Non-sudden Death Research Articles

Abstract 4135708: Obesity and the risk of cardiac death in coronary artery disease

Background: The prevalence of obesity is increasing worldwide reaching epidemic proportions. Obesity increases the risk of coronary artery disease (CAD), but there is little prospective evidence about the effect of obesity on the risk of cardiac death in CAD patients. Aim: We aimed to investigate the effect of obesity and the risk of cardiac death in a prospective cohort of CAD patients. Methods: We have prospectively enrolled 1,946 patients with CAD (mean age 66.9±8.6, 68% male), with a mean follow-up of 8.7±2.2 years. BMI was measured at baseline and was categorized into 4 groups: 1) BMI 18.5-24.9 kg/m 2 (normal weight, reference group), 2) BMI 25-29.9 kg/m 2 (overweight), 3) BMI 30-34.9 kg/m 2 (class 1 obesity), and 4) BMI >35 kg/m 2 (class 2 obesity). The primary endpoint was cardiac death and secondary endpoints were sudden cardiac death/arrest (SCD/SCA), non-sudden cardiac death, non-cardiac death, and heart failure (HF) hospitalization. Statistical analysis was performed with Cox regression and was adjusted for age, sex, type 2 diabetes, CCS class, kidney function (eGFR), systolic and diastolic blood pressure, LDL, smoking, SYNTAX score, and left ventricle ejection fraction. Results: The prevalence of BMI 18.5-24.9 kg/m 2 was 18.5% (n=359), BMI 25-29.9 kg/m 2 was 47.8% (n=929), BMI 30-34.9 kg/m 2 was 24.0% (n=466), and BMI>35 kg/m 2 was 9.7% (n=189). During the follow-up, cardiac death occurred in 156 subjects, SCD/SCA in 75 subjects, non-sudden cardiac death in 81 subjects, and non-cardiac death in 197 subjects. BMI >35 kg/m 2 was associated with an increased trend of cardiac death (adjusted HR 1.92, 95% CI 0.92-4.01; p=0.08) and an increased risk of non-sudden cardiac death (adjusted HR 4.11, 95% CI 1.58-10.68; p=0.004) and HF hospitalization (adjusted HR 2.83, 95% CI 1.06-7-54; p=0.04), but not with SCD/SCA (adjusted HR 0.79, 95% CI 0.24-2.56; p=0.69) or noncardiac death (adjusted HR 0.85, 95% CI 0.43-1.69; p=0.64). The risk of cardiac death or secondary endpoints was not increased in patients with overweight or class 1 obesity. Conclusions: Class 2 obesity was associated with an increased risk of non-sudden cardiac death and heart failure hospitalization among CAD patients. Obesity may have adverse long-term effects on cardiac function and prognosis among CAD patients, supporting the benefit of optimal weight control therapy.

The provision of bereavement care by general practitioners: data from a sentinel network

BackgroundLimited information exists regarding the prevalence of bereavement care provision by general practitioners (GPs) and in what cases they provide this. Insights into the current practice of bereavement care provision by GPs can highlight areas for improvement of the bereavement care practice. Therefore, we examined in how many cases GPs contacted relatives regarding bereavement care, and which case-specific characteristics are associated.MethodsThis study had a retrospective cross-sectional design and used data from a clustered sample of 52 GP-practices in the Netherlands. Patient cases were included if they were one year or older and died between January 1st, 2018 and December 31st, 2022. The main outcome was whether the GP had had contact with relatives regarding bereavement care or planned to do so. Descriptive statistics were used, as well as logistic regression analyses with generalized estimating equations.ResultsFollowing 86.4% of deaths, GPs either had contact with or planned to have contact with relatives of their deceased patients regarding bereavement care. This likelihood was higher in non-sudden deaths compared to sudden deaths (odds ratio [OR] 1.60). In cases of non-sudden death, GPs were more likely to provide bereavement care if an informal caregiver was involved (OR 3.81), or if the GP was part of a palliative care at home group (PaTz) (OR 2.78).ConclusionsIn the majority of cases GPs reach out to the relatives of their deceased patients to offer bereavement care. Given their familiarity with the deceased person, particularly instances of non-sudden death, the GP seems to be well-positioned to provide bereavement care, especially support that focuses on reviewing the period leading up to the death.

ECG Risk Score Model to Predict SCD in HFrEF: Retrospective Review in a Tertiary Centre

INTRODUCTION: Heart failure with reduced ejection fraction (HFrEF) patients need to be risk stratify as guidelines have shown that patients with left ventricularejection fraction (LVEF) <35% could be prevented from sudden cardiac death (SCD) by insertion of prophylactic implantable cardioverter-defibrillator (ICD). Thus we conducted a retrospective single tertiary centre study to evaluate the used of electrocardiogram (ECG) risk score model in identifying the individuals who at higher risk of SCD. MATERIALS AND METHODS: A total of 356 heart failure with reduced ejection fraction (HFrEF) patients treated at University Malaya Medical Centre between January 2017 and December 2021 were enrolled into this study. The patients’ demographics, types of heart failure, medications, and ECG parameters data were collected. The study outcomes were survivor or death in and the cause of death were subdivided into SCD or non-sudden cardiac death (non-SCD). RESULTS: A total of 156 study patients were survivor whereas another 120 had SCD and 70 had non-SCD. There were six ECG parameters that remained significant in the final model, namely the bundle branch block (BBB), abnormal P waves, QRS duration, QTc duration, TpTe interval and PR interval. The significant ECG parameters were combined into a risk score to enumerate prediction ability towards SCD. From our ECG risk score model, subject with ≥2 ECG abnormalities had more than 3-fold increased risk for SCD (HR 3.739, 95% CI 1.703-8.211, P 0.001) and the risk proportionately increased with increasing ECG abnormalities. CONCLUSION: Our findings suggested that the cumulative ECG risk score model was independently associated with SCD and particularly effective for LVEF <40% where risk stratification model remained scarce. So, we would like to propose for a prospective study to further evaluate our study outcome.

Novel Immunohistochemical and Morphological Approaches in a Retrospective Study of Post-Mortem Myocarditis.

Background and Objectives: This study presents a retrospective analysis of 26 autopsy cases from a single centre, primarily focusing on forensic cases, with a majority of male individuals. Materials and Methods: We systematically analysed autopsy reports and cardiac tissue slides using haematoxylin-eosin stain and immunohistochemistry for CD3, CD163, and IL-6. The histological assessment evaluated key variables such as inflammation severity, necrosis, and background changes using a standardised grading system. Quantitative analysis of immunohistochemical markers was performed, calculating the percentage of positively stained cells within the inflammatory infiltrate. Results: The average age was 51.6 years, slightly skewed towards older males. The fatalities varied widely, with sudden death and drug abuse being the most common conditions linked to myocarditis findings on histological examination. A strong correlation was found between the severity of inflammation (measured by size within a myocardium section) and the scoring system based on the number of inflammatory foci per section (p ≤ 0.001). Most cases showed mild to minimal fibrosis, with some exhibiting moderate to severe fibrosis, arteriosclerosis, and myocyte hypertrophy. The presence of protein CD3 in the inflammatory infiltrate revealed a moderate inverse correlation between the CD3 values and the severity of inflammation and necrosis, and a strong inverse correlation with neutrophil levels. CD3 levels were higher in sudden death cases and lower in cases with numerous inflammatory foci, highlighting the discreet nature of lymphocytic myocarditis. Macrophage presence, assessed using CD163, showed a moderate inverse correlation with neutrophil levels and significant differences between sudden death and non-sudden death cases. Macrophage-rich inflammation was observed in cases with pneumonia/bronchopneumonia-associated lesions. IL-6 expression showed a moderate direct correlation with inflammation severity (p = 0.028), severity of necrosis (p = 0.005), and the number of inflammatory foci per section (p = 0.047). A moderate inverse correlation was found between CD3 and IL-6 expression (p = 0.005). Conclusions: These findings highlight the need for a unique immunohistochemical approach in forensic cases of myocarditis, differing from guidelines for endomyocardial biopsies due to diverse inflammatory cells. The study suggests exploring inflammatory chemokines within myocarditis foci for their significance in clinical scenarios. Specifically, IL-6, a crucial pro-inflammatory interleukin, correlated significantly with the severity of inflammation and necrosis (p < 0.05). This study provides novel and valuable insights into the histopathological and immunological markers of myocarditis in autopsy cases.

Prognostic significance of beat-to-beat variability of spatial heterogeneity of repolarisation analysed from 5-minute resting electrocardiogram in coronary artery disease

Abstract Background Data on the prognostic significance of temporal variability of spatial heterogeneity of electrocardiographic repolarisation in coronary artery disease (CAD) are limited. Purpose To evaluate the prognostic value of temporal variability of T-wave morphology analysed from 5-minute resting ECG in CAD. Methods The standard deviation (SD) of T-wave morphology dispersion (TMD-SD), the SD of T-wave heterogeneity (TWH-SD), and the SD of total cosine R-to-T (TCRT-SD) were analysed on beat-to-beat basis from a 5-minute period of resting 12-lead ECG obtained before a clinical stress test in 1702 patients with angiographically verified CAD and well-preserved left ventricular function. Results During an average of 8.7±2.2 years of follow-up, 60 (3.5 %) patients experienced sudden cardiac death (SCD) or were resuscitated from a sudden cardiac arrest (SCA), 69 (4.1 %) patients experienced non-sudden cardiac death (NSCD), and 161 (9.5 %) patients died due to non-cardiac death (NCD). TMD-SD was significantly higher in patients who experienced SCD/SCA compared with those without such an event (1.72 ± 2.00 vs. 1.12 ± 1.75, p= 0.01, respectively) and in patients who succumbed to NSCD compared with those without such an event (1.57 ± 1.74 vs. 1.12 ± 1.76, p=0.04, respectively), but did not differ significantly between patients who experienced NCD and those without such an event (1.16 ± 1.42 vs. 1.14 ± 1.79, p=0.86, respectively). After adjusting for relevant clinical risk factors in the Cox multivariate hazards model, TMD-SD retained its significant association with the risk of SCD/SCA (HR 1.119, 95 % CIs 1.015–1.233, p=0.024), but not with the risk of NSCD (HR 1.089, 95 % CIs 0.983–1.206, p=0.103). Conclusion TMD-SD, representing temporal variability of spatial heterogeneity of electrocardiographic repolarisation, is independently associated with the long-term risk of SCD/SCA in CAD patients with well-preserved left ventricular function.

Prognostic significance of beat-to-beat variability of spatial heterogeneity of repolarization analyzed from a 5-minute resting electrocardiogram in coronary artery disease

BackgroundData on the prognostic significance of temporal variability of spatial heterogeneity of electrocardiographic repolarization in coronary artery disease (CAD) are limited. ObjectiveThe purpose of this study was to evaluate the prognostic value of temporal variability of T-wave morphology analyzed from a 5-minute resting electrocardiogram in CAD. MethodsThe standard deviation (SD) of T-wave morphology dispersion (TMD-SD) and the SD of total cosine R-to-T were analyzed on a beat-to-beat basis from a 5-minute period of the standard resting 12-lead electrocardiogram obtained before the clinical stress test in 1702 patients with angiographically verified CAD and well-preserved left ventricular function. ResultsDuring an average of 8.7 ± 2.2 years of follow-up, 60 patients experienced sudden cardiac death/arrest (SCD/SCA) (3.5%), 69 patients nonsudden cardiac death (NSCD) (4.1%), and 161 patients noncardiac death (9.5%). TMD-SD was significantly higher in patients who experienced SCD/SCA than in other patients (1.72 ± 2.00 vs 1.12 ± 1.75; P = .01) and higher in patients who succumbed to NSCD than in other patients (1.57 ± 1.74 vs 1.12 ± 1.76; P = .04), but it did not differ significantly between patients who experienced noncardiac death and those without such an event (1.16 ± 1.42 vs 1.14 ± 1.79; P = .86). In the Cox multivariable hazards model, TMD-SD retained its significant association with the risk of SCD/SCA (hazard ratio 1.119; 95% confidence interval 1.015–1.233; P = .024) but not with the risk of NSCD (hazard ratio 1.089; 95% confidence interval 0.983–1.206; P = .103). ConclusionTMD-SD is independently associated with the long-term risk of SCD/SCA in patients with CAD.

Giving with a warm hand: evidence on estate planning and inter-vivos transfers

Abstract In this study, we examine the importance of estate planning and inter-vivos transfers towards the end of life. To that end, we use administrative data on all deaths taking place in the Netherlands between 2006 and 2013. We link these to wealth and income tax records and the hospital discharge register. Employing these unique data, we distinguish between sudden and non-sudden deaths and study how they compare in terms of wealth at death. Our results show that non-sudden deaths are associated with significantly less financial wealth at the time of death. We interpret this difference as the result of inter-vivos transfers that result from estate planning towards the end of life. We find significant effects not only at the top of the wealth distribution but along the entire upper half of the distribution. Diseases with a relatively low survival rate that do not affect cognitive abilities appear as the most likely to trigger estate planning. These results have important implication for gift and inheritance tax schedules that allow for tax avoidance via exemptions and the progressivity of the tax rate.

Association between glycated albumin and sudden death in patients undergoing hemodialysis

BackgroundThe frequency of sudden death and its risk factors in patients undergoing hemodialysis are unknown. This study was performed to examine the association between glycated albumin (GA) and sudden death in Japanese patients undergoing hemodialysis.MethodsIn total, 260 patients undergoing hemodialysis aged ≥18 years were retrospectively followed for a mean of 4.6 years. The patients’ serum GA levels were divided into tertiles, and the patients’ sex, age, albumin level, C-reactive protein (CRP) level, and cardiothoracic ratio (CTR) were selected as adjustment factors. A logistic regression model was used to calculate the odds ratio (OR) for the occurrence of sudden death by GA level.ResultsNinety-one patients died during follow-up. Of the 91 deaths, 23 (25.2%) were defined as sudden deaths. Compared with non-sudden death cases, sudden death cases were significantly younger (p = 0.002) and had a higher proportion of men (p = 0.03), a higher proportion of diabetes (p = 0.008), and higher GA levels (p = 0.023). Compared with patients with the lowest GA levels (<15.2%), those with the highest GA levels (≥18.5%) had a sex- and age-adjusted OR for sudden death of 5.40 [95% confidence interval (CI): 1.35–21.85]. After adjusting for the albumin level, CRP level, and CTR in addition to sex and age, the OR for sudden death of patients with the highest GA levels increased to 6.80 (95%CI: 1.64–28.08); the relationship did not change.ConclusionSerum GA levels were significantly associated with sudden death in patients undergoing hemodialysis.

Ondansetron and the Risk of Sudden Cardiac Death among Individuals Receiving Maintenance Hemodialysis.

Individuals receiving hemodialysis have high incidence of sudden cardiac death and are susceptible to QT interval prolonging medication-related cardiac complications. Ondansetron, an antiemetic with known QT prolonging potential, is associated with fatal arrythmias in the general population when administered intravenously. The cardiac safety of ondansetron in the hemodialysis population is unknown. We conducted a new-user, active-comparator, cohort study using US Renal Data System data (2012-2019) to examine the association between the initiation of oral ondansetron vs. antiemetics with lesser QT prolonging potential (promethazine, metoclopramide or prochlorperazine) and the 10-day risk of sudden cardiac death among individuals receiving hemodialysis. We used inverse probability of treatment weighted survival models to estimate adjusted hazard ratios (aHRs), risk differences (aRDs), and 95% confidence intervals (CIs). We used an intention-to-treat approach in which non-sudden cardiac death was considered a competing event. We examined additional cardiac outcomes in secondary analyses. Of the 119,254 study patients, 64,978 (54.5%) initiated ondansetron, and 54,276 (45.5%) initiated a comparator antiemetic. Initiation of ondansetron versus a comparator antiemetic was associated with higher relative and absolute 10-day risks of sudden cardiac death, aHR (95% CI) = 1.44 (1.08, 1.93); aRD (95% CI) = 0.06% (0.01%, 0.11%). The number needed to harm was 1,688. Analyses of additional cardiac outcomes yielded similar findings. Compared with initiation of antiemetics with lesser QT prolonging potential, initiation of ondansetron was associated with higher short-term cardiac risks among people receiving hemodialysis.

MRI Assessment of Myocardial Deformation for Risk Stratification of Major Arrhythmic Events in Patients With Non-Ischemic Cardiomyopathy Eligible for Primary Prevention Implantable Cardioverter Defibrillators.

Implantable cardioverter-defibrillator (ICD) intervention is an established prophylactic measure. Identifying high-benefit patients poses challenges. To assess the prognostic value of cardiac magnetic resonance imaging (MRI) parameters including myocardial deformation for risk stratification of ICD intervention in non-ischemic cardiomyopathy (NICM) while accounting for competing mortality risk. Retrospective and prospective. One hundred and fifty-nine NICM patients eligible for primary ICD (117 male, 54 ± 13 years) and 49 control subjects (38 male, 53 ± 5 years). Balanced steady state free precession (bSSFP) and three-dimensional phase-sensitive inversion-recovery late gadolinium enhancement (LGE) sequences at 1.5 T or 3 T. Patients underwent MRI before ICD implantation and were followed up. Functional parameters, left ventricular global radial, circumferential and longitudinal strain, right ventricular free wall longitudinal strain (RV FWLS) and left atrial strain were measured (Circle, cvi42). LGE presence was assessed visually. The primary endpoint was appropriate ICD intervention. Models were developed to determine outcome, with and without accounting for competing risk (non-sudden cardiac death), and compared to a baseline model including LGE and clinical features. Wilcoxon non-parametric test, Cox's proportional hazards regression, Fine-Gray competing risk model, and cumulative incidence functions. Harrell's c statistic was used for model selection. A P value <0.05 was considered statistically significant. Follow-up duration was 1176 ± 960 days (median: 896). Twenty-six patients (16%) met the primary endpoint. RV FWLS demonstrated a significant difference between patients with and without events (-12.5% ± 5 vs. -16.4% ± 5.5). Univariable analyses showed LGE and RV FWLS were significantly associated with outcome (LGE: hazard ratio [HR] = 3.69, 95% CI = 1.28-10.62; RV FWLS: HR = 2.04, 95% CI = 1.30-3.22). RV FWLS significantly improved the prognostic value of baseline model and remained significant in multivariable analysis, accounting for competing risk (HR = 1.73, 95% CI = 1.12-2.66). In NICM, RV FWLS may provide additional predictive value for predicting appropriate ICD intervention. 2 TECHNICAL EFFICACY: Stage 5.

Ventricular tachycardia predicts all-cause mortality and non-sudden cardiac death in non-ischaemic cardiomyopathy

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): The DCM-VT study was partially supported by an investigator-initiated grant (IIS-310) from Biosense Webster (a Johnson &amp; Johnson company). The DANISH study was supported by unrestricted grants from Medtronic, St. Jude Medical, TrygFonden, and the Danish Heart Foundation. Background Endstage heart failure, ventricular tachycardia (VT) and sudden cardiac death (SCD) are sequels of non-ischaemic cardiomyopathies (NICM). Implantable cardioverter defibrillators (ICDs) can terminate VT and prevent SCD but mortality benefit has been limited in recent trials suggesting that VT may also be associated with non-sudden cardiovascular death (NSCVD). Purpose To assess the effect of VT on all-cause mortality and NSCVD in NICM patients with ICDs. Methods Two multicenter cohorts of NICM patients were merged for analysis: (1) patients randomized to ICD in the DANISH trial, which included patients with NICM, LVEF ≤35% and no prior VT and (2) the DCM-VT study cohort, which included consecutive NICM patients with any LVEF referred for ablation of sustained VT. Predictors for the primary composite outcome of all-cause death and heart transplant (death/HTx) and for the secondary outcome of NSCVD were assessed. In addition, propensity score matching was performed using the parameters age, gender, LVEF and eGFR. Finally, survival following VT occurrence was compared between DANISH and DCM-VT patients. Results A total of 828 patients (556 DANISH, 272 DCM-VT) were followed for a median of 3.9 years (2.1 – 5.8). DANISH patients had a median LVEF of 25% (20 – 30) and DCM-VT patients 35% (27 – 43). A total of 148 patients (DANISH 16.4%, DCM-VT 21.0%) experienced death/HTx and NSCVD occurred in 78 patients (7.7%, 12.9%, respectively). In multivariable analysis history of VT at inclusion was a significant predictor of the primary outcome with an adjusted hazard ratio (HRa) of 3.81 (95% CI 2.33 - 6.24) as were age [HRa 1.02 per year (1.01 - 1.04)], LVEF [HRa 0.96 per 1% increase (0.94 - 0.98)] and reduced eGFR [HRa 1.71 (1.15 – 2.53 )]. History of VT predicted NSCVD with an HRa of 7.54 (3.97 - 14.33). After matching, history of VT still predicted death/HTx [HR 4.12 (2.48 - 6.82)] and NSCVD [HR 6.92 (3.30 - 14.52)]. Risk of death/HTx, as well as NSCVD, for DANISH patients was similar to DCM-VT patients after they experienced their first VT event [HRa 0.90 (0.48 - 1.69) and HRa 1.07 (0.56 - 2.06) resp.]. Conclusions VT occurrence appears to be an important predictor of non-sudden CV death as well as all-cause death in NICM patients independent of other markers of heart failure severity. VT may be a marker of progressive disease and remodelling that could be incorporated into risk-stratification to help predict deterioration and need for HTx.

Research on Relationship Between Dysphagia and Sudden Death After Medullary Infarction.

Medullary infarction (MI) often leads to severe dysphagia and sudden death. We investigated whether dysphagia was associated with sudden death. Patients with MI were divided into sudden death group and nonsudden death group. Dysphagia was evaluated in 2 ways: the water-swallowing test (WST) points and the degree of dysphagia. Random undersampling (RUS), random oversampling (ROS), and synthetic minority oversampling technique (SMOTE) techniques were used to process the original data and solve the imbalance problem between 2 classes. Univariate and multivariate logistic regressions were used to analyze the association between the independent variables (WST and degree of dysphagia) and the dependent variable (sudden death or not), while the National Institutes of Health Stroke Scale (NIHSS) score was used as a control. Univariate logistic regression analysis showed that for all resampling methods, both the WST and NIHSS were risk factors for sudden death after MI. For multivariable logistic regression, the fitting effect of RUS logistic regression was satisfactory, which showed the same results. The results of the univariate logistic regression analysis of dysphagia degree showed that for all resampling methods, compared with no dysphagia, both mild to moderate dysphagia degree and severe dysphagia degree were risk factors for sudden death. For multivariable logistic regressions, the logistic regressions of the original data and the RUS resampling method were satisfactory which showed the same results. Dysphagia is closely related to sudden death after MI. The more severe the dysphagia, the higher is the incidence of sudden death.

Clinical factors affecting survival in patients with D-transposition of the great arteries after atrial switch repair: A meta-analysis.

Atrial switch repair (AtrSR) was the initial operation method in patients with D-transposition of the great arteries (D-TGA) constituting the right ventricle as a systemic one. Currently, it has been replaced with arterial switch operation (ASO), but the cohort of adults after AtrSR is still large and requires strict cardiological management of late complications. For this reason, we aimed to evaluate potential long-term mortality risk factors in patients with D-TGA after AtrSR (either Mustard or Senning procedures) Methods: We searched the MEDLINE database for suitable trials. We included 22 retrospective and prospective cohort studies of patients with D-TGA with at least 5 years mean/median follow-up time after Mustard or Senning procedures, with an endpoint of non-sudden cardiac death (n-SCD) and sudden cardiac death (SCD) after at least 30 days following surgery. A total of 2912 patients were enrolled, of whom 351 met the combined endpoint of n-SCD/SCD. The long-term mortality risk factors were New York Heart Association (NYHA) class ≥III/heart failure hospitalization (odds ratio [OR], 7.25; 95% confidence interval [CI], 2.67-19.7), tricuspid valve regurgitation (OR, 4.64; 95% CI, 1.95-11.05), Mustard procedure (OR, 2.15; 95% CI, 1.37-3.35), complex D-TGA (OR, 2.41; 95% CI, 1.31-4.43), and right ventricular dysfunction (OR, 1.94; 95% CI, 0.99-3.79). Supraventricular arrhythmia (SVT; OR, 2.07; 95% CI, 0.88-4.85) and pacemaker implantation (OR, 2.37; 95% CI, 0.48-11.69) did not affect long-term survival in this group of patients. In an additional analysis, SVT showed a statistically significant impact on SCD (OR, 2.74; 95% CI, 1.36-5.53) but not on n-SCD (OR, 1.5; 95% CI, 0.37-6.0). This meta-analysis demonstrated that at least moderate tricuspid valve regurgitation, NYHA class ≥III/heart failure hospitalization, right ventricular dysfunction, complex D-TGA, and Mustard procedure are risk factors for long-term mortality in patients after AtrSR.

Risk Factors for Sudden Death Within 2 Days After Diagnosis of COVID-19 in Korea.

We aimed to analyze the risk factors for sudden death after diagnosis of coronavirus disease 2019 (COVID-19) in South Korea and to provide evidence for informing prevention and control interventions for patients at risk of sudden death. We included 30,302 COVID-19 related deaths registered in the patient management information system (Central Disease Control Headquarters) between January 1, 2021, and December 15, 2022. We collected their epidemiological data recorded by the reporting city, province, or country. We performed multivariate logistic regression analysis to identify risk factors for sudden death after diagnosis of COVID-19. Among the 30,302 deaths, there were 7,258 (24.0%) and 23,044 (76.0%) sudden and non-sudden deaths, respectively. Sudden death means a person who died within 2 days of diagnosis and who did not receive inpatient treatment. Underlying condition, vaccination status, and place of death were significantly associated with the survival period in all age groups. Moreover, region, sex, and prescription were significantly associated with the survival period only in certain age groups. However, reinfection was not significantly associated with the survival period in any age group. To our knowledge, this is the first study on the risk factors for sudden death after a diagnosis of COVID-19, which included age, underlying condition, vaccination status, and place of death. Additionally, individuals aged < 60 years without an underlying condition were at high risk for sudden death. However, this group has relatively low interest in health, as can be seen from the high non-vaccination rate (16.1% of the general population vs. 61.6% of the corresponding group). Therefore, there is a possibility for the presence of an uncontrolled underlying disease in this population. In addition, many sudden deaths occurred due to delayed hospital visits to continue economic activities even after the onset of COVID-19 symptoms (7 days overall vs. 10 days average for the group). In conclusion, 'continued interest in health' is a key factor in avoiding sudden death in the economically active group (under 60 years of age).

Microalbuminuria during acute coronary syndrome: Association with 22-year mortality and causes of death. The ABC-8* study on heart disease. (*ABC is an acronym for Adria, Bassano, Conegliano, and Padova Hospitals)

BackgroundMicroalbuminuria is associated with adverse outcomes in acute coronary syndrome (ACS) patients. MethodsTo evaluate the very long-term association between Microalbuminuria and the overall mortality and causes of death in this clinical setting, we prospectively studied 579 unselected ACS patients admitted to three hospitals. The baseline albumin-to-creatinine ratio (ACR) was measured on days 1, 3, and 7 in 24-h urine samples. Patients were followed for 22 years or until death. ResultsVirtually all patients completed follow-up; 449(78%) had died: 41% due to non-sudden cardiac death (non-SCD), 19% sudden cardiac death (SCD), 40% due to non-cardiac (non-CD) death.Using unadjusted Cox regression analysis, ACR was a significant predictor of all-cause mortality (hazard ratio [HR] 1.26;95%confidence interval [CI] 1.22–1.31; p˂0.0001) and the three causes of death (HR 1.40;95%CI 1.32–1.48; p˂0.0001), (HR 1.22;95%CI 1.12–1.32; p˂0.0001) and (HR 1.16;95%CI 1.09–1.23; p˂0.0001) for non-SCD, SCD and non-CD respectively.Using a fully adjusted model, ACR was a significant independent predictor of all-cause mortality (HR 1.12; 95%CI 1.08–1.16; p˂0.0001) and only non-SCD (HR 1.21; 95%CI 1.14–1.29; p˂0.0001).There was a positive interaction between ACR level and history of AMI (HR 1.15; 95%CI 1.03–1.29; p = 0.01) and the presence of heart failure at admission (HR 1.11; 95%CI 1.01–1.24; p = 0.04), and negative interaction with higher than median LVEF (HR 0.89; 95%CI 0.80–0.99; p = 0.03) for all-cause mortality at the multivariable level. ConclusionBased on the present analysis, baseline urinary albumin excretion during ACS is a strong independent predictor of the very long-term mortality risk, chiefly due to non-sudden cardiac death.

Abstract 13493: Microalbuminuria During Acute Coronary Syndrome: Association With Very Long-Term Mortality and Causes of Death. The ABC-8* Study on Heart Disease

Background: Microalbuminuria is associated with adverse outcome in acute coronary syndrome (ACS) patients. Methods: To evaluate the very long-term association between microalbuminuria during ACS and the overall mortality and causes of death, we prospectively studied 579 ACS patients admitted to three Italian hospitals. The baseline albumin-to-creatinine ratio (ACR) was measured on days 1, 3, and 7 in 24-h urine samples. Patients were followed for 22 years or until death. Results: Virtually all patients completed the follow-up, representing 6756 person-years. During follow-up, 449(78%) had died: 41% due to non-sudden cardiac death (non-SCD), 19% sudden cardiac death (SCD), 40% due to non-cardiac (non-CD) death. The unadjusted Cox regression analysis showed that ACR is a significant predictor of all-cause mortality (HR:1.26; 95%CI 1.22-1.31; p˂0.0001) and the 3 causes of death (HR:1.40; 95%CI 1.32-1.48; p˂0.0001), (HR:1.22; 95%CI 1.12-1.32; p˂0.0001) and (HR:1.16; 95%CI 1.09-1.23; p˂0.0001) for non-SCD, SCD and non-CD respectively. Yet the fully adjusted model showed that ACR is a significant independent predictor of all-cause mortality (HR:1.12; 95%CI 1.08-1.16; p˂0.0001) and only non-SCD (HR:1.21; 95%CI 1.14-1.29; p˂0.0001).A positive interaction between ACR and history of AMI (HR:1.15; 95%CI 1.03-1.29; p=0.01), and the presence of heart failure during admission (HR:1.11; 95%CI 1.01-1.24; p=0.04), and a negative interaction with LVEF (HR:0.89; 95%CI 0.80-0.99; p=0.03) for all-cause death was also observed at the multivariable level. Conclusion: This prospective study shows that baseline ACR during ACS seems to be a strong independent predictor of the very long-term mortality risk, chiefly associated with non-sudden cardiac death. A positive independent interaction with indicators of heart failure has been also observed. Figure 1: Relative hazard estimates for all-cause and cause-specific mortality 22 years after ACS according to baseline ACR.

Abstract 15205: Cardiovascular Outcomes With Use of Primary Prevention Implantable Cardioverter Defibrillators in Patients With Non-Ischemic Cardiomyopathy: A Meta-Analysis and Meta-Regression Analysis

Introduction: Guidelines recommend use of implantable cardioverter defibrillator (ICD) in all patients with non-ischemic cardiomyopathy (NICM) and ejection fraction (EF) &lt; 35% for primary prevention of sudden cardiac death (SCD) and hence reduction of overall mortality. Contemporary randomized clinical trials (RCTs) with longer follow up duration have thrown into question this beneficial effect of ICDs. Hypothesis: Prophylactic use of ICDs in addition to optimal medical therapy (OMT) does not reduce adverse outcomes in patients with NICM and EF &lt; 35% compared to OMT alone. Methods: Six RCTs (n=4541) comparing ICD + OMT vs OMT alone were selected from MEDLINE and EMBASE databases from inception through March 2022. Meta-analysis was performed using random effects model. Meta-regression analysis was performed with inverse-variance weighting and Knapp and Hartung adjustments for all-cause mortality. Results: ICDs did not reduce risk of all-cause mortality (Relative Risk (RR) 0.87, [95% confidence interval, 0.75-1.00], cardiovascular mortality (RR, 0.80 [0.49-1.31]), non-cardiovascular mortality (RR, 0.66 [0.13-3.34]) or non-sudden cardiac death (RR, 1.03 [0.51-2.08]). ICDs reduced the risk of sudden cardiac death (HR, 0.49 [0.26-0.92]). Meta-regression analysis did not show any association between all-cause mortality and follow up duration (p=0.09). Conclusions: ICDs reduce risk of SCD however this does not translate into meaningful improvement in long term cardiovascular outcomes.

Clinical factors affecting survival in patients with D-transposition of the great arteries after atrial switch repair: a meta-analysis

Abstract Background Atrial switch repair (AtrSR) was the initial method of operation in patients with D-transposition of the great arteries (D-TGA) constituting the right ventricle as a systemic one. Currently, it has been replaced with arterial switch operation (ASO), but the cohort of adults after AtrSR is still large and requires strict cardiological management of late complications. For this reason, we aimed to evaluate potential long-term mortality risk factors in patients with D-TGA after AtrSR (either Mustard or Senning procedure) Method We searched MEDLINE database for suitable trials. We included 22 retrospective and prospective cohort studies of patients with D-TGA with at least 5 years mean/median follow-up time after Mustard or Senning procedure, with an end-point of non-sudden cardiac death (n-SCD) and sudden cardiac death (SCD) after at least 30 days after surgery. Results A total of 2912 patients were enrolled, of which 351 met the combined endpoint of n-SCD/SCD. The long-term mortality risk factors were: NYHA&amp;gt;II/heart failure hospitalization (OR=7.25; p=0.0001), tricuspid valve regurgitation (OR=4.64; p=0.0005), Mustard procedure (OR=2.15; p=0.0008), complex D-TGA (OR=2.41; p=0.005), right ventricle dysfunction (OR=1.94; p=0.05). Supraventricular arrhythmia (SVT; OR=2.07; p=0.09) and pacemaker implantation (OR=2.37; p=0.29) did not affect long-term survival in this group of patients. In an additional analysis, SVT showed a statistically significant impact on SCD (OR=2.74; p=0.005) but not on n-SCD (OR=1.5; p=0.57). Conclusions This meta-analysis identified that at least moderate tricuspid valve regurgitation, NYHA class &amp;gt; II/heart failure hospitalization, right ventricle dysfunction, complex D-TGA and Mustard procedure as risk factors of long-term mortality in patients after AtrSR. Funding Acknowledgement Type of funding sources: None.

Continuity of physician care over the last year of life for different cause-of-death categories: a retrospective population-based study.

The mix of care provided by family physicians, specialists and palliative care physicians can vary by the illnesses leading to death, which may result in disruptions of continuity of care at the end of life. We measured continuity of outpatient physician care in the last year of life across differing causes of death and assessed factors associated with higher continuity. We conducted a retrospective descriptive study of adults who died in Ontario between 2013 and 2018, using linked provincial health administrative data. We calculated 3 measures of continuity (usual provider, Bice-Boxerman and sequential continuity), which range from 0 to 1, from outpatient physician visits over the last year of life for terminal illness, organ failure, frailty, sudden death and other causes of death. We used multivariable logistic regression models to evaluate associations between characteristics and a continuity score of 0.5 or greater. Among the 417 628 decedents, we found that mean usual provider, Bice-Boxerman and sequential continuity indices were 0.37, 0.30 and 0.37, respectively, with continuity being the lowest for those with terminal illness (0.27, 0.23 and 0.33, respectively). Higher number of comorbidities, higher neighbourhood income quintile and all non-sudden death categories were associated with lower continuity. We found that continuity of physician care in the last year of life was low, especially in those with cancer. Further research is needed to validate measures of continuity against end-of-life health care outcomes.

Efficacy of Implantable Cardioverter Defibrillator in Nonischemic Systolic Heart Failure According to Sex: Extended Follow-Up Study of the DANISH Trial.

Men and women may respond differently to certain therapies for heart failure with reduced ejection fraction, including implantable cardioverter defibrillators (ICD). In an extended follow-up study of the DANISH trial (Danish Study to Assess the Efficacy of ICDs in Patients With Non-Ischemic Systolic Heart Failure on Mortality), adding 4 years of additional follow-up, we examined the effect of ICD implantation according to sex. In the DANISH trial, 1116 patients with nonischemic systolic heart failure were randomized to receive an ICD (N=556) or usual clinical care (N=550). The primary outcome was all-cause mortality. Of the 1116 patients randomized in the DANISH trial, 307 (27.5%) were women. During a median follow-up of 9.5 years, women had a lower associated rate of all-cause mortality (hazard ratio [HR], 0.60 [95% CI, 0.47-0.78]) cardiovascular death (HR, 0.62 [95% CI, 0.46-0.84]), nonsudden cardiovascular death (HR, 0.59 [95% CI, 0.42-0.85]), and a numerically lower rate of sudden cardiovascular death (HR, 0.70 [95% CI, 0.40-1.25]), compared with men. Compared with usual clinical care, ICD implantation did not reduce the rate of all-cause mortality, irrespective of sex (men, HR, 0.85 [95% CI, 0.69-1.06]; women, HR, 0.98 [95% CI, 0.64-1.50]; Pinteraction=0.51). In addition, sex did not modify the effect of ICD implantation on sudden cardiovascular death (men, HR, 0.57 [95% CI, 0.36-0.92]; women, HR, 0.68 [95% CI, 0.26-1.77]; Pinteraction=0.76). In patients with nonischemic systolic heart failure, ICD implantation did not provide an overall survival benefit, but reduced sudden cardiovascular death, irrespective of sex. URL: https://www. gov; Unique identifier: NCT00542945.