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The incidence of out-of-hospital sudden unexpected death (OHSUD) in a racially and socioeconomically diverse population has been inadequately studied. We collated all OHSUDs over a 24-month period among 18- to 64-year olds in Wake County, North Carolina, to investigate geographic and socioeconomic disparity in incidence of OHSUD. An electronic query of Wake County Emergency Medical Services (EMS) identified all EMS attended out-of-hospital deaths. After excluding trauma, expected deaths, and deaths occurring in non-free-living subjects, medical records and medical examiner's reports were reviewed by a committee of cardiologists to make the determination of OHSUD. Victims were geocoded to census tracts, and demographic and socioeconomic data were obtained from the 2014 American Community Survey and 2010 US Census. Incidence was examined by sociodemographic group with univariate analysis and multivariable regression. There were 397 OHSUDs, and 53% of census tracts had >1 event. The incidence of OHSUD was 64 of 100,000; 107 of 100,000 among blacks; and 60 of 100,000 among whites. Census tracts with >1 OHSUD had a higher population of blacks, a greater proportion unmarried, a lower median household income, and a greater proportion residing in a rural area. Only median household income remained a significant predictor of OHSUD after adjustment in multivariable analysis. Low median household income of a community portends a higher incidence of sudden death. In conclusion, interventions to reduce the incidence of sudden death need to be developed with these specific communities in mind., (Copyright © 2017 Elsevier Inc. All rights reserved.)

The goal of treatment for atrial fibrillation (AF) is often to control symptoms. It remains unclear whether targets for treatment such as AF rate or AF burden are correlated with AF symptom severity. Two hundred eighty-six patients completed a questionnaire of their general health and well-being, including a detailed AF symptom assessment immediately followed by a 7-day continuous monitor. AF characteristics assessed from the monitor included AF burden, AF rate, sinus rhythm rate, frequency and severity of pauses, and premature atrial contraction or premature ventricular contraction burden. Characteristics were analyzed separately for patients with paroxysmal or persistent AF. Symptom severity was assessed using the University of Toronto Atrial Fibrillation Severity Scale. Monitor characteristics were compared with AF symptom severity. The mean age of the cohort was 61.8 years and the majority of subjects were male (65.4%). Co-morbidities included hypertension (64.5%), sleep apnea (38.4%), congestive heart failure (19.6%), and diabetes (16.4%). In those with persistent or paroxysmal AF, there were no significant predictors of AF symptom severity. Specifically, heart rate in AF or sinus rhythm, AF burden, or premature atrial contraction or premature ventricular contraction burden was not predictive of AF symptom severity. After adjusting for potential cofounders (including age, gender, and co-morbidities), these findings persisted. In conclusion, there is no value in using AF monitor characteristics to predict symptoms in patients with AF., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Atherosclerosis development is a complex process, with inflammation, indicated by elevated high-sensitivity C-reactive protein (hs-CRP), as a potential mediator. Obesity, physical activity, and depression have all been reported to affect hs-CRP. However, these factors are interconnected, and their relative individual importance remains unclear. From a separate prospective cohort study, 289 patients were selected for the present substudy. We assessed the relation of a variety of potential predictors and hs-CRP. Obesity, physical activity, and depression, in addition to several other potential factors, were analyzed in bivariate and multivariate linear regression models, adjusting for potential confounders. In unadjusted analyses, mild-to-moderate and severe depression were associated with increased hs-CRP compared to no or minimal depression. Vigorous physical activity was associated with decreased hs-CRP compared to no physical activity. All classes of obesity were associated with increased hs-CRP. In addition, attaining a college or graduate degree was associated with decreased hs-CRP compared to high school or less educational attainment. On multivariate analysis, depression was no longer associated with increased hs-CRP. Physical activity remained associated with decreased hs-CRP but only at vigorous levels. Educational attainment also remained associated but only at the collegiate or professional education level. Ultimately, obesity remained the greatest absolute predictor of elevated hs-CRP. In conclusion, in analyses of multiple factors potentially predictive of elevated hs-CRP in a large population of patients with subclinical coronary heart disease, we found the most important predictor to be obesity., (Copyright © 2013 Elsevier Inc. All rights reserved.)