#Thyroid Function and #Sudden Cardiac Death

http://circ.ahajournals.org/content/134/10/713

Conclusions: Higher FT4 levels are associated with an increased risk of SCD, even in euthyroid participants.

Molecular #Autopsy for #Sudden Unexpected Death

http://jamanetwork.com/journals/jama/article-abstract/2565740

This uncertainty may be partially resolved with postmortem genetic testing (“molecular autopsy”).2 Initial studies, limited to cardiac channelopathy and epilepsy genes, have yielded molecular diagnoses in approximately 25% of cases.

and Quality Measures for #Prevention of #Sudden Cardiac Death

http://www.onlinejacc.org/content/early/2016/12/15/j.jacc.2016.09.933

In this measure set, the writing committee presents 10 measures that are intended for ambulatory and hospital (inpatient) settings or state/municipal use. In developing this measure set, the writing committee established 2 classes of measures: 1) performance, and 2) quality.

Declining Risk of #Sudden Death in Heart #Failure
http://www.nejm.org/doi/full/10.1056/NEJMoa1609758

The risk of sudden death has changed over time among patients with symptomatic heart failure and reduced ejection fraction with the sequential introduction of medications including angiotensin-converting–enzyme inhibitors, angiotensin-receptor blockers, beta-blockers, and mineralocorticoid-receptor antagonists. We sought to examine this trend in detail. Sudden death was reported in 3583 patients.

Such patients were older and were more often male, with an ischemic cause of heart failure and worse cardiac function, than those in whom sudden death did not occur. There was a 44% decline in the rate of sudden death across the trials (P=0.03). The cumulative incidence of sudden death at 90 days after randomization was 2.4% in the earliest trial and 1.0% in the most recent trial. The rate of sudden death was not higher among patients with a recent diagnosis of heart failure than among those with a longer-standing diagnosis.

Conclusions
Rates of sudden death declined substantially over time among ambulatory patients with heart failure with reduced ejection fraction who were enrolled in clinical trials, a finding that is consistent with a cumulative benefit of evidence-based medications on this cause of death.

Young Persons With #Diabetes Have a 7-Fold Increased Risk of #Sudden Cardiac Death Compared to Persons Without Diabetes: A Nationwide Cohort Study in Denmark
http://circ.ahajournals.org/content/136/Suppl_1/A20507

Persons with diabetes mellitus (DM) have increased all-cause mortality compared to the general population. Mortality rates (MR) and causes of death among children and young persons with type 1 DM (DM1) and type 2 DM (DM2) have not previously been examined in a nationwide setting. Therefore, the aim of this nationwide and unselected study was to examine all-cause and cardiac MR in children and young adults with DM1 and DM2. Furthermore, we aimed to calculate MR ratio between persons with and without DM

The leading cause of death among persons with DM was cardiac diseases (n=230, 34%) with a MR ratio between persons with and without DM of 8 (95% CI, 7-10, p<0.001). Among persons with DM, 118 (17%) suffered sudden cardiac death and the MR ratio between persons with and without DM was 7 (95% CI, 6-9, p<0.001). The most common causes of SCD in autopsied decedents were coronary artery disease (n=18, 47%) and sudden arrhythmic death syndrome (n=10, 26%).

Conclusion: Children and young adults with DM have a 5-fold increased all-cause MR and a 7-fold increased risk of SCD compared to age-matched persons without DM. This study highlights the need for continuous cardiovascular risk monitoring and management in young persons with DM