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Rappazzo KM, Egerstrom NM, Wu J, Capone AB, Joodi G, Keen S, Cascio WE, Simpson RJ. Fine particulate matter-sudden death association modified by ventricular hypertrophy and inflammation: a case-crossover study. Front Public Health 2024; 12:1367416. [PMID: 38835616 PMCID: PMC11148389 DOI: 10.3389/fpubh.2024.1367416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 04/23/2024] [Indexed: 06/06/2024] Open
Abstract
Background Sudden death accounts for approximately 10% of deaths among working-age adults and is associated with poor air quality. Objectives: To identify high-risk groups and potential modifiers and mediators of risk, we explored previously established associations between fine particulate matter (PM2.5) and sudden death stratified by potential risk factors. Methods Sudden death victims in Wake County, NC, from 1 March 2013 to 28 February 2015 were identified by screening Emergency Medical Systems reports and adjudicated (n = 399). Daily PM2.5 concentrations for Wake County from the Air Quality Data Mart were linked to event and control periods. Potential modifiers included greenspace metrics, clinical conditions, left ventricular hypertrophy (LVH), and neutrophil-to-lymphocyte ratio (NLR). Using a case-crossover design, conditional logistic regression estimated the OR (95%CI) for sudden death for a 5 μg/m3 increase in PM2.5 with a 1-day lag, adjusted for temperature and humidity, across risk factor strata. Results Individuals having LVH or an NLR above 2.5 had PM2.5 associations of greater magnitude than those without [with LVH OR: 1.90 (1.04, 3.50); NLR > 2.5: 1.25 (0.89, 1.76)]. PM2.5 was generally less impactful for individuals living in areas with higher levels of greenspace. Conclusion LVH and inflammation may be the final step in the causal pathway whereby poor air quality and traditional risk factors trigger arrhythmia or myocardial ischemia and sudden death. The combination of statistical evidence with clinical knowledge can inform medical providers of underlying risks for their patients generally, while our findings here may help guide interventions to mitigate the incidence of sudden death.
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Affiliation(s)
- Kristen M Rappazzo
- U.S. Environmental Protection Agency, Office of Research and Development, Center for Public Health and Environmental Assessment, Research Triangle Park, NC, United States
| | - Nicole M Egerstrom
- Gillings Global School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jianyong Wu
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, OH, United States
| | - Alia B Capone
- Division of Cardiology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Family Medicine, University of Maryland Medical Center, Baltimore, MD, United States
| | - Golsa Joodi
- Division of Cardiology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Susan Keen
- Division of Cardiology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Cardiovascular Medicine, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Wayne E Cascio
- U.S. Environmental Protection Agency, Office of Research and Development, Center for Public Health and Environmental Assessment, Research Triangle Park, NC, United States
| | - Ross J Simpson
- Division of Cardiology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Stephenson P, Hansen D, Lalani N, Biggs J. Nursing and Medical Students' Responses About End-of-Life Communication Reveal Educational Opportunities for Spiritual Care. J Nurs Educ 2023; 62:601-605. [PMID: 37934687 DOI: 10.3928/01484834-20230906-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
BACKGROUND The need for improved spiritual care education is a national directive, prompting many nursing and medical education programs to respond with spiritual curriculum. This article reports on research that tested an educational intervention to enhance nursing and medical students' understanding of end-of-life communication with families. METHOD This mixed-methods study included three reflection questions to ascertain students' attitudes about their own death and dying. RESULTS Many of the students' responses were spiritual in nature. Findings revealed two important misconceptions about death and one educational strategy that can be used to help students identify potential sources of spiritual discomfort in clinical situations. CONCLUSION The findings offer a glimpse into the attitudes and beliefs of nursing and medical students that could influence how they view and deliver spiritual care, contributing to the evidence base for spiritual care education and curriculum. [J Nurs Educ. 2023;62(11):601-605.].
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Slehria T, Keen S, Inigo JD, Simpson RJ. A Gap in Knowledge-Sudden Death and Preeclampsia. Am J Cardiol 2023; 202:199-200. [PMID: 37454636 DOI: 10.1016/j.amjcard.2023.06.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 06/24/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Trisha Slehria
- Department of Internal Medicine, University of Iowa Healthcare, Iowa City, Iowa.
| | - Susan Keen
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Philadelphia
| | | | - Ross J Simpson
- Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Ottaviani G, Ramos SG. Autopsy for Medical Diagnostics: Finding the Cause of Sudden Unexpected Death through Investigation of the Cardiac Conduction System by Serial Sections. Diagnostics (Basel) 2023; 13:diagnostics13111919. [PMID: 37296771 DOI: 10.3390/diagnostics13111919] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 05/27/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
Sudden unexpected death (SUD) is a fatal event that occurs in an apparently healthy subject in a way that such an abrupt outcome could have not been predicted. SUD-including sudden intrauterine unexplained death (SIUD), sudden neonatal unexpected death (SNUD), sudden infant death syndrome (SIDS), sudden unexpected death of the young (SUDY), and sudden unexpected death in the adult (SUDA)-occurs as the first manifestation of an unknown underlying disease or within a few hours of the presentation of a disease. SUD is a major unsolved, shocking form of death that occurs frequently and can happen at any time without warning. For each case of SUD, a review of clinical history data and performance of a complete autopsy, particularly focused on the study of the cardiac conduction system, were carried out according to the necropsy protocol devised by the Lino Rossi Research Center, Università degli Studi di Milano, Italy. Research cases collected and selected for this study were represented by 75 SUD victims that were subdivided into 15 SIUD, 15 SNUD, 15 SUDY, and 15 SUDA victims. After a routine autopsy and clinical history analysis, death remained unexplained, and hence a diagnosis of SUD was assigned to 75 subjects, which included 45 females (60%) and 30 (40%) males ranging in age from 27 gestational weeks to 76 years. Serial sections of the cardiac conduction system disclosed frequent congenital alterations of the cardiac conduction system in fetuses and infants. An age-related significant difference in distribution among the five age-related groups was detected for the following anomalies of the conduction system: central fibrous body (CFB) islands of conduction tissue, fetal dispersion, resorptive degeneration, Mahaim fiber, CFB cartilaginous meta-hyperplasia, His bundle septation, sino-atrial node (SAN) artery fibromuscular thickening, atrio-ventricular junction hypoplasia, intramural right bundle branch, and SAN hypoplasia. The results are useful for understanding the cause of death for all SUD cases that were unexpected and would have otherwise remained unexplained, so as to motivate medical examiners and pathologists to perform more in-depth studies.
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Affiliation(s)
- Giulia Ottaviani
- Lino Rossi Research Center, Anatomic Pathology, Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, 20122 Milan, Italy
| | - Simone G Ramos
- Pathology and Legal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14040-900, Brazil
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Sefton C, Keen S, Tybout C, Lin FC, Jiang H, Joodi G, Williams JG, Simpson RJ. Characteristics of sudden death by clinical criteria. Medicine (Baltimore) 2023; 102:e33029. [PMID: 37083784 PMCID: PMC10118332 DOI: 10.1097/md.0000000000033029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/30/2023] [Indexed: 04/22/2023] Open
Abstract
Sudden death is a leading cause of deaths nationally. Definitions of sudden death vary greatly, resulting in imprecise estimates of its frequency and incomplete knowledge of its risk factors. The degree to which time-based and coronary artery disease (CAD) criteria impacts estimates of sudden death frequency and risk factors is unknown. Here, we apply these criteria to a registry of all-cause sudden death to assess its impact on sudden death frequency and risk factors. The sudden unexpected death in North Carolina (SUDDEN) project is a registry of out of-hospital, adjudicated, sudden unexpected deaths attended by Emergency Medical Services. Deaths were not excluded by time since last seen or alive or by prior symptoms or diagnosis of CAD. Common criteria for sudden death based on time since last seen alive (both 24 hours and 1 hour) and prior diagnosis of CAD were applied to the SUDDEN case registry. The proportion of cases satisfying each of the 4 criteria was calculated. Characteristics of victims within each restrictive set of criteria were measured and compared to the SUDDEN registry. There were 296 qualifying sudden deaths. Application of 24 hour and 1 hour timing criteria compared to no timing criteria reduced cases by 25.0% and 69.6%, respectively. Addition of CAD criteria to each timing criterion further reduced qualifying cases, for a total reduction of 81.8% and 90.5%, respectively. However, characteristics among victims meeting restrictive criteria remained similar to the unrestricted population. Timing and CAD criteria dramatically reduces estimates of the number of sudden deaths without significantly impacting victim characteristics.
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Affiliation(s)
- Christopher Sefton
- Internal Medicine Residency Program, Cleveland Clinic Foundation, Cleveland, OH
| | - Susan Keen
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Caroline Tybout
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Feng-Chang Lin
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC
| | - Huijun Jiang
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC
| | - Golsa Joodi
- Division of Cardiology, University of California, Los Angeles, CA
| | | | - Ross J. Simpson
- Division of Cardiology, University of North Carolina, Chapel Hill, NC
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Coute RA, Nathanson BH, Kurz MC, DeMasi S, McNally B, Mader TJ. Annual and lifetime economic productivity loss due to adult out-of-hospital cardiac arrest in the United States: A study for the CARES Surveillance Group. Resuscitation 2021; 167:111-117. [PMID: 34389450 DOI: 10.1016/j.resuscitation.2021.07.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/29/2021] [Accepted: 07/04/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To estimate the annual and lifetime economic productivity loss due to adult out-of-hospital cardiac arrest (OHCA) in the United States (U.S.). METHODS All adult (age ≥ 18 years) non-traumatic EMS-treated OHCA with complete data for age, sex, race, and survival outcomes from the CARES database for 2013-2018 were included. Annual and lifetime labor productivity values, based on age and gender, were obtained from previously published national economic data. Productivity losses for OHCA events were calculated by year in U.S. dollars. Productivity losses for survivors were assigned by cerebral performance category score (CPC): CPC 1 and 2 = 0% productivity loss; CPC 3-5 = 100% productivity loss. Sensitivity analyses were performed assigning CPC 2 varying productivity losses (0-100%) based on CPC score and discharge location. Lifetime productivity values assumed 1% annual growth and 3% discount rate and were adjusted for inflation based on 2016 values. Results were extrapolated to annual U.S. population estimates for the study period. RESULTS A total of 338,492 (96.5%) cases met inclusion criteria. The mean annual and lifetime productivity losses per OHCA in 2018 were $48,224 and $638,947 respectively. The total annual economic productivity loss due to OHCA in the U.S. increased from $7.4B in 2013 to $11.3B in 2018. Lifetime economic productivity loss increased from $95.2B in 2013 to $150.2B in 2018. Sensitivity analyses yielded similar findings. Per annual death, OHCA ranked third ($10.2B) in annual economic productivity loss in the U.S. behind cancer ($22.9B) and heart disease ($20.3B) in 2018. CONCLUSION Adult non-traumatic OHCA events are associated with significant annual and lifetime economic productivity losses and should be the focus of public health resources to improve preventative measures and survival outcomes.
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Affiliation(s)
- Ryan A Coute
- Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL, United States; Cardiac Arrest Registry to Enhance Survival (CARES) Surveillance Group, Atlanta, GA, United States.
| | | | - Michael C Kurz
- Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL, United States; Department of Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham, AL, United States; Center for Injury Science, University of Alabama School of Medicine, Birmingham, AL, United States
| | - Stephanie DeMasi
- Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL, United States
| | - Bryan McNally
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, United States
| | - Timothy J Mader
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, United States
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Ford J, Bushnell G, Griffith AM, Joodi G, Ashoka A, Patel N, Husain M, Pursell IW, Sears SF, Mounsey JP, Simpson RJ. Mental Disorders, Substance Use Disorders, and Psychotropic Medication Use Among Sudden-Death Victims. Psychiatr Serv 2021; 72:378-383. [PMID: 33593102 DOI: 10.1176/appi.ps.201900389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors sought to estimate the prevalence of mental and substance use disorders and psychotropic medication prescriptions among working-age sudden-death victims. METHODS Using a written protocol, the authors screened for sudden deaths attended by emergency medical services (EMS) in a large metropolitan county in North Carolina from March 1, 2013, to February 28, 2015. Sudden-death cases were adjudicated by three cardiologists. Mental health and chronic disease diagnoses and treatments were abstracted from EMS, medical examiner, toxicology, and autopsy reports and from clinical records for the past 5 years before death. RESULTS Sudden death was identified for 399 adults ages 18-64 years, 270 of whom had available medical records. Most sudden-death victims were White (63%) and male (65%), had a comorbid condition such as hypertension or respiratory disease, and had a mean±SD age of death of 53.6±8.8 years. Most victims (59%) had at least one mental health or substance use disorder documented in a recent medical record; 76%-78% of victims with a mental disorder had a documented psychotropic medication prescription. However, fewer than one-half (41%) had a documented referral to a mental health professional. The most common diagnostic categories were depressive, anxiety, and alcohol-related disorders. Almost one-half (46%) of the victims had a recent psychotropic prescription, most commonly antidepressants (29%) and benzodiazepines (19%). CONCLUSIONS Mental illness, substance use disorders, and psychotropic medication prescriptions were prevalent among sudden-death victims. The health care needs of these individuals may be better addressed by collaborative care for general medical and mental disorders.
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Affiliation(s)
- Jessica Ford
- Department of Psychology, East Carolina University, Greenville, North Carolina (Ford, Griffith, Sears); Mental and Behavioral Health Service Line, Greenville Health Care Center, Durham U.S. Department of Veterans Affairs Medical Center, Greenville, North Carolina (Ford); Department of Biostatistics and Epidemiology, Rutgers University, New Brunswick, New Jersey (Bushnell); School of Medicine, Yale University, New Haven, Connecticut (Joodi); School of Medicine, University of Arizona, Tucson (Ashoka); Department of Cardiology and Cardiac Electrophysiology, University of North Carolina, Chapel Hill (Patel, Husain, Simpson); Department of Medical Specialties, University of Arkansas for Medical Sciences, Little Rock (Pursell, Mounsey)
| | - Greta Bushnell
- Department of Psychology, East Carolina University, Greenville, North Carolina (Ford, Griffith, Sears); Mental and Behavioral Health Service Line, Greenville Health Care Center, Durham U.S. Department of Veterans Affairs Medical Center, Greenville, North Carolina (Ford); Department of Biostatistics and Epidemiology, Rutgers University, New Brunswick, New Jersey (Bushnell); School of Medicine, Yale University, New Haven, Connecticut (Joodi); School of Medicine, University of Arizona, Tucson (Ashoka); Department of Cardiology and Cardiac Electrophysiology, University of North Carolina, Chapel Hill (Patel, Husain, Simpson); Department of Medical Specialties, University of Arkansas for Medical Sciences, Little Rock (Pursell, Mounsey)
| | - Ashley M Griffith
- Department of Psychology, East Carolina University, Greenville, North Carolina (Ford, Griffith, Sears); Mental and Behavioral Health Service Line, Greenville Health Care Center, Durham U.S. Department of Veterans Affairs Medical Center, Greenville, North Carolina (Ford); Department of Biostatistics and Epidemiology, Rutgers University, New Brunswick, New Jersey (Bushnell); School of Medicine, Yale University, New Haven, Connecticut (Joodi); School of Medicine, University of Arizona, Tucson (Ashoka); Department of Cardiology and Cardiac Electrophysiology, University of North Carolina, Chapel Hill (Patel, Husain, Simpson); Department of Medical Specialties, University of Arkansas for Medical Sciences, Little Rock (Pursell, Mounsey)
| | - Golsa Joodi
- Department of Psychology, East Carolina University, Greenville, North Carolina (Ford, Griffith, Sears); Mental and Behavioral Health Service Line, Greenville Health Care Center, Durham U.S. Department of Veterans Affairs Medical Center, Greenville, North Carolina (Ford); Department of Biostatistics and Epidemiology, Rutgers University, New Brunswick, New Jersey (Bushnell); School of Medicine, Yale University, New Haven, Connecticut (Joodi); School of Medicine, University of Arizona, Tucson (Ashoka); Department of Cardiology and Cardiac Electrophysiology, University of North Carolina, Chapel Hill (Patel, Husain, Simpson); Department of Medical Specialties, University of Arkansas for Medical Sciences, Little Rock (Pursell, Mounsey)
| | - Ankita Ashoka
- Department of Psychology, East Carolina University, Greenville, North Carolina (Ford, Griffith, Sears); Mental and Behavioral Health Service Line, Greenville Health Care Center, Durham U.S. Department of Veterans Affairs Medical Center, Greenville, North Carolina (Ford); Department of Biostatistics and Epidemiology, Rutgers University, New Brunswick, New Jersey (Bushnell); School of Medicine, Yale University, New Haven, Connecticut (Joodi); School of Medicine, University of Arizona, Tucson (Ashoka); Department of Cardiology and Cardiac Electrophysiology, University of North Carolina, Chapel Hill (Patel, Husain, Simpson); Department of Medical Specialties, University of Arkansas for Medical Sciences, Little Rock (Pursell, Mounsey)
| | - Neil Patel
- Department of Psychology, East Carolina University, Greenville, North Carolina (Ford, Griffith, Sears); Mental and Behavioral Health Service Line, Greenville Health Care Center, Durham U.S. Department of Veterans Affairs Medical Center, Greenville, North Carolina (Ford); Department of Biostatistics and Epidemiology, Rutgers University, New Brunswick, New Jersey (Bushnell); School of Medicine, Yale University, New Haven, Connecticut (Joodi); School of Medicine, University of Arizona, Tucson (Ashoka); Department of Cardiology and Cardiac Electrophysiology, University of North Carolina, Chapel Hill (Patel, Husain, Simpson); Department of Medical Specialties, University of Arkansas for Medical Sciences, Little Rock (Pursell, Mounsey)
| | - Mariya Husain
- Department of Psychology, East Carolina University, Greenville, North Carolina (Ford, Griffith, Sears); Mental and Behavioral Health Service Line, Greenville Health Care Center, Durham U.S. Department of Veterans Affairs Medical Center, Greenville, North Carolina (Ford); Department of Biostatistics and Epidemiology, Rutgers University, New Brunswick, New Jersey (Bushnell); School of Medicine, Yale University, New Haven, Connecticut (Joodi); School of Medicine, University of Arizona, Tucson (Ashoka); Department of Cardiology and Cardiac Electrophysiology, University of North Carolina, Chapel Hill (Patel, Husain, Simpson); Department of Medical Specialties, University of Arkansas for Medical Sciences, Little Rock (Pursell, Mounsey)
| | - Irion W Pursell
- Department of Psychology, East Carolina University, Greenville, North Carolina (Ford, Griffith, Sears); Mental and Behavioral Health Service Line, Greenville Health Care Center, Durham U.S. Department of Veterans Affairs Medical Center, Greenville, North Carolina (Ford); Department of Biostatistics and Epidemiology, Rutgers University, New Brunswick, New Jersey (Bushnell); School of Medicine, Yale University, New Haven, Connecticut (Joodi); School of Medicine, University of Arizona, Tucson (Ashoka); Department of Cardiology and Cardiac Electrophysiology, University of North Carolina, Chapel Hill (Patel, Husain, Simpson); Department of Medical Specialties, University of Arkansas for Medical Sciences, Little Rock (Pursell, Mounsey)
| | - Samuel F Sears
- Department of Psychology, East Carolina University, Greenville, North Carolina (Ford, Griffith, Sears); Mental and Behavioral Health Service Line, Greenville Health Care Center, Durham U.S. Department of Veterans Affairs Medical Center, Greenville, North Carolina (Ford); Department of Biostatistics and Epidemiology, Rutgers University, New Brunswick, New Jersey (Bushnell); School of Medicine, Yale University, New Haven, Connecticut (Joodi); School of Medicine, University of Arizona, Tucson (Ashoka); Department of Cardiology and Cardiac Electrophysiology, University of North Carolina, Chapel Hill (Patel, Husain, Simpson); Department of Medical Specialties, University of Arkansas for Medical Sciences, Little Rock (Pursell, Mounsey)
| | - John Paul Mounsey
- Department of Psychology, East Carolina University, Greenville, North Carolina (Ford, Griffith, Sears); Mental and Behavioral Health Service Line, Greenville Health Care Center, Durham U.S. Department of Veterans Affairs Medical Center, Greenville, North Carolina (Ford); Department of Biostatistics and Epidemiology, Rutgers University, New Brunswick, New Jersey (Bushnell); School of Medicine, Yale University, New Haven, Connecticut (Joodi); School of Medicine, University of Arizona, Tucson (Ashoka); Department of Cardiology and Cardiac Electrophysiology, University of North Carolina, Chapel Hill (Patel, Husain, Simpson); Department of Medical Specialties, University of Arkansas for Medical Sciences, Little Rock (Pursell, Mounsey)
| | - Ross J Simpson
- Department of Psychology, East Carolina University, Greenville, North Carolina (Ford, Griffith, Sears); Mental and Behavioral Health Service Line, Greenville Health Care Center, Durham U.S. Department of Veterans Affairs Medical Center, Greenville, North Carolina (Ford); Department of Biostatistics and Epidemiology, Rutgers University, New Brunswick, New Jersey (Bushnell); School of Medicine, Yale University, New Haven, Connecticut (Joodi); School of Medicine, University of Arizona, Tucson (Ashoka); Department of Cardiology and Cardiac Electrophysiology, University of North Carolina, Chapel Hill (Patel, Husain, Simpson); Department of Medical Specialties, University of Arkansas for Medical Sciences, Little Rock (Pursell, Mounsey)
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8
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Keen SK, Masoudi EA, Williams JG, Thota-Kammili S, Mirzaei M, Lin FC, Simpson RJ. Symptoms prior to sudden death. Resusc Plus 2021; 5:100078. [PMID: 34223344 PMCID: PMC8244516 DOI: 10.1016/j.resplu.2021.100078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 01/08/2021] [Accepted: 01/08/2021] [Indexed: 11/30/2022] Open
Abstract
Background Sudden death accounts for up to 15% of all deaths among working age adults. A better understanding of victims’ medical care and symptoms reported at their last medical encounter may identify opportunities for interventions to prevent sudden deaths. Methods From 2013−15, all out-of-hospital deaths, ages 18–64 reported by Emergency Medical Services (EMS) in Wake County, North Carolina were screened and adjudicated to identify 399 victims of sudden death, 264 of whom had available medical records. Demographic and clinical characteristics and prescribed medications were compared between victims with versus without a medical encounter within one month preceding death with chi-square tests and t-tests, as appropriate. Symptoms reported in medical encounters within one month preceding death were analyzed. Results Among the 264 victims with available medical records, 73 (27.7%) had at least one encounter within a month preceding death. These victims were older and more likely to have multiple chronic illnesses, yet most were not prescribed evidence-based medicines. Of these 73 victims, 30 (41.1%) reported cardiac symptoms including dyspnea, edema, and chest pain. Conclusions Many victims seek medical care and report cardiac symptoms in the month prior to sudden death. However, medications that might prevent sudden death are under prescribed. These findings suggest that there are opportunities for intervention to prevent sudden death.
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Affiliation(s)
- Susan K Keen
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Elham A Masoudi
- Department of Internal Medicine, Cone Health, Greensboro, NC, United States
| | - Jefferson G Williams
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Sanjana Thota-Kammili
- Department of Internal Medicine, Appalachian Regional Hospital, Whitesburg, KY, United States
| | - Mojtaba Mirzaei
- Department of Internal Medicine, Yale-New Haven Medical Center, Waterbury, CT, United States
| | - Feng-Chang Lin
- Department of Biostatistics and NC TraCS Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Ross J Simpson
- Department of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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9
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Keen SK, Chang A, Gupta S, Lin FC, Simpson RJ. Variations in blood pressure control by medical comorbidities prior to sudden death. J Clin Hypertens (Greenwich) 2021; 23:389-391. [PMID: 33389801 PMCID: PMC7956134 DOI: 10.1111/jch.14164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/07/2020] [Accepted: 12/17/2020] [Indexed: 12/01/2022]
Abstract
Patients with hypertension have increased risk of sudden death, but the impact of blood pressure control in sudden death is not clear. To better understand potential opportunities to prevent sudden, we assessed blood pressure control, comorbidities, and the number of recent medical encounters among all‐cause sudden death victims. Less than 40% of sudden death victims with hypertension had controlled blood pressure prior to death. Furthermore, increased frequency of medical visits and number of comorbidities were associated with better blood pressure control Strategies to address clinical inertia in hypertension treatment particularly for patients with fewer comorbidities may attenuate the risk of sudden death.
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Affiliation(s)
- Susan K Keen
- Preventive Medicine Residency, Department of Family Medicine, University of North Carolina, Chapel Hill, USA
| | | | - Suhani Gupta
- University of North Carolina, Chapel Hill, NC, USA
| | - Feng-Chang Lin
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA
| | - Ross J Simpson
- Division of Cardiology, University of North Carolina, Chapel Hill, NC, USA
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10
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Rappazzo KM, Joodi G, Hoffman SR, Pursell IW, Mounsey JP, Cascio WE, Simpson RJ. A case-crossover analysis of the relationship of air pollution with out-of-hospital sudden unexpected death in Wake County, North Carolina (2013-2015). THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 694:133744. [PMID: 31756798 PMCID: PMC6876709 DOI: 10.1016/j.scitotenv.2019.133744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 07/10/2019] [Accepted: 08/01/2019] [Indexed: 05/30/2023]
Abstract
Out-of-hospital sudden unexpected deaths are non-accidental deaths that occur without obvious underlying causes and may account for 10% of natural deaths before age 65. Short-term exposure to ambient air pollution is associated with all-cause (non-accidental) and cause-specific (e.g., cardiovascular) mortality, and with immediate exposures often yielding the highest magnitude risk estimates. Few studies have focused on short-term exposure to air pollution and sudden unexpected deaths. Using the University of North Carolina Sudden Unexpected Death in North Carolina population, we examine associations between short-term criteria air pollutant exposures with sudden unexpected deaths using a time-stratified case-crossover design, with data on criteria air pollutants from the Environmental Protection Agency's Air Quality System. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using conditional logistic regression with air pollutant exposures scaled to roughly inter-quartile ranges; models were adjusted for average temperature and relative humidity on event day and preceding 3 days. Potential for confounding by co-pollutants were examined in two pollutant models. ORs for PM2.5 at lag day 1 were elevated (adjusted OR for 5 μg/m3 increase: 1.17 (0.98, 1.40)), and were robust to co-pollutant adjustment. Elevated odds were observed for SO2 at lag day 0, and reduced odds for O3 at lag day 0; however, these associations were somewhat attenuated toward the null (SO2) or were not robust (O3) to co-pollutant adjustment. This analysis in a racially and socioeconomically diverse cohort, with a more inclusive definition of sudden unexpected death than is typically employed offers evidence that PM2.5 may be a clinically relevant trigger of sudden unexpected deaths in susceptible individuals.
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Affiliation(s)
- Kristen M Rappazzo
- U.S. Environmental Protection Agency, Office of Research and Development, National Health and Environmental Effects Research Laboratory, Research Triangle Park, 27711, NC, USA.
| | - Golsa Joodi
- Division of Cardiology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, 27514, NC, USA
| | - Sarah R Hoffman
- Oak Ridge Associated Universities, contractor to U.S. Environmental Protection Agency, Research Triangle Park, 27711, NC, USA; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, 27514, NC, USA
| | - Irion W Pursell
- Division of Cardiology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, 27514, NC, USA
| | - J Paul Mounsey
- Division of Cardiology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, 27514, NC, USA
| | - Wayne E Cascio
- U.S. Environmental Protection Agency, Office of Research and Development, National Health and Environmental Effects Research Laboratory, Research Triangle Park, 27711, NC, USA
| | - Ross J Simpson
- Division of Cardiology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, 27514, NC, USA
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