天津市区1985—1994年急性心肌梗塞和冠心病猝死监测分析

采用流行病学方法，在天津市市区人群中监测心肌梗塞、冠心病猝死的发病率和死亡率，了解它们的变化趋势。主要监测结果显示：①１９８５～１９９４年天津市市区心肌梗塞、冠心病猝死的发病率和死亡率处于较高的水平且有逐年增加的趋势；②心肌梗塞的发病率为４３．３３／１０万，心肌梗塞的死亡率为１４．６４／１０万；③冠心病猝死的死亡率为３８．５９／１０万。该研究为天津市提供了冠心病的基本情况；为预防和降低冠心病的发生和死亡提供了可靠的依据     

预测心源性猝死的无创性检查方法

猝死是世界范畴的健康问题，尤其是西方发达国家，猝死在人群死亡中往往占主导地位。如美国每天就大约有1200人发生猝死，每年猝死者可高达40～50万，而且大多数发生于中老年人。我国对猝死的发生率尚缺乏完整的统计资料。根据近几年有关文献报道，猝死发生率约占各种死亡的1．0％～3．6％，在所有老年人死亡中猝死约占2．3％～5．8％，而在猝死中老年人又可占到56．5％～80．0％。     

谈谈冠心病猝死

什么叫猝死?什么叫冠心病猝死? 猝(读cù,醋)是突然的意思。猝死指自然发生、出乎意料地突然死亡。近年发生率有上升趋势。关于猝死的标准目前还不统一。有的认为发生症状至死亡在半小时内为猝死,有的则认为在1小时内、6小时内或24小时内死亡叫猝死。世界卫生组织规定发病之后6小时内死亡者为猝死。 猝死的原发病很多,有冠心病史或能够排除其他病因造成的猝     

自然人群中主要心血管疾病的发病趋势分析

本文对辽宁省１９８５－１９８９年在心血管疾病监测人群中发生的急性心肌梗死，冠心病猝死，脑卒中进行了调查分析。调查质量和方法均按ＷＨＯ的统一方法进行。结果表明，五年中ＡＭＩ的平均发病率为１７．２／１０万，冠心病猝死和脑卒中分别为８．９／１０万和１６８．５／１０万。三种疾病的发病率均为男性高于女性，ＲＲ值分别为３．１３，２．９５和２．０２三种疾病的发病率均随年龄的增加而升高；观察期间冠心病猝死及脑卒中     

北京地区70万人群冠心病猝死流行病学调查

本文报告1984－1985年北京地区70万自然人群中25－74岁年龄组冠心病猝死率及其流行病学特点。结果显示：冠心病死亡中约一半为猝死。男性猝死率高于女性。猝死者大部分有心血管病史，约一半有前驱症状，但特异性较差。本文就冠心病猝死诊断标准及院外心肺复苏等问题进行了讨论。     

社区医生对心脏性猝死的干预及管理

心脏性猝死是指由心脏事件导致的，发生迅速而意外的死亡。在各类猝死事件中，因心脏病突发引起的院外猝死在80％以上，心脏性猝死中最常见的病因是冠心病。研究表明，90％以上的猝死发生在冠心病或心肌病患者身上。由于是意外事件，大部分猝死发生于院外，猝死抢救能否成功，直接取决于院外急救是否及时。因此，社区医生尤需掌握猝死的急救知识和技能，掌握辖区居民的健康和疾病状况，对容易发生猝死的高危人群建立健康档案，并且从中筛选出高危人群，由医务人员进行指导治疗及定期随访，进行猝死的干预与管理。     

农村37万自然人群的猝死调查

本文报告江苏省海门县三十七万各农村人口,1981年1月至1982年12月底两年内猝死的回顾性调查结果。二年内共有猝死80例,其中男性47例,女性33例,男女比例为1.47:1.男性猝死平均年龄为60.3岁,女性为73.4岁。猝死的年平均发生率为10.73/10万。冠心病是猝死的主要原因。冠心病猝死自症状出现至死亡一小时内达高峰。一小时内猝死者,冠心病占66.7%,1~6小时内占24.1%,说明猝死时间越短,冠心病猝死的可能性就越大。     

老年性冠心病猝死的护理体会

目的研究老年冠心病患者猝死的原因以及相应的护理措施。方法我院选择2012年10月~2013年10月间诊治的22例冠心病出现猝死的患者,对其临床资料进行分析,同时制定相应的护理措施。结果通过对发生猝死的22例老年性冠心病患者进行分析,死亡原因:6例为暴饮暴食,8例为便秘,4例为情绪激动,2例为寒冷刺激,2例为过度疲劳。结论冠心病猝死的患者发病原因主要是暴饮暴食、便秘、情绪因素为主,应制定有针对性的护理措施,以免冠心病患者出现猝死,降低老年冠心病患者发生猝死的几率。     

让我们远离心血管猝死

<正>一般猝死指在发病后6小时内突然死亡,冠心病猝死指在发病后1小时内突然死亡。据统计,心血管病猝死占总猝死的38%~66.3%,而冠心病猝死又居心血管猝死的首位。预计到2020年,冠心病死亡人数占全球死亡人数的百分比将提高到50%,达2500万人。冠心病猝死的原因是什么?心脏是人体血液循环的动力泵,分分秒秒不停地工作。通过心脏收缩,将含氧丰富的动脉血送到     

沈飞职工急性冠心病事件病死率的流行病学研究

目的对沈飞职工1992—2003年急性冠心病事件病死率进行流行病学的分析，为制定有效的降低病死率的防治措施提供依据。方法以沈阳地区MONICA方案中三台子地区沈飞职工近4万监测人群中1992—2003年发生的662例急性冠心病事件为研究样本，分析病死率的变化趋势及在不同特征人群中的分布情况。结果（1）该地区急性冠心病事件总病死率为49．2％，医院内病死率为8．3％。（2）急诊与医院外死亡人数占总死亡的83％。急诊与院外死亡是院内死亡的4．9倍（P〈0．001）。（3）男性病死率呈随年龄增长而上升趋势（P〈0．01）。女性病死率无明显变化（P〉0．05）。（4）有冠心病史人群病死率59．7％，无此病史人群病死率40．1％，差别有显著性（P〈0．01）。（5）发病后1h内猝死者占死亡总人数26．1％，24h内死亡者占死亡总人数82．14％。结论沈飞职工急性冠心病事件急诊与院外死亡人数占总死亡人数的4／5；院内病死率为8．3％，有上升趋势。有冠心病史者、男性老年组病死率较高；开展有针对性的健康知识宣教，争取并缩短院前诊治时间是降低病死率的重要措施。     

Coronary heart disease death and sudden cardiac death: a 20-year population-based study

Trends in out-of-hospital coronary heart disease (CHD) death, a surrogate for sudden cardiac death (SCD), are important for understanding the decline in CHD mortality. Little is known about out-of-hospital CHD death without prior CHD diagnosis, the definition of unexpected SCD. The authors analyzed secular trends in CHD death and unexpected SCD over a 20-year period (1979-1998) to examine the association between prior CHD and SCD and to test the hypothesis that in-hospital deaths declined more than SCDs. The yearly decline in CHD mortality rates was 5.3% for in-hospital deaths and 1.8% for out-of-hospital deaths (p = 0.001). Among all SCDs, the proportion of unexpected SCD was 49%. Mortality rates for both unexpected SCD and SCD with prior CHD declined over time, but unexpected SCD declined at a slower rate than SCD with prior CHD (p = 0.001). The relative odds of prior CHD were higher among persons with SCD than among controls, but there was a modest decline in the magnitude of the association. Thus, during the past 20 years, the decline was greater for in-hospital CHD deaths than for SCDs. Since approximately half of the SCDs were unexpected and rates of these deaths declined less over time than rates of SCD with prior CHD, primary prevention is becoming increasingly more important in sustaining the decline in CHD mortality.     

State-specific mortality from sudden cardiac death--United States, 1999

Each year in the United States, 400,000-460,000 persons die of unexpected sudden cardiac death (SCD) in an emergency department (ED) or before reaching a hospital (1). Based on the latest U.S. mortality data, this report summarizes and analyzes 1999 national and state-specific SCD data. Reducing the proportion of out-of-hospital* SCDs would decrease the overall incidence of premature death in the United States. Heart attacks are the major cause of SCD; approximately 70% of SCDs are caused by coronary heart disease. National efforts are needed to increase public awareness of heart attack symptoms and signs and to reduce delay time to treatment.     

Fish and n-3 fatty acids for the prevention of fatal coronary heart disease and sudden cardiac death

Large observational studies, randomized clinical trials, and experimental studies have evaluated the effects of fish and n-3 fatty acid consumption on fatal coronary heart disease (CHD) and sudden cardiac death (SCD), clinically defined events that most often share the final common pathway of fatal ventricular arrhythmia. These different study designs, each having complementary strengths and limitations, provide strong concordant evidence that modest consumption of fish or fish oil (1-2 servings/wk of oily fish, or approximately 250 mg/d of EPA+DHA) substantially reduces the risk of CHD death and SCD. Pooled analysis of prospective cohort studies and randomized clinical trials demonstrates the magnitude and dose-response of this effect, with 36% lower risk of CHD death comparing 0 and 250 mg/d of EPA+DHA consumption (P < 0.001), but then little additional benefit with higher intakes. Reductions in risk are even larger in observational studies utilizing tissue biomarkers of n-3 fatty acids that more accurately measure dietary consumption. The concordance of findings from different studies also suggests that effects of fish or fish oil on CHD death and SCD do not vary depending on presence or absence of established CHD. The strength and consistency of the evidence, and the magnitude of this effect are each notable. Because more than one-half of all CHD deaths and two-thirds of SCD occur among individuals without recognized heart disease, modest consumption of fish or fish oil, together with smoking cessation and regular moderate physical activity, should be among the first-line treatments for prevention of CHD death and SCD.     

人群中70岁以上老年人冠心病的死亡状况分析

本文对１９９０～１９９２年发生在老年人群中（≥７０岁）的冠心病死亡进行了调查分析。结果表明，老年冠心病的平均死亡率为１．２３％，其中男性为１．５２％，女性为０．９４％，小于７５岁者死亡率高于７５岁以上者，前者为１．６９％，后者为０．８４％，两组死亡的主要病种均为冠心病猝死（ＣＳＤ）；无论男女，死亡均以工人所占比例为大（男５７．４％，女４４．８％）；各种冠心病死亡多集中在冬季；急性心肌梗塞（ＡＭＩ）死亡者多发生在夜间，ＣＳＤ则多发生在白天；ＡＭＩ病人中有９．１％未经抢救即死亡，有５４．５％在１小时内得到医疗救护，ＣＳＤ则有５９．６％的病例未经治疗而死，２９．８％的患者在发作后一小时内得到抢救。     

Screening of athletes is undesirable

The sudden demise of an athlete invariably leads to calls for prevention. Although few screening programmes live up to expectations, the 2005 European Society of Cardiology consensus statement contains a recommendation for routine pre-participation screening of asymptomatic young athletes. As the incidence of sudden cardiac death (SCD) in this group is very low (< 2 per 100,000 per year), and no test reliably identifies persons at an increased risk of SCD, the Health Council of the Netherlands advised against mandatory screening. It seems prudent, however, to consider other strategies for reducing the occurrence of exercise-related cardiac death, e.g. by stimulating prompt resuscitation efforts and, perhaps also focusing on the rapidly growing group of senior athletes at increased risk of acute cardiac (mainly coronary) events, as this group may benefit from the recent advances in CT imaging of the coronary arteries.     

Height and risk of sudden cardiac death: the Atherosclerosis Risk in Communities and Cardiovascular Health Studies

PurposeSudden cardiac death (SCD) is an important cause of mortality in the adult population. Height has been associated with cardiac hypertrophy and an increased risk of arrhythmias but also with decreased risk of coronary heart disease, suggesting a complex association with SCD.MethodsWe examined the association of adult height with the risk of physician-adjudicated SCD in two large population-based cohorts: the Cardiovascular Health Study and the Atherosclerosis Risk in Communities study.ResultsOver an average follow-up time of 11.7 years in Cardiovascular Health Study, there were 199 (3.6%) cases of SCD among 5556 participants. In Atherosclerosis Risk in Communities study, over 12.6 years, there were 227 (1.5%) cases of SCD among 15,633 participants. In both cohorts, there was a trend toward decreased SCD with taller height. In fixed effects meta-analysis, the pooled hazard ratio per 10 cm of height was 0.84; 95% confidence interval, 0.73–0.98; P = .03. The association of increased height with lower risk of SCD was slightly attenuated after inclusion of risk factors associated with height, such as hypertension and left ventricular hypertrophy. The association appeared stronger among men than women in both cohorts.ConclusionsIn two population-based prospective cohorts of different ages, greater height was associated with lower risk of SCD.     

Pregnancy in the Sickle Cell Disease and Fetomaternal Outcomes in Different Sickle cell Genotypes: A Systematic Review and Meta-Analysis

BackgroundPregnancy is a major concern among women with the sickle cell disease (SCD), and it is associated with increased adverse outcomes. The aim of the present meta-analysis is to report the fetomaternal outcomes in different sickle cell genotypes.MethodsIn this systematic review and meta-analysis, a comprehensive search of databases and search engines such as PubMed, Scopus, Web of Science, ProQuest, Cochrane Library, Science Direct and Google Scholar were performed. Any observational studies that had compared at least one outcome such as maternal outcomes, fetal outcomes, and morbidity between two groups of pregnant women with different types of sickle cell genotypes and pregnant women without SCD were evaluated.ResultsA total number of 9,827 pregnant women with SCD were examined. The results showed that pregnancy in SCD increased the risk of adverse outcomes for the mothers (including postpartum hemorrhage, prematurity, pregnancy-induced hypertension, pre-eclampsia, eclampsia, cesarean section, lower segment cesareansection, maternal death), fetus (including live births, low birth weight, intrauterine growth restriction, APGAR score at 5 min <7, stillbirth, neonatal death, perinatal mortality, acute fetal distress, intrauterine fetal death) and morbidity among the SCD(severe anemia, urinary tract infection, blood transfusion, painful crisis, acute chest syndrome, vaso-occlusive crises).ConclusionAccording to the results of this meta-analysis, pregnancy in the SCD is associated with an increased risk of maternal outcomes, fetal outcomes, and morbidity among SCD patients with different genotypes. Pregnancy in sickle cell hemoglobinopathies needs careful multidisciplinary management and cautious caring so as to decrease maternal and fetal morbidity and mortality.     

Defining Sickle Cell Disease Mortality Using a Population-Based Surveillance System, 2004 through 2008

Objective

Population-based surveillance data from California and Georgia for years 2004 through 2008 were linked to state death record files to determine the all-cause death rate among 12,143 patients identified with sickle cell disease (SCD).

Methods

All-cause death rates, by age, among these SCD patients were compared with all-cause death rates among both African Americans and the total population in the two states. All-cause death rates were also compared with death rates for SCD derived from publicly available death records: the compressed mortality files and multiple cause of death files.

Results

Of 12,143 patients identified with SCD, 615 patients died. The all-cause mortality rate for the SCD population was lower than the all-cause mortality rate among African Americans and similar to the total population all-cause mortality rates from birth through age 4 years, but the rate was higher among those with SCD than both the African American and total population rates from ages 5 through 74 years. The count of deceased patients identified by using population-based surveillance data (n=615) was more than twice as high as the count identified in compressed mortality files using SCD as the underlying cause of death alone (n=297).

Conclusion

Accurate assessment of all-cause mortality and age at death requires long-term surveillance via population-based registries of patients with accurately diagnosed SCD.Ongoing public health surveillance of sickle cell disease (SCD) is critical to understanding its course and outcomes. Such surveillance is vital for medical management, clinical and translational research, new therapy development, public health planning, and patient, family, and provider education.Multiple research studies have used data collected through limited surveillance activities to better understand age at death for patients with SCD. Studies published in the 1970s showed a poor prognosis for patients with SCD, with a median age at death of approximately 14 years, high mortality in the first five years of life, and only about 15% of deaths occurring after age 30 years.¹ Results from a 1978 study based on a newborn screening cohort in Jamaica found that 13% of children with hemoglobin SS disease and 5% of children with hemoglobin SC disease died in the first two years of life.² Follow-up studies in Jamaica confirmed this observation and showed that only 25% of deaths among those with SCD occurred in patients older than 30 years of age.³The Cooperative Study of Sickle Cell Disease, which followed SCD patients in the United States from 1978 through 1988, reported patient survival in its academic center cohort, with a median age at death of 48 years for women and 42 years for men with hemoglobin SS disease, and 68 years for women and 60 years for men with hemoglobin SC disease.⁴ This study also reported that 50% of hemoglobin SS disease deaths occurred in patients older than 45 years of age. A 2001 study, using excess mortality simulation of a Jamaican cohort, predicted that 50% of SCD deaths would occur in those older than 53 years of age.⁵ Additional studies based on newborn screening cohorts enrolled in comprehensive care systems in the United States (published in 2004 and 2010), the United Kingdom (published in 2007), and Brazil (published in 2014) indicated that mortality in the first five years of life was significantly lower than in the 1978 Jamaican report, with the expectation that 86% to 98% of children with SCD would live to adulthood.^2,6–9However, not all recent research indicates similar findings in SCD mortality. A study using data from the National Center for Health Statistics'' (NCHS''s) compressed mortality (CM) files, 1999 through 2006, estimated the mean age at death for patients with SCD to be 39 years in 2006.¹⁰ In that study, among the 483 SCD deaths in the United States reported during that year, 9% occurred in those aged 20 years or younger and 35% occurred in those older than 45 years of age. A study using NCHS''s multiple cause of death (MCOD) files, 1979 through 2005, to estimate age at death and death rates similarly found median ages at death among women and men with SCD to be 42 and 38 years, respectively.¹¹One important caveat to previous mortality studies is that researchers relied on death certificate reporting of SCD^10,11 or on populations seen at high-volume hematology clinics.^2–9 Studies based on death certificates assumed accurate and complete coding in the death record, while the clinic-based studies may have been biased to include the sickest SCD patients, who are more likely to be seen at specialty care centers. To address these limitations, we used data on SCD patients from California and Georgia who were identified during the Registry and Surveillance System for Hemoglobinopathies project and linked them to all state death record files to estimate the all-cause mortality rate and mean and median ages at death for SCD in these two states.¹²     

Underdiagnosis of Conditions Associated with Sudden Cardiac Death in Children - Is it the Absence of a Comprehensive Screening Program or a True Low Prevalence?

This study aimed to assess the prevalence of conditions associated with sudden cardiac death (SCD) among all children and children with sudden infant death syndrome (SIDS) in the State of Hawai‘i, where no comprehensive screening program is conducted for such conditions. A retrospective chart review was conducted from the single tertiary pediatric hospital in Hawai‘i, from offices of all pediatric cardiologists in Hawai‘i, and the Hawai‘i State Department of Health from 1/1/2000 to 12/31/2013. Children aged 0–18 years were included in the study. A subset of the study analyzed records of infants aged 0–12 months. SIDS rate was calculated and compared to national data. Prevalence was calculated for known conditions associated with SCD. The identified prevalence was compared to the established prevalence of conditions associated with SCD.In Hawai‘i, the infant SIDS rate (66.4/100,000) was similar to the national rate (54.4/100,000). Over 14 years, only 51 children were diagnosed with a condition associated with SCD; 28 with a cardiomyopathy and 21 with a channelopathy. A 14-year retrospective analysis in the State of Hawai‘i revealed that less than 1 in 30 children, who are expected to harbor a SCD-associated condition, had been appropriately diagnosed. The underdiagnosis of conditions associated with SCD reflects that in the absence of a comprehensive screening program, conditions without obvious signs and symptoms are difficult to diagnose. Many children with these conditions will remain at risk of SCD.