Sudden Cardiac Arrest Cases Research Articles

Sudden cardiac arrest during marathons among young, middle-aged, and senior runners

AimThere is limited evidence showing a relationship with age in the incidence of sudden cardiac arrest during exercise, which can be lethal at times MethodsTo examine the incidence by age group in sudden cardiac arrest, we prospectively observed cases of sudden cardiac arrest in full marathons certified by the Japan Association of Athletics Federations held between April 2011 and March 2019. Sudden cardiac arrest was defined as collapse during or 1 h after the race requiring chest compressions or the use of an automatic electrical defibrillation. Results4.1 million persons ran in 516 marathons. Of the participants, 78.6 % were men. By age group, 37.4 %, 34.7 %, 19.6 %, and 8.3 % belonged to the < 40 s, 40 s, 50 s, and ≥ 60 s groups, respectively. During the study period, 69 sudden cardiac arrests (1.7 per 100,000 participants, 95 % confidence interval [CI]: 1.3–2.1) were observed, of which 66 were men. The incidence per 100,000 runners of sudden cardiac arrest was 0.9 (95 % CI: 0.4, 1.4), 0.9 (95 % CI: 0.4, 1.4), 2.6 (95 % CI: 1.5, 3.8), and 5.5 (95 % CI: 2.9, 8.2) for those in their under 40 s, 40 s, 50 s, and over 60 s, respectively, with higher rates for older age groups. Compared to men, the cases of SCA among women were less common (only three cases), and the incidence did not differ by age group. ConclusionsMen, unlike women, had a higher incidence of sudden cardiac arrest during marathons according to age. Identification of this high-risk population could be important information in encouraging marathoners pre-participation self-screening.

Circadian variation pattern of sudden cardiac arrest occurred in Chinese community

BackgroundThe circadian variation pattern of sudden cardiac arrest (SCA) occurred in Chinese community including both community healthcare centres and primary hospitals remains unknown. This study analysed the circadian variation of...

Benzodiazepine use and incident risk of sudden cardiac arrest in patients with cardiovascular diseases.

Benzodiazepines (BZDs) are commonly prescribed as adjunctive drugs for patients with cardiovascular diseases (CVDs), particularly those who experience anxiety or insomnia. However, the relationship between the use of BZDs and incident risk of sudden cardiac arrest (SCA) has not been well investigated. In this study, we aimed to examine the association between the use of BZDs and the incident risk of SCA among patients with CVD. In this retrospective cohort study, a total of 74,715 eligible patients with new-onset CVD as a primary cause of hospitalization between July 2016 and August 2022 were included from the health information platform in Shenzhen, China. Among them, 61,761 BZD non-initiators were identified and matched to 12,954 BZD initiators by propensity score at a maximum ratio of 5:1. Propensity score-matched Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs). Over a 12-month follow-up period, 29 (2.24 per 1000 person-years) and 137 (2.22 per 1000 person-years) SCA cases occurred among propensity score-matched BZD initiators and non-initiators, respectively. Patients who initiated BZD treatment were associated with a 101% increased risk of SCA incidence compared with patients without BZD treatment (adjusted HR: 2.01, 95% CI: 1.42, 2.83). Furthermore, compared with the non-use (0 defined daily dose, DDD), the adjusted HR was 1.43 (95% CI: 1.32, 1.56) for the BZD consumption of ≤1 DDD and 2.58 (95% CI: 2.37, 2.81) for the BZD consumption of >1 DDD (P for trend < 0.001) within a 12-month follow-up period. This study provides evidence that BZD initiation may be associated with an increased incident risk of SCA in patients with CVD. Our finding highlights the importance of cautious prescribing BZDs in the health management of patients with CVD.

Association of triglyceride glucose index and triglyceride glucose-body mass index with sudden cardiac arrest in the general population

BackgroundInsulin resistance (IR) significantly contributes to cardiovascular disease (CVD) development. Triglyceride glucose (TyG) index and triglyceride glucose-body mass index (TyG-BMI) are recognised as convenient proxies for IR. However, their relationship with sudden cardiac arrest (SCA) remains unclear.MethodsThis prospective cohort analysis included 355,242 UK Biobank participants with available TyG index and TyG-BMI data and no history of CVD. Cox proportional risk models assessed the association between the TyG index, TyG-BMI and SCA risk. Additionally, Accelerated Failure Time (AFT) models were employed to investigate the timing of SCA onset. The impact of dynamic increases in TyG index and TyG-BMI levels on SCA risk was examined using restricted cubic spline.ResultsOver a median follow-up period of 165.4 months (interquartile range 156.5–174 months), 1,622 cases of SCA were recorded. Multivariate Cox regression analysis revealed a 9% increase in SCA risk per standard deviation increase in TyG index (adjusted hazard ratio (aHR) = 1.09, 95% confidence interval (CI) 1.04–1.15) and an 14% increase per standard deviation increase in TyG-BMI (aHR 1.14, 95% CI 1.09–1.2). AFT models indicated earlier median times to SCA occurrence with increasing quintiles of TyG index and TyG-BMI compared to the lowest quintile (P for trend < 0.05). SCA risk was linearly (P = 0.54) and non-linearly (P = 0.007) correlated with gradual increases in TyG index and TyG-BMI levels, respectively. Sex-stratified analyses showed stronger associations in women.ConclusionsHigher TyG index and TyG-BMI levels are associated with an increased SCA risk and earlier onset, particularly in women.

Vitamin D deficiency as a risk factor for sudden cardiac arrest: A multicenter case-control study

Background and aimsVitamin D is known to influence the risk of cardiovascular disease, which is a recognized risk factor for sudden cardiac arrest (SCA). However, the relationship between vitamin D and SCA is not well understood. Therefore, this study aims to investigate the association between vitamin D and SCA in out-of-hospital cardiac arrest (OHCA) patients compared to healthy controls. Methods and resultsUsing the Phase II Cardiac Arrest Pursuit Trial with Unique Registration and Epidemiologic Surveillance (CAPTURES II) registry, a 1:1 propensity score-matched case-control study was conducted between 2017 and 2020. Serum 25-hydroxyvitamin D (vitamin D) levels in patients with OHCA (454 cases) and healthy controls (454 cases) were compared after matching for age, sex, cardiovascular risk factors, and lifestyle behaviors. The mean vitamin D levels were 14.5 ± 7.6 and 21.3 ± 8.3 ng/mL among SCA cases and controls, respectively. Logistic regression analysis was used adjusting for cardiovascular risk factors, lifestyle behaviors, corrected serum calcium levels, and estimated glomerular filtration rate (eGRF). The adjusted odds ratio (aOR) for vitamin D was 0.89 (95% confidence interval [CI] 0.87–0.91). The dose-response relationship demonstrated that vitamin D deficiency was associated with SCA incidence (severe deficiency, aOR 10.87, 95% CI 4.82–24.54; moderate deficiency, aOR 2.24, 95% CI 1.20–4.20). ConclusionVitamin D deficiency was independently and strongly associated with an increased risk of SCA, irrespective of cardiovascular and lifestyle factors, corrected calcium levels, and eGFR.

Socioeconomic deprivation and racialised disparities in competitive athletes with sudden cardiac arrest from the USA

ObjectiveTo explore the association of socioeconomic deprivation and racialised outcomes in competitive athletes with sudden cardiac arrest (SCA) in the USA.MethodsSCA cases from the National Center for Catastrophic Sports Injury...

Abstract 336: Bystander CPR Maintains Shockable Rhythm in Sudden Cardiac Arrest Across EMS Response Times

Introduction: Presentation with shockable rhythm markedly improves survival from out-of-hospital sudden cardiac arrest (SCA). Shockable rhythms (ventricular fibrillation/tachycardia; VF/VT) are known to deteriorate to asystole or pulseless electrical activity (PEA) over time, but little population-based data is available regarding this phenomenon. Also, bystander CPR (BCPR) improves survival from SCA but its association with maintenance of shockable rhythms is unclear. Hypothesis: With longer EMS response time, the proportion of EMS-assessed shockable initial rhythms will decrease. BCPR may influence this association. Methods: We analyzed EMS-assessed initial rhythm of SCA cases from the Oregon SUDS study in the Portland, OR metro area (pop ~1 million). For this analysis, we included bystander-witnessed SCA cases (2002-2018) aged ≥18 with resuscitation attempted by EMS. SCA was defined as a sudden, unexpected pulseless condition of likely cardiac origin. We assessed initial rhythm proportions across EMS response times using Cochran-Armitage trend tests. Results: Among 3,309 SCA cases, 1,748 (53%) were bystander-witnessed, and of these, 706 (40%) received BCPR. Response time was 7.3 ± 3.4 minutes for cases with BCPR and 6.8 ± 3.1 minutes without BCPR (p=0.01). In the group receiving BCPR, the proportion with shockable rhythm remained near 60% across response times from &lt;3 to ≥12 minutes (Figure, solid line; p=0.88), and proportions of PEA and asystole remained stable. In the group without BCPR, shockable rhythm declined from 70% at &lt;3 minutes to 44% at ≥12 minutes response time (Figure, dashed line; p&lt;0.001), while non-shockable rhythms increased. Conclusions: Among community-based SCA cases who received bystander CPR, there was no significant decrease in shockable rhythm as response time increased. In contrast, among SCA cases without bystander CPR, longer response times were associated with a lower proportion of shockable rhythms.

Risk Factors for Sudden Cardiac Arrest Among Hispanic or Latino Adults in Southern California: Ventura PRESTO and HCHS/SOL.

Background Out-of-hospital sudden cardiac arrest (SCA) is a leading cause of mortality, making prevention of SCA a public health priority. No studies have evaluated predictors of SCA risk among Hispanic or Latino individuals in the United States. Methods and Results In this case-control study, adult SCA cases ages 18-85 (n=1,468) were ascertained in the ongoing Ventura Prediction of Sudden Death in Multi-Ethnic Communities (PRESTO) study (2015-2021) in Ventura County, California. Control subjects were selected from 3033 Hispanic or Latino participants who completed Visit 2 examinations (2014-2017) at the San Diego site of the HCHS/SOL (Hispanic Community Health Survey/Study of Latinos). We used logistic regression to evaluate the association of clinical factors with SCA. Among Hispanic or Latino SCA cases (n=295) and frequency-matched HCHS/SOL controls (n=590) (70.2% men with mean age 63.4 and 61.2 years, respectively), the following clinical variables were associated with SCA in models adjusted for age, sex, and other clinical variables: chronic kidney disease (odds ratio [OR], 7.3 [95% CI, 3.8-14.3]), heavy drinking (OR, 4.5 [95% CI, 2.3-9.0]), stroke (OR, 3.1 [95% CI, 1.2-8.0]), atrial fibrillation (OR, 3.7 [95% CI, 1.7-7.9]), coronary artery disease (OR, 2.9 [95% CI, 1.5-5.9]), heart failure (OR, 2.5 [95% CI, 1.2-5.1]), and diabetes (OR, 1.5 [95% CI, 1.0-2.3]). Conclusions In this first population-based study, to our knowledge, of SCA risk predictors among Hispanic or Latino adults, chronic kidney disease was the strongest risk factor for SCA, and established cardiovascular disease was also important. Early identification and management of chronic kidney disease may reduce SCA risk among Hispanic or Latino individuals, in addition to prevention and treatment of cardiovascular disease.

Sudden cardiac arrest in athletes and strategies to optimize preparedness.

Sudden cardiac arrest (SCA) is the leading cause of death in young athletes. Despite efforts to improve preparedness for cardiac emergencies, the incidence of out-of-hospital cardiac arrests in athletes remains high, and bystander awareness and readiness for SCA support are inadequate.Initiatives such as designing an emergency action plan (EAP) and mandating training in cardiopulmonary resuscitation (CPR) and automated external defibrillator use (AED) for team members and personnel can contribute to improved survival rates in SCA cases.This review provides an overview of SCA in athletes, focusing on identifying populations at the highest risk and evaluating the effectiveness of different screening practices in detecting conditions that may lead to SCA. We summarize current practices and recommendations for improving the response to SCA events, and we highlight the need for ongoing efforts to optimize preparedness through the implementation of EAPs and the training of individuals in CPR and AED use. Additionally, we propose a call to action to increase awareness and training in EAP development, CPR, and AED use for team members and personnel.To improve outcomes of SCA cases in athletes, it is crucial to enhance bystander awareness and preparedness for cardiac emergencies. Implementing EAPs and providing training in CPR and AED use for team members and personnel are essential steps toward improving survival rates in SCA cases.

Sudden Cardiac Arrests in the Polish Tatra Mountains: A Retrospective Study.

Achieving the optimal survival rate for sudden cardiac arrest in mountains is challenging. The odds of surviving are influenced mainly by distance, response time, and organization of the emergency medical system. The aim of this study was to analyze the epidemiology and outcomes of patients with out-of-hospital cardiac arrest in whom cardiopulmonary resuscitation was performed in the Polish Tatra Mountains. This was a retrospective analysis of data on sudden cardiac arrest collected from the database of the Tatra Mountain Rescue Service and local emergency medical system from 2001 to 2021. A total of 74 cases of sudden cardiac arrest were recorded. The mortality rate was 88% (65/74). Return of spontaneous circulation was achieved in 22 (30%) patients. A group of survivors was characterized by more frequent use of an automated external defibrillator (AED) (56% vs 14%, P=0.011), a shorter interval between cardiac arrest and emergency team arrival (12 vs 20 min, P=0.005), and a shorter time to initiation of advanced life support (ALS) (12 vs 22 min, P=0.004). All survivors had a shockable initial rhythm. The majority of survivors (8/9, 89%) had a good or moderate neurological outcome. This study confirms poor survival rate after sudden cardiac arrest in the mountain area. The use of AED, shockable initial rhythm, and shorter time interval to emergency team arrival and ALS initiation are associated with better outcomes.

A 3-year population-based study of exercise-related sudden cardiac arrest among 12- to 50-year-old Norwegians.

Regular exercise is associated with reduced risk of cardiovascular disease. Paradoxically, an increased risk of sudden cardiac arrest (SCA) is documented during or immediately after exercise and in athletes compared to the nonathletic population. Our objective was to identify, through multiple sources, the total number of exercise-related versus non-exercise-related SCA in the young population in Norway. We collected primary data from the prospective Norwegian Cardiac Arrest Registry (NorCAR) for all patients aged 12-50 suffering SCA of presumed cardiac cause from 2015 to 2017. We collected secondary data about prior physical activity and the SCA, through questionnaires. We searched media reports for SCA incidents in sports. Exercise-related SCA is defined as SCA during or <1 h after exercise. Overall, 624 patients, median age 43 years, were included from NorCAR. Two thirds (393) replied to the study invitation, of whom 236 answered the questionnaires: 95 survivors and 141 next of kin. The media search resulted in 18 relevant hits. With a multiple source approach, we identified 63 cases of exercise-related SCA, equivalent to an incidence of 0.8/100 000 person-years, versus 7.8/100 000 person-years of non-exercise-related SCA. Among those who answered (n = 236), almost two thirds (59%) exercised regularly, most commonly (45%) 1-4 h/week. Endurance exercise (38%) was the most prevalent type of regular exercise and the most common activity during exercise-related SCA (53%). The burden of exercise-related SCA was low (0.8 per 100 000 person-years) and ten times lower than non-exercise-related SCA in the young population in Norway.

Temporal Trends in Incidence and Survival From Sudden Cardiac Arrest Manifesting With Shockable and Nonshockable Rhythms: A 16-Year Prospective Study in a Large US Community

The proportion of nonshockable sudden cardiac arrests (pulseless electrical activity and asystole) continues to rise. Survival is lower than shockable (ventricular fibrillation [VF]) sudden cardiac arrests, but there is little community-based information on temporal trends in the incidence and survival from sudden cardiac arrests based on presenting rhythms. We investigated community-based temporal trends in sudden cardiac arrest incidence and survival by presenting rhythm. We prospectively evaluated the incidence of each presenting sudden cardiac arrest rhythm and survival outcomes for out-of-hospital events in the Portland, Oregon metro area (population of approximately 1 million, 2002 to 2017). We limited inclusion to cases of likely cardiac cause with resuscitation attempted by emergency medical services. Out of 3,723 overall sudden cardiac arrest cases, 908 (24%) presented with pulseless electrical activity, 1,513 (41%) with VF, and 1,302 (35%) with asystole. The incidence of pulseless electrical activity-sudden cardiac arrest remained stable over 4-year periods (9.6/100,000 in 2002 to 2005, 7.4/100,000 in 2006 to 2009, 5.7/100,000 in 2010 to 2013, and 8.3/100,000 in 2014 to 2017; unadjusted beta [β]-0.56; 95% confidence interval [CI],-3.98 to 2.85). The incidence of VF-sudden cardiac arrests decreased over time (14.6/100,000 in 2002 to 2005, 13.4/100,000 in 2006 to 2009, 12.0/100,000 in 2010 to 2013, and 11.6/100,000 in 2014 to 2017; unadjusted β-1.05; 95% CI,-1.68 to-0.42) and asystole-sudden cardiac arrests (8.6/100,000 in 2002 to 2005, 9.0/100,000 in 2006 to 2009, 10.3/100,000 in 2010 to 2013, and 15.7/100,000 in 2014 to 2017; unadjusted β 2.25; 95% CI-1.24 to 5.73) did not change significantly over time. Survival increased over time for pulseless electrical activity-sudden cardiac arrests (5.7%, 4.3%, 9.6%, 13.6%; unadjusted β 2.8%; 95% CI 1.3 to 4.4) and VF-sudden cardiac arrests (27.5%, 29.8%, 37.9%, 36.6%; unadjusted β 3.5%; 95% CI 1.4 to 5.6), but not for asystole-sudden cardiac arrests (1.7%, 1.6%, 4.0%, 2.4%; unadjusted β 0.3%; 95% CI,-0.4 to 1.1). Enhancements in the emergency medical services system's pulseless electrical activity-sudden cardiac arrest management were temporally associated with the increasing pulseless electrical activity survival rates. Over a 16-year period, the incidence of VF/ventricular tachycardia decreased over time, but pulseless electrical activity incidence remained stable. Survival from both VF-sudden cardiac arrests and pulseless electrical activity-sudden cardiac arrests increased over time with a more than 2-fold increase for pulseless electrical activity-sudden cardiac arrests.

DH-452784-4 AN ELECTROCARDIOGRAPHY-BASED DEEP LEARNING ALGORITHM FOR IDENTIFICATION OF INDIVIDUALS AT INCREASED RISK OF SUDDEN CARDIAC ARREST

Sudden cardiac arrest (SCA) is a major public health problem with significant need to improve screening methods for detection of high risk. Recently developed ECG-based deep learning (DL) models have shown high accuracy for detection of selected heart disease conditions. To train and validate a 12-lead ECG-based DL algorithm for detection of increased SCA risk. Individuals who suffered out-of-hospital SCA were prospectively ascertained in the Portland, Oregon, metro area (The Oregon Sudden Unexpected Death Study, catchment population ∼1 million, 2002-onwards). A total of 1,838 12-lead ECGs from 1,796 cases obtained by health care providers prior and unrelated to the individual SCA events were digitized and employed to develop an ECG-based DL model for prediction of SCA risk (training, validation, and testing). External validation was performed in 717 ECGs from 714 SCA cases (The Ventura Prediction of Sudden Death in Multi-ethnic Communities study, catchment population ≈850,000, 2015-onwards). Two separate control group samples were obtained from 1,350 ECGs taken from 1,325 clinically matched individuals. Compared to SCA cases in the internal dataset, individuals in the external dataset were older, and more often female or Hispanic. The prevalence of prior myocardial infarction and heart failure was lower among SCA cases in the external cohort. The DL model achieved an AUC of 0.887 (95% CI 0.857-0.915) for detection of SCA cases in the internal test dataset compared to control patients in the held-out test cohort. Despite the demographic and clinical differences, the model was successfully validated among external SCA cases with an AUC of 0.821 (95% CI 0.791-0.850). The DL model performed significantly better than a previously developed and validated conventional ECG electrical risk score, which achieved an AUC of 0.705 (0.661-0.749) in the internal cohort and 0.742 (0.710-0.774) in the external cohort. An ECG-based DL model distinguished SCA cases from clinically matched control subjects with high accuracy, performing better than a conventional ECG risk model. These findings suggest that this DL model has potential for further evaluation as a screening tool for SCA risk.

PO-03-222 CURRENT TRENDS AND OUTCOMES OF SUDDEN CARDIAC ARREST IN YOUNG ADULTS IN THE USA: INSIGHTS FROM THE NATIONAL INPATIENT SAMPLE

Sudden cardiac arrest (SCA) is a rare but devastating event in young adults. There is a lack of population studies that evaluate the current trends and outcomes of SCA in young adults. We sought to estimate current trends in incidence, risk factors and mortality rates for out-of-hospital SCA in young adults (18 – 35 years) using the national in-patient sample of the USA. The demographic data of all young adults (18 – 35 years) admitted to hospitals in the US from 2016 to 2020 was analysed using the National Inpatient Sample database. We further identified primary admissions for sudden cardiac arrest using the ICD 10 code (I46). We analyzed the trend in the incidence and mortality of SCA during the study period using the marginal effect of years. Subsequently, we compared the sociodemographic and comorbid factors of patients with out-of-hospital SCA with other young adults admitted to the hospital. Multivariate logistic regression was then used to determine the sociodemographic and comorbid factors independently associated with SCA in our population. There were approximately 3,610 cases of out of hospital cardiac arrest in the study period, with an incidence rate of 1:10000 young adult admissions. The mean age at admission was (28.3 ± 0.4 years). We noted a 16.7% increase in SCA cases from 2016 to 2020 (660 to 770 cases). Similarly, there was a 21% increase in the mortality between 2016 and 2020 (474 to 574 deaths), with a mean mortality rate of 69.7% throughout the study period. The main factors associated with increased odds of SCA in young people were the presence of arrhythmias. Other significant risk factors were male sex, a history of stroke, electrolyte abnormalities, renal failure on hemodialysis, hypertrophic cardiomyopathy, congenital heart disease, and cocaine use disorder. There is an increase in the incidence of sudden cardiac arrest in young adults, with the main risk factors being male sex, history of stroke, hypertrophic cardiomyopathy, congenital heart disease, presence of arrhythmias and cocaine use disorder. Identifying young adults with high-risk characteristics as described above and implementing risk factor modification with aggressive surveillance can reduce the incidence of SCA and the risk of death in young adults.Tabled 1Sociodemographic and comorbid factors associated with Sudden Cardiac Arrest in Young AdultsVARIABLESOdds ratioLower limit of CIUpper limit of CIP-valueAGE1.000.981.020.373RACE (Reference, Whites)BlacksHispanicsAsians-1.070.621.25-0.850.450.78-1.360.842.01-0.5530.002*0.628Female0.410.330.51<0.001*Smoking0.760.571.030.077Dyslipidemia0.430.240.770.004*History of myocardial infarction0.730.182.960.663COPD1.270.572.840.558Stroke5.462.999.97<0.001*Hypertension0.750.561.010.057Hypothyroidism1.330.842.080.225Obesity0.920.691.240.593Arrhythmia27.5221.435.3<0.001*Electrolyte Derangement13.410.517.1<0.001*ESRD on Hemodialysis2.401.463.940.001*Oxygen Dependence1.170.363.790.792Hypertrophic cardiomyopathy7.893.0420.45<0.001*Cocaine Use Disorder1.761.202.570.004*Congenital heart disease2.941.725.03<0.001*∗Statistically significant findings, COPD - chronic obstructive pulmonary disease, CI - Confidence interval Open table in a new tab

AP-452680-2 GEOSPATIAL ANALYSIS OF BYSTANDER-INITIATED AUTOMATED EXTERNAL DEFIBRILLATOR UTILIZATION IN A LARGE US COMMUNITY

Bystander use of automated external defibrillators (AED) can improve survival from out-of-hospital sudden cardiac arrest (SCA), but utilization can be variable. We hypothesized that AED distribution and utilization is determined by race/ethnicity and socioeconomic status of neighborhoods. To evaluate the distribution and utilization of bystander-initiated AED use for SCA events in a single large US community. All consecutive SCA cases with resuscitation attempted by emergency medical services (EMS) in Ventura County, CA (pop. 848,112, 43% Hispanic) were prospectively identified during 2015-2022. AED locations were obtained from the Ventura County Healthcare Agency Registry. Census tracts in the county (US Census 2018 estimates), were dichotomized as above or below the median census tract household income categorized as SES1 (income <median income) and SES2 (income >median income). AED and SCA event locations were geocoded and merged with the 2018 census tract geospatial map. The Euclidean distance (meters) between these two locations was calculated. AEDs were considered in viable proximity if located within 300 meters of the SCA event. Differences were analyzed using univariate statistical methods. Among 2515 cases (70.5±16.33 y, 65% male) of whom 684 (27%) were Hispanic, 782 (31%) were in viable proximity of an AED (Figure). There were no ethnicity-based differences in viable AED proximity (Hispanic n= 225(33%), non-Hispanic n=557 (30%), p=0.23). A total of 1442 (57%) cases (70±16.17 y, 65% male) were categorized as SES1 and 1070 (43%) cases (71±16.52 y, 65% male) as SES2. No significant differences in viable AED proximity were identified between SES1 (n= 434, 30%), and SES2 (n=348(33%); p=0.19). A total of 1361(54%) received bystander CPR, but bystander-initiated AED use was observed in 75 (3%). AED use was observed in 75/782 (9%) SCA cases in viable proximity to an AED of whom 3.1% were Hispanic and 12.2% non-Hispanic (p <0.001). SES2 cases had higher AED utilization than SES1 cases (12.4% vs. 7.8%, p = 0.02). In this western US community, AEDs in viable proximity to SCA events were distributed equitably, and not affected by neighborhood SES or ethnicity. However, bystander-initiated use for AEDs in close proximity was under 10%, indicating significant missed opportunities. These findings highlight the critical need to enhance community-wide education in bystander-initiated CPR and AED use for further improvement in SCA survival outcomes.

MP-453090-5 SUDDEN CARDIAC ARREST AS THE FIRST MANIFESTATION OF HEART DISEASE IN THE GENERAL POPULATION

The subgroup of individuals who present with sudden cardiac arrest (SCA) as the first manifestation of heart disease (FM-SCA) present the greatest challenge to effective clinical risk stratification, but population-based data in the current era is lacking. We hypothesized that improved awareness and access to health care has resulted in a reduction in prevalence of FM-SCA. We compared the prevalence secular trends of FM-SCA in two geographically distinct US populations and evaluated distinguishing characteristics. Consecutive cases of SCA were ascertained prospectively from 2 large ongoing US studies, the Oregon Sudden Unexpected Death Study (OreSUDS, Portland OR, USA, 2002-2018) and Prediction of Sudden Death in Multi-ethnic Communities (PRESTO, Ventura CA, USA, 2015-2022), total population 1.85 million residents. All out-of-hospital SCA events attended by emergency medical services were determined following an established multi-source ascertainment and adjudication process, and a detailed review of the comprehensive lifetime clinical records was conducted for each individual. Both SCA survivors and non-survivors were included. FM-SCA cases were defined as SCA with no prior heart disease diagnosis. A multi-variable model using combined data from both cohorts was used to identify distinguishing characteristics of FM-SCA vs. other SCA. A total of 3390 SCA cases (age 64.3 ± 18.8, female 34%) were identified in OreSUDS and n=2318 (age 71.6 ± 15.7, female 36%) in PRESTO. In OreSUDS, prevalence of FM-SCA was 39% (n=1282, age 58.6 ± 21.7, 32% female) and decreased modestly over time (Figure; 37% in 2002-06 to 33% in 2014-18; p=0.001 for trend). In PRESTO, overall prevalence of FM-SCA was 41% (n=949, age 68.3 ± 17.6, 33% female) and did not change significantly over time (Figure; 2015-2022; p=0.06 for trend). In multivariate comparisons of FM-SCA vs. other SCA performed in the subset of individuals with healthcare visits, younger age, male sex and lower rates of diabetes, hypertension, seizure disorder, chronic obstructive pulmonary disease and chronic renal insufficiency were associated with FM-SCA (p <0.0001). There was a modest reduction in prevalence over time, but 33-41% of individuals continued to present with FM-SCA and were distinguished by younger age, male sex and lower rates of co-morbid conditions. These findings suggest the need to develop and investigate user-friendly and cost-effective pre-screening methods to reduce FM-SCA in the general population.

PO-05-137 ECG MORPHOLOGY IS A DETERMINANT OF SURVIVAL IN PULSELESS ELECTRICAL ACTIVITY

Sudden cardiac arrest (SCA) due to pulseless electrical activity (PEA) has a poor prognosis and identification of cases with a higher likelihood of survival could facilitate the resuscitation process. In PEA, QRS frequency and morphology can vary significantly. To investigate if the frequency and morphology of the QRS can predict survival outcomes in PEA. The study population is drawn from two prospective, community-based studies of out-of-hospital SCA in the U.S.: Oregon SUDS from the Portland, OR metro area (Pop. approx. 1 million; since 2002) and Ventura PRESTO from Ventura County CA (Pop. approx. 850,000, since 2015). In the present study, we included SCA cases resuscitated by EMS that had EMS recording of the ECG available, and PEA was the presenting rhythm. We analyzed QRS frequency, regularity, and width of the presenting PEA rhythm in a subset of 347 PEA-SCA cases (34 survivors and 313 non-survivors). The mean age of the subjects was 70.3±15.5 years and 60.2% were male. The prevalence of QRS frequency >60 bpm was 23.1% and QRS width <120 ms was 32.6%. Females were more likely to have a narrow QRS complex than males (39.9% vs. 27.8%; p=0.02) but there was no sex difference in the QRS frequency. Those with QRS frequency >60 bpm had a higher survival rate than those with QRS frequency <60 bpm (17.5% vs. 7.5%: p=0.02). In addition, cases with QRS width <120 ms had a higher survival rate in comparison to cases with QRS width >120 ms (17.7% vs. 6.0%; p=0.001). Cases with both narrow QRS complex (<120 ms) and fast frequency (>60 bpm) had the highest survival rate (10/38, 26.3%). There was no difference in the survival rate between regular and irregular rhythms. PEAs with electrical activity >60 bpm and narrow QRS complex were associated with higher survival. These results suggest that resuscitation efforts are most likely to be beneficial in PEA-SCA cases that present with a narrow and fast QRS pattern.

Pengaruh Pemberian Video Animasi Mengenai Prosedur Operasional Alat Automatic External Defibrillator (AED) Terhadap Tingkat Pengetahuan Mahasiswa Keperawatan Poltekkes Kemenkes Pangkalpinang

Cases of sudden cardiac arrest can occur anywhere and anytime beyond the hospital. The American Heart Association advocates using Automatic External Defibrillators as a tool to help the sudden cardiac arrest survivor. However, the previous study showed health workers have less knowledge of tool utilization. The study aimed to determine the influence of animated videos regarding the operational procedures on the level of knowledge of the Polytechnic Pangkalpinang Ministry of Health nursing students. The queasy experimental was used with a non-equivalent control group pre-test and post-test design approach. The total of 140 participants divided into intervention groups received animated videos while the control groups received guide book only. The questionnaires used have a validity value of each question item 0.05 and reliability showed by Cronbach alpha value of 0.732. Data were analyzed using Wilcoxon Test and The Mann-Whitney test to see the comparison between the groups. The results showed an increase in the average knowledge before and after being given the intervention. However, there was no significant effect of providing animated video on the level of knowledge of nursing students (p=0.055 ≥ 0.05), and there was no significant difference between groups (p=0.889 ≥ 0.05). The development of an easy-to-access application and various learning media for introducing other medical devices is recommended for further studies.

Highlights From the Circulation Family of Journals.

Highlights From the Circulation Family of Journals.

Association between low-density lipoprotein cholesterol and sudden cardiac arrest in people with diabetes mellitus

BackgroundDyslipidemia measured as low-density lipoprotein (LDL)-cholesterol is an established risk factor of cardiovascular disease, which is more pronounced in diabetes population. Less is known about the association of LDL-cholesterol level and sudden cardiac arrest (SCA) risk in diabetes mellitus patients. This study investigated the association of LDL-cholesterol level and SCA risk in diabetes population.MethodsThis study was based on Korean National Health Insurance Service database. Patients who received general examination from 2009 to 2012 and diagnosed as type 2 diabetes mellitus were analyzed. Primary outcome was defined as SCA event identified with International Classification of Disease code.ResultsA total of 2,602,577 patients were included, with total follow-up duration of 17,851,797 person * year. Mean follow-up duration was 6.86 years, and 26,341 SCA cases were identified. Overall incidence of SCA was highest in the lowest LDL-cholesterol group (< 70 mg/dL) and decreased in a linear manner as LDL-cholesterol rises, till 160 mg/dL. Adjustment of covariates resulted in U-shape association, with highest risk of SCA in the highest LDL-cholesterol group (≥ 160 mg/dL) followed by lowest LDL-cholesterol group (< 70 mg/dL). In subgroup analysis, U-shape association between SCA risk and LDL-cholesterol was more pronounced in male, non-obese people, and those who did not use statins.ConclusionsIn people with diabetes, the association between SCA and LDL-cholesterol level was U-shaped with highest and lowest LDL-cholesterol group having higher risk of SCA than others. Low LDL-cholesterol level can be a surrogate marker for increased risk of SCA in people with diabetes mellitus and this paradoxical association should be recognized and extended to clinical preventive measures.