Pathoanatomic Findings Associated With Duty‐Related Cardiac Death in US Firefighters: A Case–Control Study

Abstract

BackgroundSudden cardiac death accounts for the greatest proportion of duty‐related deaths among US firefighters. Increased understanding of the pathoanatomic causes of sudden cardiac death and the risk associated with underlying cardiac pathologies is needed to develop evidence‐based screening recommendations.Methods and ResultsUsing autopsy data for duty‐related firefighter fatalities occurring between 1999 and 2014, this retrospective case–control study compared cardiac findings of male firefighters aged 18 to 65 years who died on duty of cardiac‐related causes with those who died of noncardiac trauma‐related causes. Data from 276 cardiac cases and 351 noncardiac trauma controls were analyzed. Among cardiac cases, the most prevalent (82%) underlying pathoanatomic substrate was comorbid coronary heart disease and cardiomegaly/left ventricular hypertrophy. Cardiac cases had a higher prevalence of cardiomegaly (heart weight >450 g), left ventricular hypertrophy (left ventricular wall thickness ≥1.2 cm), and severe coronary artery stenosis (≥75%) than trauma controls (all P<0.001). In multivariate analyses, heart weight >450 g, coronary artery stenosis ≥75%, and evidence of a prior myocardial infarction were strong independent predictors of cardiac death, with odds ratios of 6.1 (95% confidence interval, 3.6–10.4), 9.3 (95% confidence interval, 5.3–16.1), and 6.2 (95% confidence interval, 3.4–11.3), respectively.ConclusionsThe majority of cardiac fatalities had evidence of both coronary heart disease and increased heart mass, and each condition was independently associated with a markedly elevated risk of cardiac death. Targeted screening for coronary heart disease, increased heart mass, and evidence of prior myocardial infarction should be considered to reduce duty‐related cardiac deaths among firefighters.

Changes in Firefighter Weight and Cardiovascular Disease Risk Factors over Five Years

“…Obesity is also associated with a procoagulatory state in the general population ( 23 , 24 ), and firefighting has been found to increase coagulatory potential in firefighters postfirefighting activity ( 25 ). Further, obesity is associated with cardiomegaly, which is a common arrhythmogenic substrate in sudden cardiac events both in the general population ( 26 ) and in firefighters ( 8 , 27 ). Previous studies among firefighters have found that higher BMI is related to unfavorable CVD risk factors, including hypertension, high total cholesterol, elevated LDL cholesterol, and low levels of HDL cholesterol ( 10 , 17 , 18 , 20 ).…”

Exercise Testing in Firefighters : Work Capacity and Cardiovascular Risk Assessment in a Low-Risk Population

“…A recent nationally representative sample of firefighter autopsies revealed evidence of both CAD and left ventricular hypertrophy in more than 4/5 of the cases. Cardiomegaly, coronary artery stenosis, and prior myocardial infarction were all strong independent predictors of duty-related cardiac death [92]. Swedish authorities do not keep systematic records on causes of death, but they reported that cardiovascular conditions are very rare causes of on-duty deaths [93].…”

Worldwide prevalence of obesity among firefighters: a systematic review protocol

“…Obesity may interfere with job performance and increase the risk of injury during firefighting activity 13–15. Obesity also has many deleterious effects on health indices, including reduced arterial function,16 17 glucose intolerance, dyslipidemia, type 2 diabetes, hypertension, osteoarthritis,18 low-cardiorespiratory fitness,19 pathological remodelling of the heart,20 endocrine disorders21 22 and is associated with higher all-cause mortality 23…”