960-86 Implications of Alternative Classifications of Sudden Cardiac Death: A Prospective Analysis of 109 Deaths in Defibrillator Trials

In order to explore the implications of using varied definitions of sudden cardiac death (SCD), a classification (CL) committee (3 cardiologists) prospectively evaluated 109 deaths over a period of 19 months in patients with an implantable cardioverter defibriliator (ICD). The basis for CL was the CAST approach with additional assessments of the consequences of considering autopsy and ICD interrogation information. Concordance and/or discordance between committee members was recorded.ResultsOf the 834 patients followed for 19 months, there were 109 deaths: 17 were classified SCD, 51 non-SCD. and 40 non-cardiac. Of the deaths classified as SCD, 10/17 were unwitnessed as compared to 6/51 non-SCD and 3/40 non-cardiac deaths; p < 0.001. ICD detections occurred in 5/17 SCD <1 hour, 7/17 SCD <6 hours; therefore, 10/17 SCD had no ICD detection or information available. There was committee discordance in 5/17 SCD compared to 18/51 non-SCD and 16/40 non-cardiac. SCD rates as high as 3.6% (30/834) can be estimated if all SCD cases Cl by ≥1 member was counted as SCD. Likewise. a SCD rate as low as 0.8% (7/834) is possible if SCD is limited to witnessed SCD ≤1 hour; (a 4-fold difference). Autopsy information was available in 29/109 deaths. In 7 cases, autopsy findings resulted in changing a “SCD” CL (5 witnessed; 2 unwitnessed) to either non-SCD or non-cardiac [ruptured abdominal (N=21 or thoracic aortic (N=1) aneurysm, acute MI (N=1), cerebral infarction (N=1). pulmonary embolism (N=2)]. Thus, had autopsy information been unavailable or not considered, the SCD rate would have increased to 24/834 12.9%). ICD interrogation was unavailable in 51/109 (47%), most commonly due to being buried with the patient or programmed off prior to death.ConclusionA 4-fold spectrum of SCD rates is possible to report from the identical data-set. ICD interrogation has significant limitations for use in death CL, in contrast to its utility in clinical management. Autopsy results clarify cause-specific mortality in deaths that are temporally quite “sudden.” Total mortality is the most objective primary end point

Correlating perceived arrhythmia symptoms and QoL in the elderly with Heart Failure in an urban clinic: A prospective, single center study

Aims and objectives To determine the relationship between quality of life and perceived self-reported symptoms in an older, ambulatory, urban population living with heart failure. Background While arrhythmias in older individuals with heart failure are well documented, the association between perceived arrhythmia symptoms and quality of life is not well-defined. Design Prospective, cross-sectional single-centre study. Methods A single-centre, prospective study was conducted with heart failure patients recruited from an urban outpatient cardiology clinic in the United States. Fifty-seven patients completed a baseline quality of life survey with 42 of these completing the six-month follow-up survey. Quality of life was evaluated with the SF-36v2™ and frequency of symptoms with the Atrial Fibrillation Severity Scale. Subjects wore an auto triggered cardiac loop monitor (LifeStar AF Express®) for two weeks to document arrhythmias. Data analysis utilised Spearman's rank correlation and logistic regression. Results Baseline and six-month quality of life measures did not correlate with recorded arrhythmias. However, perceptions of diminished general health correlated significantly with symptoms of exercise intolerance, lightheadedness/dizziness, palpitations and chest pain/pressure. By multivariable logistic regression, more severe perceived episodes, symptoms of exercise intolerance and lightheadedness/dizziness were independently associated with diminished quality of life. Conclusion Quality of life was significantly worse in patients with perceptions of severe arrhythmic episodes and in those with symptoms of dizziness and exercise intolerance. Relevance to clinical practice The findings of this study indicate that symptomatic heart failure patients suffer from poor quality of life and that interventions are needed to improve quality of life and decrease symptom severity. Nurses who care for heart failure patients play an essential role in symptom evaluation and management and could significantly improve overall quality of life in these patients by carefully evaluating symptomatology and testing interventions and educational programmes aimed at improving quality of life

Real-World Utilization of the Pill-In-The-Pocket Method for Terminating Episodes of Atrial Fibrillation: Data From the Multinational Antiarrhythmic Interventions for Managing Atrial Fibrillation (AIM-AF) Survey

AIMS: Atrial fibrillation (AF) is the most common sustained arrhythmia encountered in clinical practice. Episodes may stop spontaneously (paroxysmal AF); may terminate only via intervention (persistent AF); or may persist indefinitely (permanent AF) (see European and American guidelines, referenced below, for more precise definitions). Recently, there has been renewed interest in an approach to terminate AF acutely referred to as \u27pill-in-the-pocket\u27 (PITP). The PITP is recognized in both the US and European guidelines as an effective option using an oral antiarrhythmic drug for acute conversion of acute/recent-onset AF. However, how PITP is currently used has not been systematically evaluated. METHODS AND RESULTS: The recently published Antiarrhythmic Interventions for Managing Atrial Fibrillation (AIM-AF) survey included questions regarding current PITP usage, stratified by US vs. European countries surveyed, by representative countries within Europe, and by cardiologists vs. electrophysiologists. This manuscript presents the data from this planned sub-study. Our survey revealed that clinicians in both the USA and Europe consider PITP in about a quarter of their patients, mostly for recent-onset AF with minimal or no structural heart disease (guideline appropriate). However, significant deviations exist. See the Graphical abstract for a summary of the data. CONCLUSION: Our findings highlight the frequent use of PITP and the need for further physician education about appropriate and optimal use of this strategy

Avoidable mortality across Canada from 1975 to 1999

BACKGROUND: The concept of 'avoidable' mortality (AM) has been proposed as a performance measure of health care systems. In this study we examined mortality in five geographic regions of Canada from 1975 to 1999 for previously defined avoidable disease groups that are amenable to medical care and public health. These trends were compared to mortality from other causes. METHODS: National and regional age-standardized mortality rates for ages less than 65 years were estimated for avoidable and other causes of death for consecutive periods (1975–1979, 1980–1985, 1985–1989, 1990–1994, and 1995–1999). The proportion of all-cause mortality attributable to avoidable causes was also determined. RESULTS: From 1975–1979 to 1995–1999, the AM decrease (46.9%) was more pronounced compared to mortality from other causes (24.9%). There were persistent regional AM differences, with consistently lower AM in Ontario and British Columbia compared to the Atlantic, Quebec, and Prairies regions. This trend was not apparent when mortality from other causes was examined. Injuries, ischaemic heart disease, and lung cancer strongly influenced the overall AM trends. CONCLUSION: The regional differences in mortality for ages less than 65 years was attributable to causes of death amenable to medical care and public health, especially from causes responsive to public health