Prospective Countywide Surveillance and Autopsy Characterization of Sudden Cardiac Death

Tseng, Zian H.; Olgin, Jeffrey E.; Vittinghoff, Eric; Ursell, Philip C.; Kim, Anthony; Sporer, Karl A.; Yeh, Chao Hsing; Colburn, Benjamin; Clark, Nisse V.; Khan, Rana; Hart, Amy P.; Moffatt, Ellen

doi:10.1161/circulationaha.117.033427

Cited by 224 publications

(189 citation statements)

References 32 publications

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“…34 In a recent study that used a definition of sudden death that was similar to the definition in our trial but that also used autopsy as a standard for determining cause of death, only 56% of the presumed sudden cardiac deaths were found to be of arrhythmic origin. 35 In our trial, five of nine participants with adjudicated arrhythmic death who were wearing the device during the event had no ventricular tachyarrhythmias (adjudicators were unaware of the arrhythmia data from the device).…”

Section: Discussionmentioning

confidence: 95%

Wearable Cardioverter–Defibrillator after Myocardial Infarction

2019

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BACKGROUNDDespite the high rate of sudden death after myocardial infarction among patients with a low ejection fraction, implantable cardioverter-defibrillators are contraindicated until 40 to 90 days after myocardial infarction. Whether a wearable cardioverter-defibrillator would reduce the incidence of sudden death during this high-risk period is unclear. METHODSWe randomly assigned (in a 2:1 ratio) patients with acute myocardial infarction and an ejection fraction of 35% or less to receive a wearable cardioverter-defibrillator plus guideline-directed therapy (the device group) or to receive only guideline-directed therapy (the control group). The primary outcome was the composite of sudden death or death from ventricular tachyarrhythmia at 90 days (arrhythmic death). Secondary outcomes included death from any cause and nonarrhythmic death. RESULTSOf 2302 participants, 1524 were randomly assigned to the device group and 778 to the control group. Participants in the device group wore the device for a median of 18.0 hours per day (interquartile range, 3.8 to 22.7). Arrhythmic death occurred in 1.6% of the participants in the device group and in 2.4% of those in the control group (relative risk, 0.67; 95% confidence interval [CI], 0.37 to 1.21; P = 0.18). Death from any cause occurred in 3.1% of the participants in the device group and in 4.9% of those in the control group (relative risk, 0.64; 95% CI, 0.43 to 0.98; uncorrected P = 0.04), and nonarrhythmic death in 1.4% and 2.2%, respectively (relative risk, 0.63; 95% CI, 0.33 to 1.19; uncorrected P = 0.15). Of the 48 participants in the device group who died, 12 were wearing the device at the time of death. A total of 20 participants in the device group (1.3%) received an appropriate shock, and 9 (0.6%) received an inappropriate shock. CONCLUSIONSAmong patients with a recent myocardial infarction and an ejection fraction of 35% or less, the wearable cardioverter-defibrillator did not lead to a significantly lower rate of the primary outcome of arrhythmic death than control. (Funded by the National Institutes of Health and Zoll Medical; VEST ClinicalTrials.gov number, NCT01446965.) a bs tr ac t

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Section: Discussionmentioning

confidence: 95%

Wearable Cardioverter–Defibrillator after Myocardial Infarction

2019

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“…CV mortality in study patients was defined as death attributable to CAD, myocardial ischemia and infarction, heart failure, fatal arrhythmia, cardiac arrest because of other causes, cerebrovascular diseases, pulmonary embolism, peripheral artery diseases, and sudden otherwise unexplained death. SCD was defined by World Health Organization criteria: a sudden, natural, non-violent and unexpected death with all potentially lethal non-cardiac causes ruled out (20). Non-CV mortality was defined as all other causes of death, i.e., infection, malignancies, gastrointestinal hemorrhage, accidents, and miscellaneous.…”

Section: Outcomes and Follow-upmentioning

confidence: 99%

A Joint Evaluation of Impaired Cardiac Sympathetic Responses and Malnutrition-Inflammation Cachexia for Mortality Risks in Hemodialysis Patients

Chang

Hsieh

et al. 2020

Front. Med.

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Background: Cardiac sympathetic response (CSR) and malnutrition-inflammation syndrome (MIS) score are validated assessment tools for patients' health condition. We aim to evaluate the joint effect of CSR and MIS on all-cause and cardiovascular (CV) mortality in patients with hemodialysis (HD). Methods: Changes in normalized low frequency (nLF) during HD were utilized for quantification of CSR. Unadjusted and adjusted hazard ratios (aHRs) of mortality risks were analyzed in different groups of nLF and MIS score. Results: In multivariate analysis, higher nLF was related to all-cause, CV and sudden cardiac deaths [aHR: 0.78 (95% confidence interval (CI): 0.72-0.85), 0.78 (95% CI: 0.70-0.87), and 0.74 (95% CI: 0.63-0.87), respectively]. Higher MIS score was associated with incremental risks of all-cause, CV and sudden cardiac deaths [aHR: 1.36 (95% CI: 1.13-1.63), 1.33 (95% CI: 1.06-1.38), and 1.50 (95% CI: 1.07-2.11), respectively]. Patients with combined lower nLF (≤6.8 nu) and higher MIS score were at the greatest risk of all-cause and CV mortality [aHR: 5.64 (95% CI: 1.14-18.09) and 5.86 (95% CI: 1.64-13.65), respectively]. Conclusion: Our data indicate a joint evaluation of CSR and MIS score to identify patients at high risk of death is more comprehensive and convincing. Considering the extremely high prevalence of cardiac autonomic neuropathy and malnutrition-inflammation cachexia in HD population, a non-invasive monitoring system composed of CSR analyzer and MIS score calculator should be developed in the artificial intelligence-based prediction of clinical events.

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“…The definition of sudden death in the current investigation was similar to that used in contemporary HF clinical trials. Despite the known issues regarding the specificity of such definitions to identify arrhythmic sudden death when compared with a gold standard of autopsy, the adjudication process was rigorously performed by a dedicated clinical events committee. Various evidence‐based medical therapies for HFrEF possess mechanistic effects that may prevent malignant dysrhythmias and have shown to decrease rates of sudden death in pivotal outcomes trials .…”

Section: Implications Of Declining Sudden Death In Heart Failure Withmentioning

confidence: 99%

Dying is not what it used to be! Impact of evolving epidemiology and treatment on mode of death in heart failure

Patel

Nohria

Butler

et al. 2019

European J of Heart Fail

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Prospective Countywide Surveillance and Autopsy Characterization of Sudden Cardiac Death

Cited by 224 publications

References 32 publications

Wearable Cardioverter–Defibrillator after Myocardial Infarction

Wearable Cardioverter–Defibrillator after Myocardial Infarction

A Joint Evaluation of Impaired Cardiac Sympathetic Responses and Malnutrition-Inflammation Cachexia for Mortality Risks in Hemodialysis Patients

Dying is not what it used to be! Impact of evolving epidemiology and treatment on mode of death in heart failure

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