardiac arrests, there still remains variation in the exact definition of cardiac arrest. 16,17 This heterogeneity may have biased our effect estimates and decreased our power to detect more granular outcomes. Although our matching included criteria to choose subjects in close geographic proximity to each other, we were not able to restrict case-control matching within the clinic, because some facilities had too few control subjects.…”

“…Validation studies of 2746 cardiac arrest outcomes against clinically adjudicated outcomes reported accuracy rates of 71%-84%. 16,17 The secondary outcomes of the study included all-cause mortality and noncardiovascular death.…”

Adverse Effects of Conventional Thrice-Weekly Hemodialysis: Is It Time to Avoid 3-Day Interdialytic Intervals?

“…Potassium Both hyper and hypokalemia are well-known risk factors of cardiac arrhythmias and sudden death [19] . Fluxes in potassium levels during the intra and interdialytic periods represent another important mechanism that could explain the day-of-week pattern of mortality.…”

Near-Term Prediction of Sudden Cardiac Death in Older Hemodialysis Patients Using Electronic Health Records

“…However, because exact timing of SCD is not recorded, it is not generally possible to differentiate between those patients who had an arrest during HD and those patients who had an arrest after completion (our population of interest). Previous work has shown that approximately 5 of 100,000 HD sessions result in an incenter SCD (15). To exclude events that occurred during the HD session, we required that postdialytic information (e.g., BP and weight) be present.…”