Incidence Of Life-threatening Events Research Articles

Incidence of life-threatening events in children with Wolff-Parkinson-White syndrome: Analysis of a large claims database.

Previous estimates of life-threatening event (LTE) risk in Wolff-Parkinson-White (WPW) syndrome are limited by selection bias inherent to tertiary care referral-based cohorts. This analysis sought to measure LTE incidence in children with WPW syndrome in a large contemporary representative population. A retrospective cohort study was conducted using claims data from the IBM MarketScan Research Databases, evaluating subjects with WPW syndrome (age 1-18 years) from any encounter between January 1, 2013, and December 31, 2018. Subjects with congenital heart disease and cardiomyopathy were excluded. The primary outcome was diagnosis of ventricular fibrillation (VF); a composite outcome, LTE, was defined as occurrence of VF and/or cardiac arrest. VF and LTE rates were compared to matched representative controls without WPW syndrome (3:1 ratio). The prevalence of WPW syndrome was 0.03% (8733/26,684,581) over a median follow-up of 1.6 years (interquartile range 0.7-2.9 years). Excluding congenital heart disease/cardiomyopathy, 6946 subjects were analyzed. An LTE occurred in 49 subjects (0.7%), including VF in 20 (0.3%). The incidence of VF was 0.8 events per 1000 person-years, and the incidence of LTE was 1.9 events per 1000 person-years. There were no occurrences of VF in controls; the rate of LTE was 70 times higher in subjects with WPW syndrome (0.7%; 95% confidence interval 0.5%-0.9%) than in controls (0.01%; 95% confidence interval 0%-0.02%). The use of a large claims data setallowed for an evaluation of VF and LTE risk in an unselected pediatric population with WPW syndrome. The observed range of 0.8-1.9 events per 1000 person-years is consistent with prior reports from selected populations. A comparison of event rates to matched controls confirms and quantifies the significant elevation in VF and LTE risk in pediatric WPW syndrome.

Abstract 17031: Incidence of Life-Threatening Events in Children With Wolff-Parkinson-White Syndrome

Introduction: Life-threatening events (LTE) in patients with Wolff-Parkinson-White Syndrome (WPW) are rare, with considerable variation in published rates. Existing data on LTE incidence represent selected populations or tertiary referral-based cohorts. Access to large observational datasets allows, for the first time, measurement of the risk of LTE in an unselected, contemporary WPW population. Methods: A retrospective cohort study was conducted using administrative claims from Truven Health Analytics (MarketScan ® ) to identify all WPW patients (aged ≤18 years) from both inpatient and outpatient encounters between January 2013 and December 2016. Prevalence of WPW was measured. A composite outcome, LTE, was defined as an episode that included ventricular fibrillation or cardiac arrest. Secondary outcomes included diagnoses of atrial fibrillation (AF) and supraventricular tachycardia (SVT). Factors associated with LTE were evaluated by creating multivariable models. Results: The prevalence of WPW in the study population was 0.025% (4,717/18,884,579). Subjects with WPW were 57% male, had a median age of 13 yrs (IQR 7-16 yrs), with coincident Ebstein’s anomaly in 1.9%, other congenital heart disease (CHD) in 12%, and cardiomyopathy (CM) in 2%. Over the study period, SVT was reported in 20.3% (n=957/4,717), and AF in 1.3% (n=61/4,717) of subjects. Patients with AF were 79% male (n=48/61), with median age 16 yrs (IQR 14-17 yrs), with CHD in 25% (n=15/61) and CM in 7% (n=4/61). LTE occurred in 23 subjects: 70% male (n=16/23), at median age 16 yrs (IQR 7-17 yrs), with CHD in 9% (n=2/23) and CM in 13% (n=3/23); AF was reported in 3 patients with LTE. The incidence of LTE was 1.4 events per 1000 person years of follow up (23/16,514). In a multivariate model including age, gender, CHD, and CM, the only independent predictor of LTE was CM (OR 10.2, 95% CI 2.4-31.1, p<0.001). Conclusions: Use of a large claims dataset allowed for evaluation of LTE risk in an unselected pediatric WPW population. This WPW-related LTE estimate of 1.4/1000 person years can serve as a benchmark for assessment of risk reduction interventions on a population level. Incidence of LTE in this unselected contemporary cohort is consistent with observed rates in prior reports from selected populations.

Incidence and Management of Life-Threatening Adverse Events During Cardiac Catheterization for Congenital Heart Disease

Continued advancements in congenital cardiac catheterization and interventions have resulted in increased patient and procedural complexity. Anticipation of life-threatening events and required rescue measures is a critical component to preprocedural preparation. We sought to determine the incidence and nature of life-threatening adverse events in congenital and pediatric cardiac catheterization, risk factors, and resources necessary to anticipate and manage events. Data from 8905 cases performed at the 8 participating institutions of the Congenital Cardiac Catheterization Project on Outcomes were captured between 2007 and 2010 [median 1,095/site (range 133–3,802)]. The incidence of all life-threatening events was 2.1 % [95 % confidence interval (CI) 1.8–2.4 %], whereas mortality was 0.28 % (95 % CI 0.18–0.41 %). Fifty-seven life-threatening events required cardiopulmonary resuscitation, whereas 9 % required extracorporeal membrane oxygenation. Use of a risk adjustment model showed that age <1 year [odd ratio (OR) 1.9, 95 % CI 1.4–2.7, p < 0.001], hemodynamic vulnerability (OR 1.6, 95 % CI 1.1–2.3, p < 0.01), and procedure risk (category 3: OR 2.3, 95 % CI 1.3–4.1; category 4: OR 4.2, 95 % CI 2.4–7.4) were predictors of life-threatening events. Using this model, standardized life-threatening event ratios were calculated, thus showing that one institution had a life-threatening event rate greater than expected. Congenital cardiac catheterization and intervention can be performed safely with a low rate of life-threatening events and mortality; preprocedural evaluation of risk may optimize preparation of emergency rescue and bailout procedures. Risk predictors (age < 1, hemodynamic vulnerability, and procedure risk category) can enhance preprocedural patient risk stratification and planning.Electronic supplementary materialThe online version of this article (doi:10.1007/s00246-013-0752-y) contains supplementary material, which is available to authorized users.

Urban Public School Teachers' Attitudes and Perceptions of the Effectiveness of CPR and Automated External Defibrillators

ABSTRACT Recent legislation and public policy has placed new responsibilities on public school teachers, requiring that they be trained to respond to medical emergencies, especially cardiac arrest. This study examined urban public school teachers' perceptions of the efficacy of cardiopulmonary resuscitation (CPR) and automated external defibrillators (AEDs) via a written survey. Two hundred fifty-nine (259) teachers in a single, large, urban school district were randomly selected, and 77.6% responded. Only 16.3% had received CPR training within the past 2 years. The majority of teachers believed that CPR alone (83.0%) and CPR/AED (92.6%) prior to ambulance arrival would result in a favorable outcome of cardiac arrest. Less than half (47.5%) indicated that they would attempt to provide CPR if a coworker or student collapsed. The majority (72.7%) of teachers believed that schools should have AEDs, and 62.6% believed that public funds should be used to purchase the AEDs. This study suggests that urban teachers have an unrealistically high perception of the efficacy of both CPR and AEDs, and that they would be unwilling to provide CPR in a medical emergency. This information, along with the known low incidence of life-threatening events in schools, suggests a very limited effectiveness of CPR and AED programs for schoolteachers.