Please use this identifier to cite or link to this item:
https://hdl.handle.net/20.500.14279/13451
Title: | Pathoanatomic Findings Associated With Duty-Related Cardiac Death in US Firefighters: A Case-Control Study | Authors: | Smith, Denise Louise Haller, Jeannie M. Korre, Maria Fehling, Patricia C. Sampani, Konstantina Grossi Porto, Luiz Guilherme Christophi, Costas A. Kales, Stefanos N. |
Major Field of Science: | Medical and Health Sciences | Field Category: | Clinical Medicine | Keywords: | Autopsy;Cardiomegaly;Coronary heart disease;Firefighting;Left ventricular hypertrophy | Issue Date: | 1-Sep-2018 | Source: | Journal of the American Heart Association, 2018, vol. 7, no. 18 | Volume: | 7 | Issue: | 18 | Journal: | Journal of the American Heart Association | Abstract: | Background Sudden cardiac death accounts for the greatest proportion of duty-related deaths among US firefighters. Increased understanding of the pathoanatomic causes of sudden cardiac death and the risk associated with underlying cardiac pathologies is needed to develop evidence-based screening recommendations. Methods and Results Using autopsy data for duty-related firefighter fatalities occurring between 1999 and 2014, this retrospective case-control study compared cardiac findings of male firefighters aged 18 to 65 years who died on duty of cardiac-related causes with those who died of noncardiac trauma-related causes. Data from 276 cardiac cases and 351 noncardiac trauma controls were analyzed. Among cardiac cases, the most prevalent (82%) underlying pathoanatomic substrate was comorbid coronary heart disease and cardiomegaly/left ventricular hypertrophy. Cardiac cases had a higher prevalence of cardiomegaly (heart weight >450 g), left ventricular hypertrophy (left ventricular wall thickness ≥1.2 cm), and severe coronary artery stenosis (≥75%) than trauma controls (all P<0.001). In multivariate analyses, heart weight >450 g, coronary artery stenosis ≥75%, and evidence of a prior myocardial infarction were strong independent predictors of cardiac death, with odds ratios of 6.1 (95% confidence interval, 3.6-10.4), 9.3 (95% confidence interval, 5.3-16.1), and 6.2 (95% confidence interval, 3.4-11.3), respectively. Conclusions The majority of cardiac fatalities had evidence of both coronary heart disease and increased heart mass, and each condition was independently associated with a markedly elevated risk of cardiac death. Targeted screening for coronary heart disease, increased heart mass, and evidence of prior myocardial infarction should be considered to reduce duty-related cardiac deaths among firefighters. | ISSN: | 20479980 | DOI: | 10.1161/JAHA.118.009446 | Rights: | © The Authors | Type: | Article | Affiliation : | College Saratoga Springs NY Cyprus University of Technology Harvard University Medical School Cambridge MA Medicine University of Brasilia |
Appears in Collections: | Άρθρα/Articles |
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JAHA.118.009446.pdf | Fulltext | 441.33 kB | Adobe PDF | View/Open |
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