Abstract 10847: Circadian Variation of In-Hospital and Out-of-Hospital Sudden Cardiac Arrest

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Yicheng Tang ◽  
Tarryn Tertulien ◽  
Samir Saba
Keyword(s):  
Cardiac Arrest ◽  
Seasonal Pattern ◽  
Circadian Variation ◽  
Sudden Cardiac Arrest ◽  
Patient Characteristics ◽  
Activity Level ◽  
Common Mechanism ◽  
Circadian Pattern ◽  
Co Morbidity ◽  
Comorbidity Burden

Introduction: Several studies have reported circadian periodicity of sudden cardiac arrest (SCA), most commonly a nadir in event frequency during overnight hours. It remains unclear to what extent this circadian pattern is influenced by variation in patients’ physical activities. One way to elucidate this is to compare patients with out-of-hospital (OHCA) versus in-hospital (IHCA) cardiac arrests, which has not been previously done. We hypothesize that the circadian pattern of SCA will be preserved in a mixed contemporary cohort of OHCA and IHCA survivors. Methods: A total of 1,433 consecutive survivors of SCA in the Pittsburgh area from 2002 to 2012 were included. Patient demographics including clinical histories and details of SCA were collected using records from emergency medical services and rapid response teams. Unwitnessed SCA and those with potential non-cardiac confounders were excluded. The distribution of SCA throughout the day and associated patient characteristics were tested for differences using chi-square test and student’s t-test. Results: Of the 1,224 patients analyzed, 706 had IHCA and 518 OHCA. We observed a nadir of SCA in the nighttime hours between 0000 - 0600 in both IHCA and OHCA groups (p<0.001). Patients who arrested in this nighttime window had more co-morbidities (p=0.01) and lower percent of angiographically confirmed acute myocardial infarction (p=0.025). A similar circadian pattern was noted for patients with higher or lower comorbidity burden (p<0.001), although more blunted in sicker patients, as well as for patients whose arrest was due to a shockable rhythm (p<0.001). Correspondingly, the IHCA group had higher co-morbidity burden (p<0.001) and a blunted nighttime nadir compared to the OHCA group (p<0.001). We did not observe a temporal variation by day of week but did see a seasonal pattern with a peak in SCA in the Pittsburgh cold months (p<0.001). Conclusion: The typical pattern of nighttime nadir in SCA is seen in both OHCA and IHCA but is more blunted in sicker patients and in the hospital. This suggests a common mechanism that transcends differences between the two settings but may be influenced by non-cardiac comorbidities or environmental factors such as activity level.

Comparison of Circadian Variation for In-Hospital Versus Out-of-Hospital Sudden Cardiac Arrest Survivors

2021 ◽  
Author(s):  
Yicheng Tang ◽  
Tarryn Tertulien ◽  
Aditya Bhonsale ◽  
Krishna Kancharla ◽  
Nathan Anthony Mark Estes ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Circadian Variation ◽  
Sudden Cardiac Arrest

Effects of obesity on overall survival (OS) of patients with acute myeloid leukemia (AML).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18510-e18510
Author(s):  
Prajwal Dhakal ◽  
Elizabeth Lyden ◽  
Andrea Lee ◽  
Joel Michalski ◽  
Zaid S. Al-Kadhimi ◽  
...  
Keyword(s):  
Cox Regression ◽  
Significant Risk ◽  
Patient Characteristics ◽  
Continuous Variable ◽  
Cell Transplant ◽  
Obese Patients ◽  
Co Morbidity ◽  
Comorbidity Burden ◽  
Baseline Characteristics ◽  
Morbidity Index

e18510 Background: The relationship between obesity and prognosis of AML has not been established. Our retrospective study aimed to determine the effect of obesity on OS of AML. Methods: AML patients diagnosed from 2000-2016 at University of Nebraska Medical Center were included. Body mass index (BMI) at the time of AML diagnosis was divided into 3 groups: normal (18.5≤25 kg/m2) or underweight (<18.5 kg/m2); over-weight (25-30 kg/m2); and obese (≥30 kg/m2). Chi-square test, Kruskal-Wallis test and ANOVA were used to look at the association of different BMI groups with other patient characteristics. Mann-Whitney test was used for pairwise comparisons of hematopoietic cell transplant (HCT) co-morbidity index and Bonferroni correction was used to adjust p-values. OS, defined as time from diagnosis to death from any cause, was determined by Kaplan-Meier method and comparisons were done using log-rank test. Cox Regression was performed to detect survival effect of BMI (as continuous variable). P<0.05 was considered statistically significant. Results: A total of 314 patients were included in the study (Table): 46% were female, 35% had adverse cytogenetics, 15% had FLT3-ITD mutation, 68% received intensive chemotherapy and 30% underwent HCT. 38% of total patients were obese. Baseline characteristics were similar in all 3 BMI groups except co-morbidity index (p=0.04). OS for normal/underweight, overweight and obese groups at 1 year was 85%, 92%, and 94% respectively (p=0.84). BMI, as a continuous variable, was not a significant risk factor for death (HR 1.00, 95% CI 0.98-1.03). Conclusions: Obese patients, compared to non-obese patients, did not differ in baseline characteristics other than increased comorbidity burden. Obesity, when adjusted for other characteristics, did not have any effect on OS of patients with AML. Patient characteristics. [Table: see text]

scholarly journals Sudden cardiac death in young people and athletes

2018 ◽  
Vol 12 (2) ◽  
pp. 74 ◽  
Author(s):  
Domenico Corrado ◽  
Alessandro Zorzi
Keyword(s):  
Cardiac Arrest ◽  
Young People ◽  
Sudden Death ◽  
Young Subject ◽  
Sudden Cardiac Arrest ◽  
Common Mechanism ◽  
Prodromal Symptoms ◽  
Italian Experience ◽  
Medical Evaluation ◽  
Tragic Event

The sudden death of a young subject or athlete is a rare but tragic event. The most common mechanism of cardiac arrest leading to sudden death is abrupt ventricular fibrillation as a consequence of an underlying cardiovascular disease. The culprit diseases are often clinically silent and unlikely to be suspected or diagnosed on the basis of spontaneous symptoms. The longrunning Italian experience with medical evaluation of young individuals before their participation in sports has provided compelling evidence that screening the young populations for at-risk cardiac diseases offers the potential to identify asymptomatic athletes who have potentially lethal cardiovascular abnormalities and may protect them from the risk of sudden death. In this review we will discuss cardiovascular causes of sudden death in young people and athletes with particular emphasis on pathological findings and pathophysiology of sudden cardiac arrest. Occurrence of prodromal symptoms, possible early diagnosis at preparticipation screening and early defibrillation in the sports arenas will also be addressed.

All cause 30 readmission in patients with history of sudden cardiac arrest

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
I Mastoris ◽  
P Acharya ◽  
N Haglund ◽  
A Sauer ◽  
Z Shah
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Cardiac Arrest ◽  
Sudden Cardiac Arrest ◽  
Patient Characteristics ◽  
Initial Diagnosis ◽  
Current Evidence ◽  
Readmission Rates ◽  
Initial Event ◽  
History Of

Abstract Background Sudden cardiac arrest (SCA) remains a significant cause of morbidity and mortality. Current evidence on readmission rates and causes after SCA are scarce. Purpose To describe patient characteristics, predictors of readmission and outcomes patients with history of sudden cardiac arrest and 30-day readmission Methods We analyzed the National Readmission Database for years 2016 and 2017 to identify all patients with initial diagnosis of SCA and 30 days readmission after the initial event. We analyzed baseline characteristics and looked into predictors, outcomes and diagnoses of re-admission. Results We identified 79,844 patients with an initial diagnosis of SCA that were discharged alive after index admission. Of those 14,387 (18.01%) had one readmission and 3,978 (4.99%) had more than one readmission. The mean age was 64 years and 41.3% were females. Hypertension, dyslipidemia, diabetes, CAD, CHF and CKD were present in 76.5%, 42.4%, 46.3%, 50.4%, 62.3% and 43.5% respectively. Overall mortality was 9.1% and length of stay 7.8 days. (Table 1). Congestive heart failure was the predominant diagnosis for readmission (Figure). Female sex (HR=0.93; p=0.004) was the only independent risk factor for all cause readmission. Conclusions Patients with history of SCA that have a 30-day readmission have significantly more comorbidities and length of day. Congestive heart failure is the predominant diagnosis for readmission Funding Acknowledgement Type of funding source: None

Sign in / Sign up

Export Citation Format

Share Document