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1.
J Forensic Sci ; 65(1): 117-127, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31404479

RESUMO

Sudden cardiac death is a significant cause of mortality in adults with congenital heart disease (CHD). The Cook County Medical Examiner's Office database was queried for cases of CHD as a cause of death in the period between July 2008 and April 2019. Twenty-two cases were identified, including 11 decedents with simple defects and 10 decedents with complex defects. All of the subjects were in apparent good health at the time of death. In the absence of other obvious causes of death, simple defects were considered cases of sudden cardiac death. Significant cardiac morphological changes were common in complex defects. While 16 cases had known, diagnosed/treated CHD, 5 cases had no diagnosis prior to autopsy. In these cases, the ability to recognize CHD (sometimes subtle) helped in determining the causes of death. Therefore, forensic pathologists must be able to properly recognize various forms of CHD and request consultations, when needed.


Assuntos
Morte Súbita Cardíaca/epidemiologia , Cardiopatias Congênitas/mortalidade , Cardiopatias Congênitas/patologia , Adulto , Distribuição por Idade , Idoso , Cardiomegalia/patologia , Chicago/epidemiologia , Médicos Legistas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Distribuição por Sexo , Adulto Jovem
2.
Presse Med ; 48(12): 1401-1405, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31699540

RESUMO

Sudden cardiac death represents a major public health issue, with up to 50% of the cardiovascular mortality. Coronary artery disease and dilated cardiomyopathy both represent almost 90% of sudden cardiac death burden. Primary prevention using implantable cardioverter defibrillator relies, in this population, on the left ventricle ejection fraction simple measurement. In this paper, we aim to discuss in which extent a better understanding of competing risk situation may help for a better patient selection and eventually for optimizing primary prevention using implantable cardioverter defibrillator.


Assuntos
Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis , Cardiomiopatia Dilatada/epidemiologia , Cardiomiopatia Dilatada/terapia , Morte Súbita Cardíaca/epidemiologia , Humanos , Seleção de Pacientes , Prevenção Primária/instrumentação , Prevenção Primária/métodos , Risco , Medição de Risco , Fatores de Risco , Disfunção Ventricular Esquerda/epidemiologia , Disfunção Ventricular Esquerda/terapia
3.
West J Emerg Med ; 20(5): 810-817, 2019 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-31539339

RESUMO

INTRODUCTION: Sudden cardiac death is a rare cause of death in young athletes. Current screening techniques include history and physical exam (H and P), with or without an electrocardiogram (ECG). Adding point of care cardiac ultrasound has demonstrated benefits, but there is limited data about implementing this technology. We evaluated the feasibility of adding ultrasound to preparticipation screening for collegiate athletes. METHODS: We prospectively enrolled 42 collegiate athletes randomly selected from several sports. All athletes were screened using a 14-point H and P based on 2014 American College of Cardiology (ACC) and American Heart Association (AHA) guidelines, ECG, and cardiac ultrasound. RESULTS: We screened 11 female and 31 male athletes. On ultrasound, male athletes demonstrated significantly larger interventricular septal wall thickness (p = 0.002), posterior wall thickness (p <0.001) and aortic root breadth (p = 0.002) compared to females. Based on H and P and ECGs alone and a combination of H and P with ECG, no athletes demonstrated a positive screening for cardiac abnormalities. However, with combined H and P, ECG, and cardiac ultrasound, one athlete demonstrated positive findings. CONCLUSIONS: We believe that adding point of care ultrasound to the preparticipation exam of college athletes is feasible. This workflow may provide a model for athletic departments' screening.


Assuntos
Atletas , Morte Súbita Cardíaca/prevenção & controle , Cardiopatias/diagnóstico , Programas de Rastreamento/métodos , Sociedades , Estudantes , Universidades , Adolescente , Morte Súbita Cardíaca/epidemiologia , Ecocardiografia , Eletrocardiografia , Feminino , Cardiopatias/epidemiologia , Humanos , Incidência , Masculino , Esportes , Estados Unidos/epidemiologia , Adulto Jovem
4.
Arch Cardiovasc Dis ; 112(8-9): 523-531, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31471226

RESUMO

This review summarizes the main findings of the French multicentre DAI-PP pilot programme, and discusses the related clinical and research perspectives. This project included retrospectively (2002-2012 period) more than 5000 subjects with structural heart disease who received an implantable cardioverter defibrillator (ICD) for primary prevention of sudden cardiac death, and were followed for a mean period of 3 years. The pilot phase of the DAI-PP programme has provided valuable information on several practical and clinically relevant aspects of primary prevention ICD implantation in the real-world population, which are summarized in this review. This pilot has led to a prospective evaluation that started in May 2018, assessing ICD therapy in primary and secondary prevention in patients with structural and electrical heart diseases, with remote monitoring follow-up using a dedicated platform. This should further enhance our understanding of sudden cardiac death, to eventually optimize the field of preventative actions.


Assuntos
Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis , Cardioversão Elétrica/instrumentação , Prevenção Primária/métodos , Morte Súbita Cardíaca/epidemiologia , França/epidemiologia , Humanos , Estudos Multicêntricos como Assunto , Projetos Piloto , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
5.
Int Heart J ; 60(5): 1083-1090, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31447468

RESUMO

Contemporary studies have identified rs10494366 in the nitric oxide synthase 1 adaptor protein (NOS1AP) gene as a new genetic marker in modulating the QT interval and sudden cardiac death (SCD) in general populations. However, the conclusions were not coincident. Therefore, we conducted for the first time a system evaluation of the relativity of rs10494366, the QT interval, and sudden death by meta-analysis. In our study, the meta-analysis displayed the GG genotype of rs10494366 correlated with the QT interval in women with no heterogeneity, and in diabetes mellitus (DM) patients with minor heterogeneity. In the Caucasian population, the correlation of rs10494366 and sudden death was significant. The heterogeneity referred to the relevance between rs10494366 and sudden death in the Asian population. In conclusion, the minor allele of rs10494366 may have an impact on the QT interval in women or DM patients and may have a potential role in sudden death in the Caucasian population.


Assuntos
Proteínas Adaptadoras de Transdução de Sinal/genética , Morte Súbita Cardíaca/epidemiologia , Predisposição Genética para Doença/epidemiologia , Síndrome do QT Longo/genética , Síndrome do QT Longo/mortalidade , Polimorfismo de Nucleotídeo Único/genética , Alelos , Grupo com Ancestrais do Continente Asiático/genética , China , Morte Súbita Cardíaca/etnologia , Eletrocardiografia , Feminino , Genótipo , Humanos , Masculino , Análise de Sobrevida
6.
Med Clin North Am ; 103(5): 913-930, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31378334

RESUMO

Sudden cardiac death (SCD) is a leading cause of death in the United States. Despite improvements in therapy, the incidence of SCD as a proportion of overall cardiovascular death remains relatively unchanged. This article aims to answer the question, "Who is at risk for SCD?" In the process, it reviews the definition, pathophysiology, epidemiology, and risk factors of SCD. Patients at risk for SCD and appropriate treatment strategies are discussed.


Assuntos
Doença das Coronárias/complicações , Morte Súbita Cardíaca/epidemiologia , Adulto , Idoso , Doença das Coronárias/fisiopatologia , Morte Súbita Cardíaca/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição de Risco , Volume Sistólico , Estados Unidos/epidemiologia
8.
Cardiol Clin ; 37(3): 319-326, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31279425

RESUMO

The challenge presented by sudden cardiac death in dialysis patients is to better define risk factors and delineate multiple etiologies. Only then can therapy be tailored to the highest risk patients and the incidence of sudden cardiac death be reduced. This article details the many possible etiologies and presents a brief overview of more recent research that may in the future prove of great benefit in improving the mortality of our patients with end-stage renal disease.


Assuntos
Morte Súbita Cardíaca/epidemiologia , Falência Renal Crônica/complicações , Medição de Risco , Prevenção Secundária/métodos , Morte Súbita Cardíaca/etiologia , Morte Súbita Cardíaca/prevenção & controle , Saúde Global , Humanos , Incidência , Fatores de Risco
10.
Cardiol Rev ; 27(4): 189-197, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31180938

RESUMO

Arrhythmogenic cardiomyopathy (AC) is a hereditary disorder characterized by degeneration of cardiac myocytes and their subsequent replacement by fat and fibrous tissue primarily in the right ventricle. Our study aimed to systematically evaluate the impact of significant demographic, clinical, electrocardiographic, and echocardiographic factors in arrhythmic events in AC patients. MEDLINE and Cochrane library databases were manually searched without year or language restriction or any other limits until July 31, 2017. A pooled odds ratio with 95% confidence intervals was calculated for each of the risk factors. Our search retrieved 26 studies (n = 2680 patients, mean age: 37.9 years old, males: 51.9%) which were included in the quantitative synthesis. The most reliable predicting factors/parameters are the following: (1) male gender, (2) presyncope, (3) left ventricular dysfunction, (4) T-wave inversions in inferior leads, (5) proband status, (6) late potentials, (7) syncope, (8) inducibility at electrophysiological study, (9) right ventricular dysfunction, (10) epsilon waves, and (11) premature ventricular contractions greater than 1000/24 h. On the contrary, family history of sudden cardiac death, palpitations, premature ventricular contractions greater than 500/24 h, and T-wave inversions in right precordial leads fail to determine the outcome in this meta-analysis. In conclusion, multiple risk factors have been associated with arrhythmic events in AC patients. However, larger studies are needed to discriminate those patients who will benefit from implantable cardioverter defibrillators.


Assuntos
Displasia Arritmogênica Ventricular Direita , Morte Súbita Cardíaca/etiologia , Eletrocardiografia , Estudos Observacionais como Assunto , Medição de Risco , Função Ventricular Direita/fisiologia , Displasia Arritmogênica Ventricular Direita/complicações , Displasia Arritmogênica Ventricular Direita/fisiopatologia , Displasia Arritmogênica Ventricular Direita/terapia , Morte Súbita Cardíaca/epidemiologia , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis , Saúde Global , Humanos , Incidência , Fatores de Risco
11.
J Biomed Sci ; 26(1): 39, 2019 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-31118017

RESUMO

Sudden cardiac death (SCD) is a sudden, unexpected death that is caused by the loss of heart function. While SCD affects many patients suffering from coronary artery diseases (CAD) and heart failure (HF), a considerable number of SCD events occur in asymptomatic individuals. Certain risk factors for SCD have been identified and incorporated in different clinical scores, however, risk stratification using such algorithms is only useful for health management rather than for early detection and prediction of future SCD events in high-risk individuals. In this review, we discuss different molecular biomarkers that are used for early detection of SCD. This includes genetic biomarkers, where the majority of them are genomic variants for genes that encode for ion channels. Meanwhile, protein biomarkers often denote proteins that play roles in pathophysiological processes that lead to CAD and HF, notably (i) atherosclerosis that involves oxidative stress and inflammation, as well as (ii) cardiac tissue damage that involves neurohormonal and hemodynamic regulation and myocardial stress. Finally, we outline existing challenges and future directions including the use of OMICS strategy for biomarker discovery and the multimarker panels.


Assuntos
Biomarcadores/análise , Morte Súbita Cardíaca/epidemiologia , Humanos , Fatores de Risco
12.
Am J Cardiol ; 123(12): 1900-1905, 2019 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-31053292

RESUMO

The pathophysiology of sudden cardiac death (SCD) remains incompletely understood. Genetic mutations can create a favorable substrate for SCD. Our aim is to evaluate the evidence of single nucleotide polymorphisms (SNPs) as predictors of SCD. We searched the Medline database (2000 to 2017) and selected all case-control or cohort studies that reported associations between SNPs and SCD. Our search terms included "polymorphisms" and "sudden death." We collected the study design, population ethnic background, gene testing strategy, the association between the SNP and SCD, and the cardiovascular comorbidities of the population. Our search yielded 723 studies, of which we included 24 based upon our inclusion criteria. The studies had a total population of 78,165 participants, with a median age of 62.5 years (IQR 56 to 66) and 35% (IQR 13 to 32) were female. Almost all studies were conducted in white patients of European descent and the most commonly used genetic strategy was candidate gene panels. Fifteen of the studies had a case-control design that included SCD patients without known heart disease as the comparison group and the other 9 studies included patients with heart failure and coronary artery disease. The studies evaluated 53 SNPs and the most common genetic loci were SCN5A, RyR2, CASQ2, NOSA1P, and AGTR. SNPs with the 3 strongest statistically significant ORs >1 were: rs6684209 of CASQ2 (odds ratio [OR] 19), rs3814843 of CALM1 (OR 5.5), and rs35594137 of GJA5 (OR 3.6). In Conclusion, many SNPs are associated with SCD, with the strongest associations seen in SNPs of genes related to intracellular calcium handling. These findings were generated primarily using a candidate gene strategy in white patients with European descent.


Assuntos
Morte Súbita Cardíaca/epidemiologia , Polimorfismo de Nucleotídeo Único , Humanos
13.
Prog Cardiovasc Dis ; 62(3): 265-271, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31075277

RESUMO

Sudden cardiac death (SCD) is a major public health issue in the United States and worldwide. It is estimated to affect between 1 and 1.5 million patients worldwide annually, with the global burden expected to rise due to the concomitant rise in coronary artery disease in the developing world. Although arrhythmic causes of SCD such as ventricular tachycardia and ventricular fibrillation are common and well-studied, non-arrhythmic causes are also important, with diverse etiologies from ischemia-related structural heart disease to non-ischemic heart diseases, non-atherosclerotic coronary pathologies, and inflammatory states. Recent research has also found that risk factors and/or demographics predispose certain individuals to a higher risk of non-arrhythmia-related SCD. This review discusses the epidemiology, mechanisms, etiologies, and management of non-arrhythmic SCD.


Assuntos
Doença das Coronárias/complicações , Morte Súbita Cardíaca/etiologia , Infarto do Miocárdio/complicações , Adulto , Aneurisma Coronário/complicações , Aneurisma Coronário/diagnóstico por imagem , Morte Súbita Cardíaca/epidemiologia , Humanos , Lactente , Fatores de Risco , Tomografia Computadorizada por Raios X
14.
J Cardiovasc Med (Hagerstown) ; 20(7): 450-458, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30985353

RESUMO

OBJECTIVE: The objective was to provide an exhaustive characterization of ECG features in a large cohort of dilated cardiomyopathies (DCMs) and then investigate their possible prognostic role in the long term. BACKGROUND: ECG is an accessible, reproducible, low-cost diagnostic and prognostic tool. However, an extensive description of ECG features and their long-term prognostic role in a large cohort of DCM is lacking. METHODS: All available baseline ECGs of DCM patients enrolled from 1992 to 2013 were systematically analysed. Patients underwent to a complete clinical-laboratory evaluation. The study outcome measures were death or heart transplant (D/HT) and sudden death or malignant ventricular arrhythmias (SD/MVA). RESULTS: Four hundred and fourteen DCM patients were enrolled. During a median follow-up of 125 months, 55 and 57 patients experienced D/HT and SD/MVA, respectively. At multivariate analysis, left ventricular hypertrophy (P = 0.017), heart rate (HR, P = 0.005) and anterolateral T-wave inversion (P = 0.041) predicted D/HT. Regarding SD/MVA, S wave amplitude in V2 (P = 0.008), R wave amplitude in DIII (P = 0.007), anterolateral T-wave inversion (P = 0.017) emerged as predictors. At receiver-operating curve analyses, the addition of ECG models to the clinical-laboratory evaluation significantly increased the area under the curve both for D/HT (from 0.68 to 0.74, P = 0.042) and SD/MVA (from 0.70 to 0.77, P = 0.048). CONCLUSION: The exhaustive systematic evaluation of ECG has an incremental impact in the prognostication of a large cohort of DCM patients, also regarding the arrhythmic stratification.


Assuntos
Cardiomiopatia Dilatada/diagnóstico , Eletrocardiografia , Frequência Cardíaca , Adulto , Arritmias Cardíacas/diagnóstico por imagem , Arritmias Cardíacas/mortalidade , Arritmias Cardíacas/fisiopatologia , Cardiomiopatia Dilatada/mortalidade , Cardiomiopatia Dilatada/fisiopatologia , Cardiomiopatia Dilatada/cirurgia , Morte Súbita Cardíaca/epidemiologia , Feminino , Transplante de Coração , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
15.
J Athl Train ; 54(4): 349-355, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31013114

RESUMO

CONTEXT: Sudden death in sport at the high school and collegiate levels has been described extensively in the literature. However, few epidemiologic data exist on the incidence of sudden death specifically in American youth sport before secondary school athletics. OBJECTIVE: To describe the epidemiology of sudden death in organized youth sports in the United States from 2007 through 2015. DESIGN: Descriptive epidemiology study. SETTING: Organized American youth sports. PATIENTS OR OTHER PARTICIPANTS: Cases of sudden death that occurred in youth athletes 17 years of age and younger in non-high school organized sports were included. DATA COLLECTION AND ANALYSIS: Information on sudden deaths between August 1, 2007, and December 31, 2015, was obtained via LexisNexis and other publicly available news or media reports. Total youth sport participation rates from 2007 to 2015 were provided by the Sport & Fitness Industry Association. Athlete age, sex, sport, level of play, event type, date of death, setting, and official and speculated causes of death were examined. Data are presented as deaths per year, percentage of total sudden deaths, and deaths per 10 million participants. RESULTS: From 2007 to 2015, 45 sudden deaths were reported in American youth sports. The mean age of patients was 13 ± 2 years. The overall incidence rate was 1.83 deaths/10 million athlete-years. Males experienced a greater number of sudden deaths than females (n = 36/45, 80%). Basketball had the highest number of sudden deaths from 2007 to 2015, with a total of 16 occurrences. The most frequent cause of sudden death was cardiac related (n = 34/45, 76%). Most sudden deaths occurred during practices (n = 32/45, 71%). CONCLUSIONS: Sudden deaths in organized youth sports in the United States from 2007 through 2015 were most often experienced during practices by males, were cardiac related, and occurred while playing basketball. These findings are similar to those in high school and collegiate sports. This study affirms the need for further epidemiologic research into sudden deaths at the organized youth sport level.


Assuntos
Atletas/estatística & dados numéricos , Morte Súbita Cardíaca/epidemiologia , Instituições Acadêmicas , Universidades , Esportes Juvenis/estatística & dados numéricos , Adolescente , Criança , Feminino , Humanos , Incidência , Masculino , Estados Unidos/epidemiologia
16.
Am J Cardiol ; 123(12): 1915-1920, 2019 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-30967290

RESUMO

Although the presence of chronic total occlusion (CTO) has been associated with long-term mortality in the patients with ST-segment elevation myocardial infarction, the influence of having CTO on in-hospital mortality in sudden cardiac arrest (SCA)-acute coronary syndrome (ACS) patients has not been reported. Therefore, we examined the association between the presence of CTO and in-hospital mortality in those patients. Consecutive 106 SCA-ACS patients who received coronary angiography were retrospectively included. The factors associated with in-hospital mortality were analyzed. Among 106 patients, 40 (38%) patients died during hospitalization. Multivariate analysis revealed presence of CTO dependent on infarct-related artery (IRA-dependent-CTO) (hazard ratio [HR] = 2.88, p = 0.004), diabetes mellitus (HR = 2.04, p = 0.044), percutaneous cardiopulmonary support use (HR = 2.22, p = 0.045), successful recanalization (HR = 0.31, p = 0.004), and peak creatine kinase muscle-brain fraction (HR = 1.11, p < 0.001) were significantly associated with mortality. In conclusion, presence of IRA-dependent-CTO was significantly associated with in-hospital mortality in SCA-ACS patients.


Assuntos
Síndrome Coronariana Aguda/complicações , Oclusão Coronária/complicações , Oclusão Coronária/mortalidade , Morte Súbita Cardíaca/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Síndrome Coronariana Aguda/mortalidade , Idoso , Angiografia Coronária , Oclusão Coronária/diagnóstico por imagem , Feminino , Mortalidade Hospitalar , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Taxa de Sobrevida
19.
Congenit Heart Dis ; 14(4): 525-533, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30889316

RESUMO

OBJECTIVE: Sudden cardiac death is common in the adult congenital heart disease (ACHD) population. Knowledge and experience about the use of implantable cardioverter defibrillators (ICD) in ACHD patients is very limited. We aimed to characterize a cohort of patients with ACHD and ICDs. DESIGN: Thirty consecutive ACHD patients submitted to an ICD implantation in a single tertiary center were evaluated. Data on baseline clinical features, heart defect, indication for ICD, type of device, appropriate therapies, ICD-related complication, and mortality during follow-up were collected. RESULTS: Of the 30 patients, 56.7% received appropriate therapies due to ventricular tachycardia (VT) or ventricular fibrillation (VF). The rate of inappropriate therapies and device-related complications was 33.3%. Secondary prevention and primary prevention patients with class I indications for ICD had more appropriate therapies than complication, but this relationship was reversed for patients with class II indications. Remote monitoring played an important role in diagnosing new atrial arrhythmias before scheduled visits in 46.2% of patients, leading to a change in medication. VT/VF episodes were associated with a composite of death, cardiac transplantation, and hospital admission (OR 13.0; 95% CI: 2.1-81.5). CONCLUSION: ICDs are not only useful in preventing SCD, but also have a major role in diagnosing atrial tachyarrhythmias ahead of scheduled visits. Although improvements in ICD technology might reduce complications and inappropriate therapies, adequate selection of candidates for primary prevention still remains difficult because of the lack of clear indications.


Assuntos
Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis , Cardiopatias Congênitas/terapia , Prevenção Primária/métodos , Adulto , Morte Súbita Cardíaca/epidemiologia , Morte Súbita Cardíaca/etiologia , Feminino , Seguimentos , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/mortalidade , Humanos , Incidência , Masculino , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Fatores de Tempo
20.
J Am Soc Nephrol ; 30(4): 611-623, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30885935

RESUMO

BACKGROUND: Individuals receiving maintenance hemodialysis may be particularly susceptible to the lethal cardiac consequences of drug-induced QT prolongation because they have a substantial cardiovascular disease burden and high level of polypharmacy, as well as recurrent exposure to electrolyte shifts during dialysis. Electrophysiologic data indicate that among the selective serotonin reuptake inhibitors (SSRIs), citalopram and escitalopram prolong the QT interval to the greatest extent. However, the relative cardiac safety of SSRIs in the hemodialysis population is unknown. METHODS: In this retrospective cohort study, we used data from a cohort of Medicare beneficiaries receiving hemodialysis included in the US Renal Data System registry (2007-2014). We used a new-user design to compare the 1-year risk of sudden cardiac death among hemodialysis patients initiating SSRIs with a higher potential for prolonging the QT interval (citalopram, escitalopram) versus the risk among those initiating SSRIs with lower QT-prolonging potential (fluoxetine, fluvoxamine, paroxetine, sertraline). We estimated adjusted hazard ratios using inverse probability of treatment weighted survival models. Nonsudden cardiac death was treated as a competing event. RESULTS: The study included 30,932 (47.1%) hemodialysis patients who initiated SSRIs with higher QT-prolonging potential and 34,722 (52.9%) who initiated SSRIs with lower QT-prolonging potential. Initiation of an SSRI with higher versus lower QT-prolonging potential was associated with higher risk of sudden cardiac death (adjusted hazard ratio, 1.18; 95% confidence interval, 1.05 to 1.31). This association was more pronounced among elderly individuals, females, patients with conduction disorders, and those treated with other non-SSRI QT-prolonging medications. CONCLUSIONS: The heterogeneous QT-prolonging potential of SSRIs may differentially affect cardiac outcomes in the hemodialysis population.


Assuntos
Citalopram/efeitos adversos , Morte Súbita Cardíaca/epidemiologia , Falência Renal Crônica/terapia , Inibidores de Captação de Serotonina/efeitos adversos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Doença do Sistema de Condução Cardíaco/epidemiologia , Depressão/tratamento farmacológico , Eletrocardiografia , Feminino , Fluoxetina/efeitos adversos , Fluvoxamina/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Peroxidase/efeitos adversos , Sistema de Registros , Diálise Renal , Estudos Retrospectivos , Fatores de Risco , Sertralina/efeitos adversos , Fatores Sexuais , Estados Unidos/epidemiologia
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