Atrial fibrillation (AF) and obstructive sleep apnea (OSA) frequently coexist and synergistically increase cardiovascular risk. While their pathophysiologic interplay is well established, national data on mortality trends involving both conditions are scarce.
Methods
We analyzed mortality data from the CDC WONDER platform (1999–2020), including adults aged ≥ 25 years with AF (ICD-10 I48.x) listed as the underlying cause of death and OSA (G47.33) as a contributing condition. Age-adjusted mortality rates (AAMRs) and average annual percent changes (AAPCs) were calculated using Joinpoint regression, stratified by sex, race/ethnicity, urbanization, region, and age.
Results
A total of 32,142 AF-related deaths with OSA were identified. The overall AAMR was 0.60 per 100 000, increasing significantly over time (AAPC: 16.69%, 95% CI: 15.62–17.77). Mortality rose across all demographic groups, with the steepest increases among adults ≥ 85 years (AAPC: 19.40%), females (AAPC: 17.77%), rural residents (AAPC: 17.51%), and White individuals (AAPC: 16.95%). Regionally, the Midwest (AAMR: 0.79) and West (0.72) had the highest rates. State-level variation ranged from 1.90 (Oregon) to 0.19 (Mississippi). Despite lower absolute AAMRs among Hispanic and Asian populations, significant upward trends were observed. OSA appears frequently underdiagnosed or untreated in high-risk groups, potentially exacerbating AF mortality.
Conclusions
AF-related mortality involving OSA has risen sharply over the past two decades, outpacing many other cardiovascular trends. These findings underscore the urgent need for integrated AF-OSA screening and treatment pathways, with attention to underserved and disproportionately affected populations.
{"title":"Trends in Atrial Fibrillation-Related Mortality Among Older Adults With Obstructive Sleep Apnea in the United States, 1999–2020","authors":"Ibrahim Nagmeldin Hassan, Mohamed Ibrahim, Siddig Yaqub, Muhsin Ibrahim, Haythem Abdalla, Ghada Aljaili, Wafa Osman, Nagmeldin Abuassa, Hamza Ashraf, Maryam Shoukat","doi":"10.1002/clc.70178","DOIUrl":"https://doi.org/10.1002/clc.70178","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Atrial fibrillation (AF) and obstructive sleep apnea (OSA) frequently coexist and synergistically increase cardiovascular risk. While their pathophysiologic interplay is well established, national data on mortality trends involving both conditions are scarce.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed mortality data from the CDC WONDER platform (1999–2020), including adults aged ≥ 25 years with AF (ICD-10 I48.x) listed as the underlying cause of death and OSA (G47.33) as a contributing condition. Age-adjusted mortality rates (AAMRs) and average annual percent changes (AAPCs) were calculated using Joinpoint regression, stratified by sex, race/ethnicity, urbanization, region, and age.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 32,142 AF-related deaths with OSA were identified. The overall AAMR was 0.60 per 100 000, increasing significantly over time (AAPC: 16.69%, 95% CI: 15.62–17.77). Mortality rose across all demographic groups, with the steepest increases among adults ≥ 85 years (AAPC: 19.40%), females (AAPC: 17.77%), rural residents (AAPC: 17.51%), and White individuals (AAPC: 16.95%). Regionally, the Midwest (AAMR: 0.79) and West (0.72) had the highest rates. State-level variation ranged from 1.90 (Oregon) to 0.19 (Mississippi). Despite lower absolute AAMRs among Hispanic and Asian populations, significant upward trends were observed. OSA appears frequently underdiagnosed or untreated in high-risk groups, potentially exacerbating AF mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>AF-related mortality involving OSA has risen sharply over the past two decades, outpacing many other cardiovascular trends. These findings underscore the urgent need for integrated AF-OSA screening and treatment pathways, with attention to underserved and disproportionately affected populations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 7","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70178","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144624744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Riya Bhagwan, Rayyan Nabi, Shree Rath, Sohaib Aftab Ahmad Chaudhry, Shehdev Meghwar, Diya Rathi, Sandhiya Prem Kumar, Neha Bhagwan Das, Peter Collins, Hasan Ahmad, Raheel Ahmed
Background
Sudden cardiac death (SCD) is a leading cause of mortality in the United States, with significant variations across demographic and geographic factors. This study analyzes trends in SCD-related mortality among adults (> 25 years) from 1999 to 2020 using the CDC WONDER database.
Methods
We extracted data on SCD-related deaths (ICD-10 code I46.1) and calculated age-adjusted mortality rates (AAMR) per 100 000 population, stratified by sex, race/ethnicity, urbanization, and census region. Joinpoint regression was performed to estimate the annual percent change (APC) and average annual percent change (AAPC) with 95% confidence intervals (CI).
Results
A total of 279 599 SCD-related deaths were recorded from 1999 to 2020. Overall AAMR declined significantly (AAPC: −1.20%; 95% CI: −1.58% to −0.82%) until 2018, followed by a sharp increase from 2018 to 2020 (APC: +6.93%; 95% CI: +3.04% to +10.96%). Declines were most pronounced in American Indian/Alaska Native populations (−3.67%), while the highest increases post-2018 were observed in Hispanic (+13.1%) and Asian/Pacific Islander groups (+12.3%). Urban areas experienced greater post-2018 increases compared to rural areas. Regional disparities were evident, with the West showing the steepest rise in mortality.
Conclusion
While SCD mortality declined from 1999 to 2018, a concerning reversal has emerged since 2018, particularly in specific racial/ethnic groups and urban areas. Further research is needed to investigate underlying causes, including the potential impact of COVID-19, healthcare disparities, and lifestyle factors.
{"title":"Trends in Sudden Cardiac Death Related Mortality in Adults in the United States: A CDC WONDER Database Analysis, 1999–2020","authors":"Riya Bhagwan, Rayyan Nabi, Shree Rath, Sohaib Aftab Ahmad Chaudhry, Shehdev Meghwar, Diya Rathi, Sandhiya Prem Kumar, Neha Bhagwan Das, Peter Collins, Hasan Ahmad, Raheel Ahmed","doi":"10.1002/clc.70180","DOIUrl":"https://doi.org/10.1002/clc.70180","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Sudden cardiac death (SCD) is a leading cause of mortality in the United States, with significant variations across demographic and geographic factors. This study analyzes trends in SCD-related mortality among adults (> 25 years) from 1999 to 2020 using the CDC WONDER database.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We extracted data on SCD-related deaths (ICD-10 code I46.1) and calculated age-adjusted mortality rates (AAMR) per 100 000 population, stratified by sex, race/ethnicity, urbanization, and census region. Joinpoint regression was performed to estimate the annual percent change (APC) and average annual percent change (AAPC) with 95% confidence intervals (CI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 279 599 SCD-related deaths were recorded from 1999 to 2020. Overall AAMR declined significantly (AAPC: −1.20%; 95% CI: −1.58% to −0.82%) until 2018, followed by a sharp increase from 2018 to 2020 (APC: +6.93%; 95% CI: +3.04% to +10.96%). Declines were most pronounced in American Indian/Alaska Native populations (−3.67%), while the highest increases post-2018 were observed in Hispanic (+13.1%) and Asian/Pacific Islander groups (+12.3%). Urban areas experienced greater post-2018 increases compared to rural areas. Regional disparities were evident, with the West showing the steepest rise in mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>While SCD mortality declined from 1999 to 2018, a concerning reversal has emerged since 2018, particularly in specific racial/ethnic groups and urban areas. Further research is needed to investigate underlying causes, including the potential impact of COVID-19, healthcare disparities, and lifestyle factors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 7","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70180","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144624532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Previous studies have reported an association between atrial fibrillation (AF) and systemic inflammation. In the present study, the authors investigated the prognostic value of the CALLY index—a composite marker reflecting both systemic inflammation and nutritional status—in predicting AF recurrence following catheter ablation [1]. They demonstrated that the CALLY index was an independent predictor of post-ablation AF recurrence. While this is an intriguing finding, several concerns merit consideration.
The authors' hypothesis is based on the assumption that systemic inflammation, as represented by the CALLY index, contributes to the development of AF [1]. However, the mechanisms underlying AF recurrence may differ from those responsible for the initial onset of AF. In particular, pulmonary vein reconnection is widely recognized as a primary cause of AF recurrence after ablation [2]. Did the authors assess the presence of pulmonary vein reconnection in patients with recurrent AF? It is possible that the CALLY index is more closely associated with non-pulmonary vein foci of AF recurrence [3].
As the CALLY index includes albumin and C-reactive protein levels, it may reflect hepatic function rather than cardiac-specific inflammation. The direct relationship between the CALLY index and cardiac pathology thus remains unclear. Advanced imaging modalities—such as cardiac magnetic resonance imaging or computed tomography—may help elucidate the relationship among the CALLY index, myocardial inflammation, and AF recurrence.
How the CALLY index could be used to guide strategies for preventing AF recurrence remains uncertain. If the index reflects impaired hepatic function, interventions such as alcohol restriction might be beneficial [4]. However, in the present study, the prevalence of alcohol consumption did not differ significantly between patients with and without AF recurrence [1].
{"title":"How to Demonstrate the Association Between the Inflammation and Atrial Fibrillation Recurrence","authors":"Naoya Kataoka, Teruhiko Imamura","doi":"10.1002/clc.70177","DOIUrl":"https://doi.org/10.1002/clc.70177","url":null,"abstract":"<p>Previous studies have reported an association between atrial fibrillation (AF) and systemic inflammation. In the present study, the authors investigated the prognostic value of the CALLY index—a composite marker reflecting both systemic inflammation and nutritional status—in predicting AF recurrence following catheter ablation [<span>1</span>]. They demonstrated that the CALLY index was an independent predictor of post-ablation AF recurrence. While this is an intriguing finding, several concerns merit consideration.</p><p>The authors' hypothesis is based on the assumption that systemic inflammation, as represented by the CALLY index, contributes to the development of AF [<span>1</span>]. However, the mechanisms underlying AF recurrence may differ from those responsible for the initial onset of AF. In particular, pulmonary vein reconnection is widely recognized as a primary cause of AF recurrence after ablation [<span>2</span>]. Did the authors assess the presence of pulmonary vein reconnection in patients with recurrent AF? It is possible that the CALLY index is more closely associated with non-pulmonary vein foci of AF recurrence [<span>3</span>].</p><p>As the CALLY index includes albumin and C-reactive protein levels, it may reflect hepatic function rather than cardiac-specific inflammation. The direct relationship between the CALLY index and cardiac pathology thus remains unclear. Advanced imaging modalities—such as cardiac magnetic resonance imaging or computed tomography—may help elucidate the relationship among the CALLY index, myocardial inflammation, and AF recurrence.</p><p>How the CALLY index could be used to guide strategies for preventing AF recurrence remains uncertain. If the index reflects impaired hepatic function, interventions such as alcohol restriction might be beneficial [<span>4</span>]. However, in the present study, the prevalence of alcohol consumption did not differ significantly between patients with and without AF recurrence [<span>1</span>].</p><p>The authors have nothing to report.</p><p>The authors have nothing to report.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 7","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70177","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144589895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Syed Muhammad Rayyan, Bakhtiyar Ameer, Mueed Iqbal, Muhammad Abdul Haseeb Khan, Farmanullah Khan
<p>We read with great interest the article published by Fleurestil and his colleagues. Fleurestil and colleagues have provided valuable insights into in-hospital outcomes after left atrial appendage occlusion (LAAO) among Hispanic/Latino patients using the National Inpatient Sample (NIS). Yet, in striving for equitable stroke prevention, several further considerations merit attention [<span>1</span>].</p><p>While the authors note absence of echocardiographic and catheterization details, they do not address variability in device selection (e.g., Watchman vs. Amplatzer), catheter access routes, or operator experience. Each device has distinct learning curves and complication profiles, and proficiency varies markedly across centers. Future studies should partner with the NCDR LAAO Registry—which captures device type, sheath size, fluoroscopy time, and operator volume—to determine whether specific techniques or low-volume operators disproportionately contribute to the elevated infectious and vascular complications seen in Hispanic/Latino groups [<span>2</span>].</p><p>By design, NIS only captures index hospitalization events. Yet device-related thrombus, late pericardial effusions, and stroke recurrence often manifest weeks to months later. Incorporating linkage to claims data (e.g., Medicare Part A/B) or designing a prospective, multicenter registry with mandatory 12-month follow-up would illuminate whether early in-hospital disparities translate into divergent long-term safety and efficacy outcomes.</p><p>Though Fleurestil et al. briefly cite insurance status and language barriers, they do not quantify health literacy, immigration status, or neighborhood deprivation. Embedding validated instruments—such as the Rapid Estimate of Adult Literacy in Medicine (REALM) [<span>3</span>] or Area Deprivation Index [<span>4</span>]—into future LAAO registries would allow risk adjustment for social determinants and guide culturally tailored peri-procedural education.</p><p>Administrative coding cannot verify periprocedural anticoagulation regimens or post-implant adherence. Given that suboptimal anticoagulant use may drive both bleeding and thrombotic events, prospective studies should incorporate pharmacy fill data and wearable adherence monitors. Moreover, qualitative interviews could uncover patient-level barriers to compliance, enabling development of targeted interventions (e.g., bilingual mobile reminders).</p><p>With only 6814 Hispanic/Latino cases (4.9%), the study risks type II error for less frequent outcomes and cannot explore heterogeneity within the Hispanic/Latino umbrella (e.g., Caribbean vs. Central American ancestry). Pooling data across international centers, or applying Bayesian hierarchical models, would enhance power and allow disaggregation by cultural background, socioeconomic bracket, and comorbidity clusters.</p><p>Clinical endpoints—mortality, bleeding, vascular complications—while critical, overlook quality-of-life and patient satisf
我们饶有兴趣地阅读了Fleurestil和他的同事发表的文章。Fleurestil及其同事利用国家住院患者样本（NIS）对西班牙/拉丁裔患者左心耳闭塞（LAAO）后的住院结果提供了有价值的见解。然而，在争取公平预防中风的过程中，有几个进一步的考虑值得注意。虽然作者注意到超声心动图和导管细节的缺失，但他们没有解决设备选择的可变性（例如，Watchman vs. Amplatzer），导管进入路径或操作员经验。每种设备都有不同的学习曲线和复杂情况，不同中心的熟练程度差异很大。未来的研究应与NCDR LAAO登记处合作，该登记处捕获器械类型、护套大小、透视时间和操作人员体积，以确定特定技术或小体积操作人员是否不成比例地导致西班牙裔/拉丁裔人群感染和血管并发症的增加[10]。按照设计，NIS仅捕获索引住院事件。然而，与器械相关的血栓、晚期心包积液和中风复发往往在几周到几个月后出现。结合与索赔数据的联系（例如，医疗保险A/B部分）或设计具有强制性12个月随访的前瞻性多中心登记将阐明早期住院差异是否转化为不同的长期安全性和有效性结果。虽然Fleurestil等人简要地引用了保险状况和语言障碍，但他们没有量化健康素养、移民身份或邻里剥夺。在未来的LAAO登记中嵌入有效的工具，如成人医学素养快速评估（REALM）[3]或地区剥夺指数[4]，将允许对社会决定因素进行风险调整，并指导根据文化量身定制的过程中教育。行政编码不能验证围手术期抗凝治疗方案或植入后依从性。鉴于不理想的抗凝剂使用可能导致出血和血栓事件，前瞻性研究应纳入药房填充数据和可穿戴依从性监测。此外，定性访谈可以揭示患者层面的依从性障碍，从而能够制定有针对性的干预措施（例如，双语移动提醒）。只有6814例西班牙裔/拉丁裔病例（4.9%），该研究存在II型错误的风险，结果较少，无法探索西班牙裔/拉丁裔人群的异质性（例如，加勒比与中美洲血统）。跨国际中心汇集数据，或应用贝叶斯分层模型，将增强权力，并允许按文化背景、社会经济阶层和共病集群进行分解。临床终点——死亡率、出血、血管并发症——虽然至关重要，但却忽视了生活质量和患者满意度。纳入标准化的患者报告结果测量（PROMs），如房颤对生活质量的影响（AFEQT）问卷[5]，将提供一个关于LAAO如何影响康复、症状负担和恢复日常活动的整体观点。为了促进公平护理，我们敦促LAAO社区超越行政数据集。利用详细的程序登记（如NCDR）[2]，整合纵向随访，嵌入社会经济和依从性指标，采用稳健的统计方法，并捕获以患者为中心的结果，将共同阐明观察到的差异的驱动因素。只有通过这种全面的、多学科的努力，我们才能定制LAAO策略，真正服务于有房颤相关中风风险的不同西班牙裔/拉丁裔人群。恭敬地提交。作者没有什么可报告的。作者没有什么可报告的。作者声明无利益冲突。
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Abdalhakim Shubietah, Abubakar Nazir, Mohamed S. Elgendy, Ameer Awashra, Jehad Zeidalkilani, Mohammad Alqadi, Suleiman Khreshi
Background
The impact of a “weekend effect” on US acute coronary syndrome (ACS) mortality remains uncertain. We compared weekend and weekday age-adjusted mortality rates (AAMRs) and analyzed demographic, geographic, and temporal trends from 1999 to 2020.
Methods
We conducted a national analysis of ACS deaths (age ≥ 25 years) using CDC WONDER (ICD-10: I20.0; I21.0–I21.4; I21.9; I22.0–I22.9; I24.8; I24.9). Crude and AAMRs (per 100 000; 2000 U.S. standard) were calculated, and trends were assessed by joinpoint regression to estimate annual percent changes (APCs) and average APCs (AAPCs).
Results
From 1999 to 2020, there were 3, 101, 451 ACS deaths: 2, 222, 468 on weekdays (AAMR 46.4; 95% CI 46.39–46.51) and 878, 983 on weekends (AAMR 18.4), a 2.5:1 ratio. Both periods saw two-phase declines—APCs of ≈ –6.4%/year before 2009–2010 and –3.3 to –3.7%/year thereafter (all p < 0.001). Disparities persisted: Black adults had the highest AAMRs (20.9 weekend; 53.2 weekday), rural rates exceeded urban (28.7 vs. 15.8; 72.0 vs. 40.2), men exceeded women (23.8 vs. 14.0; 60.2 vs. 35.4), and rates rose steeply with age (weekend 0.3–223.0; weekday 0.7–561.0). After 2009, declines slowed, and weekday deaths in Black adults rose after 2018.
Conclusions
The weekend effect on ACS mortality is minimal, with weekday deaths far outnumbering weekend deaths. Persistent—and sometimes widening—disparities by race, rurality, sex, and age highlight the need for equity-focused interventions, strengthened rural cardiac care, and targeted prevention.
“周末效应”对美国急性冠脉综合征（ACS）死亡率的影响仍不确定。我们比较了周末和工作日的年龄调整死亡率（AAMRs），并分析了1999年至2020年的人口、地理和时间趋势。方法采用CDC WONDER (ICD-10: I20.0；I21.0-I21.4;I21.9;I22.0-I22.9;I24.8;I24.9)。原油和AAMRs（每10万）；2000年美国标准)，并通过连接点回归评估趋势，以估计年百分比变化（APCs）和平均APCs （AAPCs）。结果1999 - 2020年，ACS死亡病例3101 451例，工作日死亡病例2 222 468例(AAMR 46.4；95% CI 46.39-46.51)，周末878,983 (AAMR 18.4)，比例为2.5:1。这两个时期都出现了两个阶段的下降——2009-2010年之前的apc为≈ -6.4% /年，之后为-3.3 - -3.7% /年（p <； 0.001）。差异仍然存在：黑人成年人的AAMRs最高(周末20.9；53.2个工作日)，农村超过城市(28.7 vs 15.8；72.0 vs. 40.2)，男性超过女性(23.8 vs. 14.0；60.2 vs. 35.4)，随着年龄的增长，发病率急剧上升(周末0.3-223.0；工作日0.7 - -561.0)。2009年之后，下降速度放缓，2018年之后，黑人成年人平日死亡人数上升。结论周末对ACS死亡率的影响很小，工作日死亡人数远远超过周末死亡人数。种族、农村、性别和年龄之间持续存在（有时还在扩大）的差异凸显了以公平为重点的干预措施、加强农村心脏保健和有针对性的预防的必要性。
{"title":"Do Patients With Acute Coronary Syndrome Face Higher Mortality on Weekends Versus Weekdays? A Comprehensive Analysis of Demographic, Geographic, and Temporal Trends in the United States","authors":"Abdalhakim Shubietah, Abubakar Nazir, Mohamed S. Elgendy, Ameer Awashra, Jehad Zeidalkilani, Mohammad Alqadi, Suleiman Khreshi","doi":"10.1002/clc.70175","DOIUrl":"https://doi.org/10.1002/clc.70175","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The impact of a “weekend effect” on US acute coronary syndrome (ACS) mortality remains uncertain. We compared weekend and weekday age-adjusted mortality rates (AAMRs) and analyzed demographic, geographic, and temporal trends from 1999 to 2020.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a national analysis of ACS deaths (age ≥ 25 years) using CDC WONDER (ICD-10: I20.0; I21.0–I21.4; I21.9; I22.0–I22.9; I24.8; I24.9). Crude and AAMRs (per 100 000; 2000 U.S. standard) were calculated, and trends were assessed by joinpoint regression to estimate annual percent changes (APCs) and average APCs (AAPCs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From 1999 to 2020, there were 3, 101, 451 ACS deaths: 2, 222, 468 on weekdays (AAMR 46.4; 95% CI 46.39–46.51) and 878, 983 on weekends (AAMR 18.4), a 2.5:1 ratio. Both periods saw two-phase declines—APCs of ≈ –6.4%/year before 2009–2010 and –3.3 to –3.7%/year thereafter (all <i>p</i> < 0.001). Disparities persisted: Black adults had the highest AAMRs (20.9 weekend; 53.2 weekday), rural rates exceeded urban (28.7 vs. 15.8; 72.0 vs. 40.2), men exceeded women (23.8 vs. 14.0; 60.2 vs. 35.4), and rates rose steeply with age (weekend 0.3–223.0; weekday 0.7–561.0). After 2009, declines slowed, and weekday deaths in Black adults rose after 2018.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The weekend effect on ACS mortality is minimal, with weekday deaths far outnumbering weekend deaths. Persistent—and sometimes widening—disparities by race, rurality, sex, and age highlight the need for equity-focused interventions, strengthened rural cardiac care, and targeted prevention.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 7","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70175","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144582038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Educational attainment and economic status are important socioeconomic characteristics and are associated with metabolic diseases and premature death risk. However, their relative importance and contributions to premature death remain unclear.
Methods
Data were collected from ten survey waves of the National Health and Nutrition Examination Survey from 1999 to 2018. Deaths before age 75 from all-cause and cause-specific mortality were ascertained from linkage to the National Death Index with follow-up through 2019. Weighted Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CI) for death by educational attainment and income level. Population-attributable fractions (PAFs) were calculated to quantify the proportional contributions of low income and low educational attainment to mortality.
Results
Over an average of 10.1 years of follow-up, 4310 premature deaths were confirmed from 43 637 participants. Low income and low educational attainment were associated with increased risks of all-cause and cause-specific mortality, respectively. The associations between low educational attainment and mortality risk disappeared after mutual adjusting for income and education. However, among those with high school education or above, the adjusted HRs of middle income and low income were 1.81 (95% CI, 1.48–2.21) and 2.88 (95% CI, 2.31–3.59) for all-cause mortality. The PAF showed that low educational attainment did not contribute to mortality, while 33.0% of premature deaths were attributable to low income.
Conclusions
Income had a greater impact on mortality risk than education. The disparities in mortality risk could be reduced by narrowing the income differentials.
{"title":"Association Between Educational Inequality and Income Inequality With Metabolic Diseases and Cause-Specific Mortality","authors":"Jingya Niu, Xiaotong Li, Qiaoyun Chen, Wei Yang, Lixia Suo, Zhu Chen","doi":"10.1002/clc.70173","DOIUrl":"https://doi.org/10.1002/clc.70173","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Educational attainment and economic status are important socioeconomic characteristics and are associated with metabolic diseases and premature death risk. However, their relative importance and contributions to premature death remain unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data were collected from ten survey waves of the National Health and Nutrition Examination Survey from 1999 to 2018. Deaths before age 75 from all-cause and cause-specific mortality were ascertained from linkage to the National Death Index with follow-up through 2019. Weighted Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CI) for death by educational attainment and income level. Population-attributable fractions (PAFs) were calculated to quantify the proportional contributions of low income and low educational attainment to mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Over an average of 10.1 years of follow-up, 4310 premature deaths were confirmed from 43 637 participants. Low income and low educational attainment were associated with increased risks of all-cause and cause-specific mortality, respectively. The associations between low educational attainment and mortality risk disappeared after mutual adjusting for income and education. However, among those with high school education or above, the adjusted HRs of middle income and low income were 1.81 (95% CI, 1.48–2.21) and 2.88 (95% CI, 2.31–3.59) for all-cause mortality. The PAF showed that low educational attainment did not contribute to mortality, while 33.0% of premature deaths were attributable to low income.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Income had a greater impact on mortality risk than education. The disparities in mortality risk could be reduced by narrowing the income differentials.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 7","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70173","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144564136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abdul Nadeem Akhter, Fnu Aisha, Aimen Binte Moazzam, Sardar Humayun Babar Khan, Jahanzeb Malik, Abida Parveen
Background
Epicardial fat thickness (EFT) is a visceral fat depot with pro-inflammatory properties, located adjacent to coronary vessels, and has been proposed as a marker of coronary artery disease (CAD). This study aimed to evaluate the association between EFT and the presence and severity of CAD in patients with type 2 diabetes mellitus.
Methods
This retrospective study was conducted at the Abbas Institute of Medical Sciences (AIMS) between January 2020 and March 2025 (Study ID: AIMS/25/007). A total of 2340 diabetic patients (mean age: 58.3 ± 9.6 years) were included. EFT was measured using transthoracic echocardiography, and CAD presence and severity were assessed via coronary angiography. Logistic regression analysis was used to evaluate associations, with results expressed as odds ratios (OR) with 95% confidence intervals (CI).
Results
Elevated EFT (≥ 5 mm) was observed in 1281 patients (54.7%). CAD was present in 1121 individuals (47.9%), with significantly higher rates in those with elevated EFT (65.7% vs. 26.3%, p < 0.001). EFT ≥ 5 mm was associated with a 5.38-fold increased odds of CAD (95% CI: 4.59–6.30, p < 0.001). Moreover, patients with elevated EFT had a significantly higher prevalence of multi-vessel CAD, indicating a correlation between EFT and disease severity.
Conclusions
In diabetic patients, elevated EFT is significantly associated with both the presence and severity of CAD. EFT measurement via echocardiography may serve as a simple, noninvasive tool for cardiovascular risk stratification and early intervention planning.
心外膜脂肪厚度（EFT）是一种具有促炎特性的内脏脂肪库，位于冠状血管附近，被认为是冠状动脉疾病（CAD）的标志。本研究旨在评估EFT与2型糖尿病患者冠心病的存在和严重程度之间的关系。方法本回顾性研究于2020年1月至2025年3月在阿巴斯医学科学研究所（AIMS）进行（研究ID: AIMS/25/007）。共纳入2340例糖尿病患者，平均年龄58.3±9.6岁。使用经胸超声心动图测量EFT，并通过冠状动脉造影评估CAD的存在和严重程度。采用Logistic回归分析评估相关性，结果以比值比（OR）和95%置信区间（CI）表示。结果1281例（54.7%）患者EFT升高（≥5 mm）。1121例（47.9%）患者出现CAD， EFT升高的患者出现CAD的比例明显更高（65.7% vs. 26.3%, p < 0.001）。EFT≥5 mm与CAD风险增加5.38倍相关（95% CI: 4.59-6.30, p < 0.001）。此外，EFT升高的患者多血管CAD患病率明显更高，表明EFT与疾病严重程度之间存在相关性。结论在糖尿病患者中，EFT升高与冠心病的存在和严重程度显著相关。通过超声心动图测量EFT可作为心血管危险分层和早期干预计划的简单、无创工具。
{"title":"Epicardial Fat Thickness as a Marker of Coronary Artery Disease in Diabetics: A Single Center Study","authors":"Abdul Nadeem Akhter, Fnu Aisha, Aimen Binte Moazzam, Sardar Humayun Babar Khan, Jahanzeb Malik, Abida Parveen","doi":"10.1002/clc.70171","DOIUrl":"https://doi.org/10.1002/clc.70171","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Epicardial fat thickness (EFT) is a visceral fat depot with pro-inflammatory properties, located adjacent to coronary vessels, and has been proposed as a marker of coronary artery disease (CAD). This study aimed to evaluate the association between EFT and the presence and severity of CAD in patients with type 2 diabetes mellitus.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study was conducted at the Abbas Institute of Medical Sciences (AIMS) between January 2020 and March 2025 (Study ID: AIMS/25/007). A total of 2340 diabetic patients (mean age: 58.3 ± 9.6 years) were included. EFT was measured using transthoracic echocardiography, and CAD presence and severity were assessed via coronary angiography. Logistic regression analysis was used to evaluate associations, with results expressed as odds ratios (OR) with 95% confidence intervals (CI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Elevated EFT (≥ 5 mm) was observed in 1281 patients (54.7%). CAD was present in 1121 individuals (47.9%), with significantly higher rates in those with elevated EFT (65.7% vs. 26.3%, <i>p</i> < 0.001). EFT ≥ 5 mm was associated with a 5.38-fold increased odds of CAD (95% CI: 4.59–6.30, <i>p</i> < 0.001). Moreover, patients with elevated EFT had a significantly higher prevalence of multi-vessel CAD, indicating a correlation between EFT and disease severity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In diabetic patients, elevated EFT is significantly associated with both the presence and severity of CAD. EFT measurement via echocardiography may serve as a simple, noninvasive tool for cardiovascular risk stratification and early intervention planning.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 7","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70171","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144558092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hibah Siddiqui, Zahra Imran, Dua Ali, Maryam Sajid, Taimor Mohammed Khan, Hussain Salim, Muhammad Salik Uddin, Shaheer Qureshi, Muzammil Farhan, Saad Ahmed Waqas
Introduction
Diabetes mellitus and hypertension are major contributors to cardiovascular and renal disease mortality, yet their combined long-term impact on mortality trends in the United States remains underexplored. This study evaluates national trends in DM and hypertension-related mortality from 2000 to 2023, analyzing disparities across sex, age groups, race/ethnicity, urbanization, and geographic regions.
Methods
We analyzed mortality data from the CDC-WONDER database, identifying deaths with DM and hypertension as listed causes among adults aged 25 and older. Age-adjusted mortality rates (AAMRs) per 100,000 were calculated, and temporal trends were assessed using Joinpoint regression to determine annual percentage changes.
Results
A total of 2,742,668 DM and hypertension-related deaths were recorded. The AAMR nearly doubled from 33.7 per 100,000 in 2000 to 66.2 per 100,000 in 2023. A sharp increase was observed from 2018 to 2021 (APC: 16.3 [95% CI: 11.8–19.6]), followed by a decline through 2023. Men had consistently higher mortality rates than females. Mortality rates were highest among older adults (65+ years), Non-Hispanic Black individuals, and nonmetropolitan populations. The South had the highest mortality rates, with Mississippi and the District of Columbia reporting the greatest burden.
Conclusions
DM and hypertension-related mortality has significantly increased over the past two decades, with notable demographic and geographic disparities. Public health interventions should prioritize high-risk populations to mitigate mortality trends and improve health equity.
{"title":"A Rising Crisis: Escalating Burden of Diabetes Mellitus and Hypertension-Related Mortality Trends in the United States, 2000–2023","authors":"Hibah Siddiqui, Zahra Imran, Dua Ali, Maryam Sajid, Taimor Mohammed Khan, Hussain Salim, Muhammad Salik Uddin, Shaheer Qureshi, Muzammil Farhan, Saad Ahmed Waqas","doi":"10.1002/clc.70167","DOIUrl":"https://doi.org/10.1002/clc.70167","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Diabetes mellitus and hypertension are major contributors to cardiovascular and renal disease mortality, yet their combined long-term impact on mortality trends in the United States remains underexplored. This study evaluates national trends in DM and hypertension-related mortality from 2000 to 2023, analyzing disparities across sex, age groups, race/ethnicity, urbanization, and geographic regions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed mortality data from the CDC-WONDER database, identifying deaths with DM and hypertension as listed causes among adults aged 25 and older. Age-adjusted mortality rates (AAMRs) per 100,000 were calculated, and temporal trends were assessed using Joinpoint regression to determine annual percentage changes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 2,742,668 DM and hypertension-related deaths were recorded. The AAMR nearly doubled from 33.7 per 100,000 in 2000 to 66.2 per 100,000 in 2023. A sharp increase was observed from 2018 to 2021 (APC: 16.3 [95% CI: 11.8–19.6]), followed by a decline through 2023. Men had consistently higher mortality rates than females. Mortality rates were highest among older adults (65+ years), Non-Hispanic Black individuals, and nonmetropolitan populations. The South had the highest mortality rates, with Mississippi and the District of Columbia reporting the greatest burden.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>DM and hypertension-related mortality has significantly increased over the past two decades, with notable demographic and geographic disparities. Public health interventions should prioritize high-risk populations to mitigate mortality trends and improve health equity.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 7","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70167","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144524925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jeanne SY Ong, Ming Fatt Kham, Jonah Goh, Francis Phng, Po Fun Chan, Poay Huan Loh, Christine Wu
Background
Heart failure (HF) is a prevalent cause of hospital readmissions. Our study aims to determine the correlation between the Kansas City Cardiomyopathy Questionnaire (KCCQ) scores and 6-month readmission in our Southeast Asian population.
Methods
We evaluated KCCQ-12 in a cohort of 180 patients at first post-discharge visit after a recent hospitalization for HF with reduced ejection fraction (HFrEF). Logistic regression was used to determine the predictive significance of the KCCQ scores for 6-month HF readmission. The selection of predictive parameters was performed using Stepwise Akaike Information Criterion (StepAIC).
Results
Out of 180 patients, 52 (29%) were readmitted for HF within 6 months. The mean KCCQ score was higher in the non-readmitted group (78.5) compared to the readmitted group (69.7, p = 0.0129). Multivariate analysis indicated a significant association between higher KCCQ scores (better health status) and lower HF readmission rates (adjusted OR = 0.929, p = 0.0255). The initial predictive model, using patient demographic data, had an AUC score of 0.64. Integrating KCCQ scores with demographics, length of stay (LOS), medical history and discharge medication variables raised the AUC score to 0.82.
Conclusion
KCCQ scores recorded at first post-discharge encounter were found to have a significant relationship with 6-month readmissions in our cohort, suggesting that KCCQ scores can serve as an effective clinical indicator of 6 month readmissions.
背景：心力衰竭（HF）是再入院的常见原因。我们的研究旨在确定堪萨斯城心肌病问卷（KCCQ）评分与东南亚人群6个月再入院之间的相关性。方法：我们在180例近期因心力衰竭伴射血分数降低（HFrEF）住院的患者出院后首次就诊的队列中评估了KCCQ-12。采用Logistic回归确定KCCQ评分对6个月HF再入院的预测意义。采用逐步赤池信息准则（Stepwise Akaike Information Criterion, StepAIC）进行预测参数的选择。结果180例患者中，52例（29%）在6个月内因心衰再次入院。非再入院组KCCQ平均评分（78.5）高于再入院组（69.7,p = 0.0129）。多因素分析显示，较高的KCCQ评分（较好的健康状况）与较低的心衰再入院率之间存在显著相关性（调整OR = 0.929, p = 0.0255）。使用患者人口统计数据的初始预测模型的AUC评分为0.64。综合人口学、住院时间（LOS）、病史和出院用药变量，KCCQ得分提高到0.82。结论出院后首次就诊时记录的KCCQ评分与6个月再入院有显著关系，提示KCCQ评分可作为6个月再入院的有效临床指标。
{"title":"Evaluating the Prognostic Value of Kansas City Cardiomyopathy Questionnaire (KCCQ) Scores for 6-Month Readmissions in Southeast Asian Populations With Heart Failure","authors":"Jeanne SY Ong, Ming Fatt Kham, Jonah Goh, Francis Phng, Po Fun Chan, Poay Huan Loh, Christine Wu","doi":"10.1002/clc.70136","DOIUrl":"https://doi.org/10.1002/clc.70136","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Heart failure (HF) is a prevalent cause of hospital readmissions. Our study aims to determine the correlation between the Kansas City Cardiomyopathy Questionnaire (KCCQ) scores and 6-month readmission in our Southeast Asian population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We evaluated KCCQ-12 in a cohort of 180 patients at first post-discharge visit after a recent hospitalization for HF with reduced ejection fraction (HFrEF). Logistic regression was used to determine the predictive significance of the KCCQ scores for 6-month HF readmission. The selection of predictive parameters was performed using Stepwise Akaike Information Criterion (StepAIC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Out of 180 patients, 52 (29%) were readmitted for HF within 6 months. The mean KCCQ score was higher in the non-readmitted group (78.5) compared to the readmitted group (69.7, <i>p</i> = 0.0129). Multivariate analysis indicated a significant association between higher KCCQ scores (better health status) and lower HF readmission rates (adjusted OR = 0.929, <i>p</i> = 0.0255). The initial predictive model, using patient demographic data, had an AUC score of 0.64. Integrating KCCQ scores with demographics, length of stay (LOS), medical history and discharge medication variables raised the AUC score to 0.82.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>KCCQ scores recorded at first post-discharge encounter were found to have a significant relationship with 6-month readmissions in our cohort, suggesting that KCCQ scores can serve as an effective clinical indicator of 6 month readmissions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 7","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70136","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144524924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. Silvola, L. Pakanen, L. Holmström, J. S. Perkiömäki, M. A. E Eskuri, H. V. Huikuri, M. J. Junttila
Background
Sudden cardiac death (SCD) remains a major cause of death despite progress in prevention and intervention of cardiac diseases. The most common cause of nonischemic SCD in young individuals in Northern Finland is primary myocardial fibrosis (PMF).
Methods
Fingesture study consists of 5869 prospectively collected subjects with SCD from Northern Finland collected from 1998 to 2017. Nonischemic etiology was the cause of SCD in 1477 (25%) subjects out of which primary myocardial fibrosis was the cause of SCD in 184 (12%) subjects (65% men, median age 55 ± 16 years). We examined the ante mortem ECG and medical history of the subjects to discover preceding symptoms and ECG changes.
Results
Prior health care contact in electronic health record system (EHR) was found for 89 (48%) subjects and ECG was available for 52 (28%) subjects. Both medical history and ECG were available for 20 subjects (11%). We observed that transient loss of consciousness (TLOC) was the most common symptom recorded and was reported by 33 (37%) subjects. ECG was abnormal in 38 (73%) subjects. Fragmented QRS (fQRS) complex was found in 26 (50%) subjects. Vast majority, 87% of subjects had either TLOC or abnormal ECG. Only seven subjects with ECG or EHR history available had normal ECG and did not have TLOC.
Conclusions
Many SCD victims with primary myocardial fibrosis had abnormal ECG or history of TLOC. The results suggest that the combination should generate careful cardiovascular examination to detect underlying myocardial disease and possibly prevent SCD.
{"title":"Primordial Symptoms and ECG Among Sudden Cardiac Death Victims Due to Primary Myocardial Fibrosis","authors":"H. Silvola, L. Pakanen, L. Holmström, J. S. Perkiömäki, M. A. E Eskuri, H. V. Huikuri, M. J. Junttila","doi":"10.1002/clc.70057","DOIUrl":"https://doi.org/10.1002/clc.70057","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Sudden cardiac death (SCD) remains a major cause of death despite progress in prevention and intervention of cardiac diseases. The most common cause of nonischemic SCD in young individuals in Northern Finland is primary myocardial fibrosis (PMF).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Fingesture study consists of 5869 prospectively collected subjects with SCD from Northern Finland collected from 1998 to 2017. Nonischemic etiology was the cause of SCD in 1477 (25%) subjects out of which primary myocardial fibrosis was the cause of SCD in 184 (12%) subjects (65% men, median age 55 ± 16 years). We examined the ante mortem ECG and medical history of the subjects to discover preceding symptoms and ECG changes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Prior health care contact in electronic health record system (EHR) was found for 89 (48%) subjects and ECG was available for 52 (28%) subjects. Both medical history and ECG were available for 20 subjects (11%). We observed that transient loss of consciousness (TLOC) was the most common <i>symptom</i> recorded and was reported by 33 (37%) subjects. ECG was abnormal in 38 (73%) subjects. Fragmented QRS (fQRS) complex was found in 26 (50%) subjects. Vast majority, 87% of subjects had either TLOC or abnormal ECG. Only seven subjects with ECG or EHR history available had normal ECG and did not have TLOC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Many SCD victims with primary myocardial fibrosis had abnormal ECG or history of TLOC. The results suggest that the combination should generate careful cardiovascular examination to detect underlying myocardial disease and possibly prevent SCD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 7","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70057","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144520089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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