424 - Cardiac Healthcare Disparities in Schizophrenia at the End-of-Life

Background:Schizophrenia is a serious mental illness associated an early mortality of 15 to 20 years. Eighty percent of deaths are due to cardiovascular disease, and the risk of sudden cardiac death is three- times greater than the general population. Both modifiable and non-modifiable risk factors like lifestyle, medication side-effects, genetics, and healthcare disparities have been identified, but this relationship is not fully understood.Research Objective:To examine cardiac-related healthcare utilization of individuals with schizophrenia at the end-of-life.Method:As a retrospective cohort study the Mayo Clinic Unified Data Platform (UDP) was used to identify a schizophrenia group (SG) (n = 610) 50 years or older with a death date between 1/1/1999 – 1/1/2019 and control group (n = 610) matched by gender (53% women) and age of death (72.8 ± 12.4 years). Measures of cardiovascular healthcare utilization were evaluated within a 12-month period prior to death. Pearson’s chi-square (χ2), analysis of variance was used (ANOVA), and logistic regression were used for statistical analysis.Results:SG was more likely than controls to be unmarried, unemployed, or from racial minority groups (all p<0.001) and was more likely to have diabetes mellitus (p<0.001) or cardiovascular disease (p=0.004). SG was less likely to receive an electrocardiogram (ECG) (p<0.001), echocardiogram (p=0.003), or cardiac catheterization procedure (p<0.001), and more likely to receive hemoglobin A1C testing (p<0.001). Of those receiving an ECG, SG had a greater mean QTc interval (453.8 ms vs. 438.0 ms; p<0.001) and were twice as likely to have an ECG result interpreted as “prolonged QTc” (p<0.001).Between group differences for utilization of troponin or low-density lipoprotein testing, or pacemaker- related procedures were not statistically significant.Conclusion:Individuals with schizophrenia in this cohort were less likely to receive cardiovascular evaluations and interventions during their last year of life. Despite the higher likelihood for prolonged QTc, a recognized biomarker of cardiac risk, SG was less likely to receive an ECG. Given the greater cardiac comorbidity and higher risk of sudden cardiac death in schizophrenia, interventions are needed to address these disparities in care.

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Diagnostic Application of Postmortem Cardiac Troponin I Pericardial Fluid/Serum Ratio in Sudden Cardiac Death

Diagnostics ◽

10.3390/diagnostics11040614 ◽

2021 ◽

Vol 11 (4) ◽

pp. 614

Author(s):

Diana Hernández-Romero ◽

María del Rocío Valverde-Vázquez ◽

Juan Pedro Hernández del Rincón ◽

José A. Noguera-Velasco ◽

María D. Pérez-Cárceles ◽

...

Keyword(s):

Myocardial Infarction ◽

Sudden Cardiac Death ◽

Cardiac Troponin ◽

Cardiac Death ◽

Troponin I ◽

Sampling Site ◽

Pericardial Fluid ◽

Cardiac Troponin I ◽

Control Group ◽

Complementary Method

In approximately 5% of unexpected deaths, establishing a conclusive diagnosis exclusively on the basis of anatomo-pathological findings in a classic autopsy is difficult. Postmortem biomarkers have been actively investigated as complementary indicators to help to reach valid conclusions about the circumstances of death. Several studies propose either the pericardial fluid or peripheral veins as a location for troponin determination, but the optimum sampling site is still a matter of debate. Our objective was to evaluate the association between the ratio of troponin values in the pericardial fluid and serum (determined postmortem) and the diagnosis of acute myocardial infarction (AMI) in the context of sudden cardiac death. We included 175 forensic cases. Two groups were established: AMI deaths (48; 27.4%) and the control group (127; 72.6%). The cardiac Troponin I (cTnI) values in the pericardial fluid and the troponin ratio were found to be associated with the cause of death. Univariate regression analyses showed that both age and the cTnI ratio were significantly associated with the diagnosis of AMI death. In a multivariate analysis, adjusting for confounding factors, the age and cTnI ratio were independent predictors of death from myocardial infarction. We performed a receiver operating characteristic (ROC) curve for the cTnI ratio for AMI death and selected a cut-off point. Our biomarker was found to be a valuable and highly effective tool for use in the forensic field as a complementary method to facilitate diagnosis in nonconclusive autopsies.

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Association between digoxin use and sudden cardiac death in individuals with the rs10494366 variant of the NOS1AP gene

European Heart Journal ◽

10.1093/ehjci/ehaa946.3394 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

N Soroush ◽

A Aarnoudse ◽

F Shokri ◽

M Van Den Berg ◽

F Ahmadizar ◽

...

Keyword(s):

Sudden Cardiac Death ◽

Cardiac Death ◽

Smoking Status ◽

Adaptor Protein ◽

Therapeutic Window ◽

P Value ◽

Qtc Interval ◽

Total Study Population ◽

Increased Risk

Abstract Background Digoxin is one of the oldest cardiovascular medications still used to treat heart failure and atrial fibrillation. Due to its narrow therapeutic window, it is associated with life threatening intoxication and arrhythmias, and with QTc-shortening. Common genetic variation in the nitric oxide synthase-1 adaptor protein (NOS1AP) has been associated with QTc interval prolongation. Purpose We investigated whether the rs10494366 variant of the NOS1AP gene modified the risk of SCD in patients using digoxin. Methods In a prospective population-based cohort study, we included data of the three cohorts, started as of January 1st, 1991 until January 1st 2014. Digoxin current use on the date of cardiac death in cases and the same day of follow-up in the remainder of the cohort was a time-dependent exposure. The main outcome was SCD defined as sudden and unexpected death as a result of cardiac causes, according to international criteria. Identification and adjudication of SCD was performed independently, before the start of this study. We used Cox proportional hazard regression analysis to investigate the associations between NOS1AP rs10494366 variant and incident SCD among digoxin users compared to non-users. Associations were adjusted for age, sex (model 1) in addition to BMI, prevalent diabetes, myocardial infarction, baseline hypertension and smoking status (past, current, never) (model 2). Results We included 14,594 individuals, with a mean age of 65.3 (SD 10.3) years. Almost 59% were female. The cumulative incidence of SCD was 9.5% (609 cases) by the end of follow up. Among them, 98 (16%) individuals were exposed to digoxin at the time of death. In model 1, NOS1AP rs10494366 variant was not associated with SCD in the total study population. However, an interaction term of the gene with the daily dose of digoxin was significantly associated with increased risk of SCD (p-value 0.0001). In model 2, the risk of SCD in current users of digoxin was 4.2 [95% CI 1.3–13.8] for the GG genotype; 2.1 [95% CI 1.1–4.2] for the GT genotype, and 1.5 [95% CI 0.7–3.2] for the TT genotype. Conclusion NOS1AP rs10494366 variant modified the risk of sudden cardiac death in users of digoxin. Our study suggests that individuals with the homozygous minor GG allele have a fourfold increased risk of sudden cardiac death. Funding Acknowledgement Type of funding source: None

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Effects of BMI and LDL-cholesterol change pattern on cardiovascular disease in normal adults and diabetics

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2020-001340 ◽

2020 ◽

Vol 8 (2) ◽

pp. e001340

Author(s):

Tae Mi Youk ◽

Min Jin Kang ◽

Sun Ok Song ◽

Eun-Cheol Park

Keyword(s):

Cardiovascular Disease ◽

Ldl Cholesterol ◽

Density Lipoprotein ◽

Diabetic Control ◽

Individual Variability ◽

Control Group ◽

Simple Method ◽

Change Pattern ◽

Patients With Diabetes ◽

Variability Model

IntroductionTo examine how the risk of cardiovascular disease changes according to degree of change in body mass index (BMI) and low-density lipoprotein (LDL)-cholesterol in patients with diabetes using the health medical examination cohort database of the National Health Insurance Service in Korea. In comparison, the pattern in a non-diabetic control group was also examined.Research design and methodsThe study samples were 13 800 patients with type 2 diabetes and 185 898 non-diabetic controls, and their baseline characteristics and repeatedly measured BMI and LDL-cholesterol until occurrence of cardiovascular disease were collected in longitudinal data. We used the variability model that is joint of mixed effects and regression model, then estimated parameters about variability by Bayesian methods.ResultsThe risk of cardiovascular disease was increased significantly with high average real variability (ARV) of BMI in the patients with diabetes, but the risk of cardiovascular disease was not increased according to degree of ARV in non-diabetic controls. The Bayesian variability model was used to analyze the effects of BMI and LDL-cholesterol change pattern on development of cardiovascular disease in diabetics, showing that variability did not have a statistically significant effect on cardiovascular disease. This shows the danger of the former simple method when interpreting only the mean of the absolute value of the variation.ConclusionsThe approach of simple SD in previous studies for estimation of individual variability does not consider the order of observation. However, the Bayesian method used in this study allows for flexible modeling by superimposing volatility assessments on multistage models.

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Patients Living With HIV Are Less Likely to Receive Appropriate Statin Therapy for Cardiovascular Disease Risk Reduction

Journal of Pharmacy Practice ◽

10.1177/0897190021999790 ◽

2021 ◽

pp. 089719002199979

Author(s):

Roshni P. Emmons ◽

Nicholas V. Hastain ◽

Todd A. Miano ◽

Jason J. Schafer

Keyword(s):

Cardiovascular Disease ◽

Logistic Regression ◽

Statin Therapy ◽

Risk Reduction ◽

Blood Cholesterol ◽

Control Group ◽

Atherosclerotic Cardiovascular Disease ◽

Ascvd Risk ◽

Living With Hiv ◽

To Receive

Background: Recent studies suggest that statins are underprescribed in patients living with HIV (PLWH) at risk for atherosclerotic cardiovascular disease (ASCVD), but none have assessed if eligible patients receive the correct statin and intensity compared to uninfected controls. Objectives: The primary objective was to determine whether statin-eligible PLWH are less likely to receive appropriate statin therapy compared to patients without HIV. Methods: This retrospective study evaluated statin eligibility and prescribing among patients in both an HIV and internal medicine clinic at an urban, academic medical center from June-September 2018 using the American College of Cardiology/American Heart Association guideline on treating blood cholesterol to reduce ASCVD risk. Patients were assessed for eligibility and actual treatment with appropriate statin therapy. Characteristics of patients appropriately and not appropriately treated were compared with chi-square testing and predictors for receiving appropriate statin therapy were determined with logistic regression. Results: A total of 221/300 study subjects were statin-eligible. Fewer statin-eligible PLWH were receiving the correct statin intensity for their risk benefit group versus the uninfected control group (30.2% vs 67.0%, p < 0.001). In the multivariable logistic regression analysis, PLWH were significantly less likely to receive appropriate statin therapy, while those with polypharmacy were more likely to receive appropriate statin therapy. Conclusion: Our study reveals that PLWH may be at a disadvantage in receiving appropriate statin therapy for ASCVD risk reduction. This is important given the heightened risk for ASCVD in this population, and strategies that address this gap in care should be explored.

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A Comparison of Lipid Profile Between Sedentary and Non Sedentary Workers

TAJ Journal of Teachers Association ◽

10.3329/taj.v22i1.5014 ◽

1970 ◽

Vol 22 (1) ◽

pp. 10-14

Author(s):

Iftekhar Mahmood ◽

MM Rahman Khan ◽

M Khalilur Rahman ◽

MM Hoque Chowdhury

Keyword(s):

Cardiovascular Disease ◽

Life Style ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Epidemiological Studies ◽

Control Group ◽

Age Group ◽

Sedentary Life ◽

Bank Employees ◽

Sedentary Life Style

In different epidemiological studies, an association between sedentary life style and incidence of cardiovascular diseases has been demonstrated. Dyslipidaemia is one of the important risk factors of cardiovascular disease. An association of dyslipidaemia with sedentary life style has been considered. This study was carried out among 50 sedentary workers (teachers, office staffs, bank employees) at Pabna District and 50 individuals with non-sedentary jobs matched for age group and sex for the control group to see the association. Body mass index (BMI), blood pressure (BP), plasma level of glucose, total cholesterol, low density lipoprotein (LDL), and triglycerides (Tgs) were found to be significantly higher whereas high density lipoprotein (HDL) was found to be significantly lower among the sedentary workers as compared with the control subjects. From the study, it appears that dyslipidaemia is more common in sedentary workers and the relative risk for cardiovascular disease is increased among them due to the sedentary nature of their jobs. DOI: 10.3329/taj.v22i1.5014 TAJ 2009; 22(1): 10-14

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Abstract 12008: Nos1 Adapter Protein Nos1ap Overexpression Alters Qtc Intervals in Transgenic Mice

Circulation ◽

10.1161/circ.130.suppl_2.12008 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Tatjana Williams ◽

Anahi P Arias-Loza ◽

Marco Abeßer ◽

Joachim Schmitt ◽

Kai Schuh ◽

...

Keyword(s):

Ion Channels ◽

Sudden Cardiac Death ◽

Transgenic Mice ◽

Cardiac Death ◽

Genetic Alterations ◽

Luciferase Assay ◽

Qtc Interval ◽

Cross Sectional ◽

Programmed Stimulation ◽

Increased Susceptibility

Background: Congenital long- or short-QT syndrome may lead to life-threatening ventricular tachycardia and sudden cardiac death. Apart from rare disease-causing mutations in ion channels, common genetic variations in the neuronal nitric oxide synthase (NOS1) regulator NOS1AP, have recently been associated with QT interval variations in a human whole-genome association study. In fact, NOS1AP SNPs have been linked to increases in QTc intervals and sudden cardiac death. We therefore speculate that myocardial NOS1AP overexpression may lead to a decrease of the QTc interval and an increased susceptibility to rhythm disorders. Methods and Results: We generated transgenic mice (TG) with a conditional myocardial NOS1AP overexpression and focused on electrical alterations. Conditional overexpression of NOS1AP resulted in a 147% ventricular increase in TG mice compared to WT littermates. NOS1AP was mainly located at the sarcolemma where it interacted with NOS1 and the L-type Ca2+- channel. HW/BW ratio, ventricular ANP expression, ventricular cross-sectional area and collagen deposition were not altered in NOS1AP mice under baseline conditions. However, NOS1AP overexpressing mice showed a clear decrease of QTc intervals (33 vs. 48 ms). They were more prone to bradycardia (resting heart rate 467 bpm vs. 666 bpm). Atrial programmed stimulation repeatedly caused atrial tachycardia. Ventricular programmed stimulation caused VT in some mice with NOS1AP overexpression. We also investigated the functional effect of the human rs16847548 (T/C). We found that this SNP decreased NOS1AP promoter activity in a viral NOS1AP luciferase assay, suggesting that this SNP downregulates NOS1AP expression in humans. Conclusion: Myocardial overexpression of NOS1AP leads to a significant shortening of the QTc interval with an increased susceptibility to atrial and ventricular rhythm disorders. SNP rs16847548 in NOS1AP resulted in downregulation of NOS1AP expression which provides an explanation for elongation of QTc intervals. In summary, not only a mutation in ion channels itself but also genetic alterations in expression of ion channel modifiers, such as NOS1AP, have an impact on QTc intervals.

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Prevention of atrial fibrillation – non-modifiable and modifiable risk factors for AF

In a good rythm ◽

10.5604/01.3001.0014.2845 ◽

2020 ◽

Vol 2 (55) ◽

pp. 14-19

Author(s):

Agnieszka Wojdyła-Hordyńska ◽

Grzegorz Hordyński

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Atrial Fibrillation ◽

Cardiovascular Disease ◽

Cardiovascular Diseases ◽

Sudden Cardiac Death ◽

Cardiac Death ◽

Combined Treatment ◽

Lifestyle Changes ◽

Modifiable Risk Factors

Atrial fibrillation is one of the most common arrhythmias, with a significant increase in incidence in recent years. AF is a major cause of stroke, heart failure, sudden cardiac death, and cardiovascular disease. Timely intervention and modification of risk factors increase chance to stop the disease. Aggressive, multilevel prevention tactics are a component of combined treatment, including – in addition to lifestyle changes, anticoagulant therapy, pharmacotherapy and invasive anti-arrhythmic treatment – prevention of cardiovascular diseases, hypertension, ischemia, valvular disease and heart failure.

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Management of Cardiovascular Disease in Dialysis Patients

10.2310/im.12060 ◽

2017 ◽

Author(s):

John K. Roberts ◽

John P. Middleton

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Cardiovascular Disease ◽

Acute Myocardial Infarction ◽

Sudden Cardiac Death ◽

Cardiac Death ◽

Volume Overload ◽

Current Evidence ◽

Dialysis Patients ◽

Esrd Patients

Cardiovascular disease is a common cause of death and disease in patients with end-stage renal disease (ESRD). Registry data show that 41% of deaths in ESRD patients are due to a variety of cardiovascular causes, such as acute myocardial infarction, congestive heart failure, arrhythmia/sudden cardiac death, and stroke. In the general population, each of these disease entities in isolation can be effectively managed according to evidence from large clinical trials and evidence-based guidelines. However, many of these trials did not include patients with ESRD, limiting the transferability of this evidence to the care of patients on dialysis. To complicate matters, cardiovascular events in ESRD patients are likely augmented from a unique interplay of cardiac risk due to both reduced kidney function and the necessity for artificial renal replacement therapies. In this light, the patient on dialysis is subjected to a series of unique factors: the continued presence of the metabolic perturbations of uremia and the peculiar environment of the dialysis treatment itself. Since the ESRD heart is under a considerable amount of strain due to chronic volume overload, rapid electrolyte and fluid shifts, and accelerated vascular calcification, management can be complex and outcomes multifactorial. In this review, we summarize the current evidence regarding management of acute myocardial infarction, heart failure, sudden cardiac death, and atrial fibrillation. We also address modifiable risk factors related to the dialysis procedure itself and highlight recent randomized controlled trials that included dialysis patients and measured important cardiovascular outcomes.

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How to Predict the Impact of Methylphenidate on Cardiovascular Risk in Children with Attention Deficit Disorder: Methylphenidate Improves Autonomic Dysfunction in Children with ADHD

ISRN Pharmacology ◽

10.5402/2012/170935 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4 ◽

Cited By ~ 7

Author(s):

Reiner Buchhorn ◽

Christian Müller ◽

Christian Willaschek ◽

Kambiz Norozi

Keyword(s):

Sudden Cardiac Death ◽

Attention Deficit ◽

Attention Deficit Disorder ◽

Cardiac Death ◽

Control Group ◽

Healthy Children ◽

Children With Adhd ◽

Heart Defect ◽

Adhd Children ◽

The Impact

Background. Although stimulants have long been touted as treatments for attention deficit disorder with or without hyperactivity (ADHD), in recent years, increasing concerns have been raised about the cardiovascular safety of these medications. We aimed to prove if measurements of autonomic function with time domain analysis of heart rate variability (HRV) in 24-hour Holter ECG are useful to predict the risk of sudden cardiac death in ADHD children and adolescents. Methods. We analysed HRV obtained from children with the diagnosis of ADHD prior to (N=12) or during medical therapy (N=19) with methylphenidate (MPH), aged 10.8±2.0 years (mean ± SD), who were referred to our outpatient Paediatric Cardiology Clinic to rule out heart defect. As a control group, we compared the HRV data of 19 age-matched healthy children without heart defect. Results. Average HRV parameters from 24-hour ECG in the ADHD children prior to MPH showed significant lower values compared to healthy children with respect to rMSSD (26±4 ms versus 44±10 ms, P≤0.0001) and pNN50 (6.5±2.7% versus 21.5±9.0%, P≤0.0001). These values improved in MPH-treated children with ADHD (RMSSD: 36±8 ms; pNN50: 14.2±6.9%). Conclusion. Children who suffer from ADHD show significant changes in HRV that predominantly reflects diminished vagal tone, a well-known risk factor of sudden cardiac death in adults. In our pilot study, MPH treatment improved HRV.

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Sudden cardiac death rates in an Australian population: a data linkage study

Australian Health Review ◽

10.1071/ah14226 ◽

2015 ◽

Vol 39 (5) ◽

pp. 561 ◽

Cited By ~ 3

Author(s):

Jia-Li Feng ◽

Siobhan Hickling ◽

Lee Nedkoff ◽

Matthew Knuiman ◽

Christopher Semsarian ◽

...

Keyword(s):

Public Health ◽

Cardiovascular Disease ◽

Heart Disease ◽

Sudden Cardiac Death ◽

Cause Of Death ◽

Cardiac Death ◽

Linkage Study ◽

Mortality Data ◽

Prevention Measures ◽

Hospital Morbidity

Objective The aim of the present study was to develop criteria to identify sudden cardiac death (SCD) and estimate population rates of SCD using administrative mortality and hospital morbidity records in Western Australia. Methods Four criteria were developed using place, death within 24 h, principal and secondary diagnoses, underlying and associated cause of death, and/or occurrence of a post mortem to identify SCD. Average crude, age-standardised and age-specific rates of SCD were estimated using population person-linked administrative data. Results In all, 9567 probable SCDs were identified between 1997 and 2010, with one-third aged ≥35 years having no prior admission for cardiovascular disease. SCD was more frequent in men (62.1%). The estimated average annual crude SCD rate for the period was 34.6 per 100 000 person-years with an average annual age-standardised rate of 37.8 per 100 000 person-years. Age-specific standardised rates were 1.1 per 100 000 person-years and 70.7 per 100 000 person-years in people aged 1–34 and ≥35 years, respectively. Ischaemic heart disease (IHD) was recorded as the underlying cause of death in approximately 80% of patients aged ≥35 years, followed by valvular heart disease and heart failure. IHD was the most common cause of death in those aged 1–34 years, followed by unspecified cardiomyopathy and dysrhythmias. Conclusions Administrative morbidity and mortality data can be used to estimate rates of SCD and therefore provide a suitable methodology for monitoring SCD over time. The findings highlight the magnitude of SCD and its potential for public health prevention. What is known about the topic? There is considerable variability in rates of SCD worldwide. Different data sources and varied methods of case ascertainment likely contribute to this variation. What does this paper add? The rate of SCD in Australia is low compared with international estimates from USA, Ireland, Netherlands and China. Two in every three cases of SCD aged ≥35 years had a hospitalisation history of cardiovascular disease, highlighting the opportunity for prevention. What are the implications for practitioners? High-quality person-linked administrative hospital morbidity and registered mortality data can be used to estimate rates of SCD in the population. Understanding the magnitude and distribution of SCD is imperative for developing effective public health policy and prevention measures.

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