Skip to main content
Log in

Further prospective evidence of a circadian variation in the frequency of call for sudden cardiac death

  • Original
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

Abstract

Objective

To determine whether in a larger data base call for sudden cardiac death exhibits a specific circadian rhythm similar to that recently demonstrated by Levine et al.

Design and setting

The time of the day of calls received for out-of-hospital cardiac arrests (OOHCA) prospectively registered between 1983 and '90 by 7 major Belgian prehospital EMS-MICU services. Chrono-biologic assessment was made by two-harmonic linear regression analysis of the data tabulated by hour of the day. The hourly distribution of calls for OOHCAS was subjected to Fourier transformation resulting in a periodogram.

Patients

3471 OOHCAs with presumed cardiac etiology and age of more than 18 years versus 2007 impatients registered in the same period.

Measurements and results

Significant and remarkably similar circadian patterns were found (R-square=0.84) for the cardiac origin OOHCAs and the ventricular fibrillation OOHCAs. There is a low incidence during the night and an increased incidence from 6 a.m. until noon with an additional early afternoon-peak. The data were always better fitted when applying sinusoids with periods of 8 and 24 h instead of 12 and 24 h. Our observed circadian distribution resembles the reported circadian variation of ischaemic episodes, ventricular tachycardia and acute myocardial infarction in the awake hours. The time distribution of OOHCA (cardiac origin) differs significantly from OOHCA (non-cardiac origin) and from in-hospital cardiac arrests. The in-hospital CA pattern shows less deviation. The age dependent variation in the incidence of cardiac origin OOHCAs, was not obvious for the ventricular fibrillation subgroup.

Conclusion

Knowledge about the cyclical nature of incidence of cardiac arrests is useful to improve intersystem comparisons and make sound decisions about prophylaxis, treatment and allocation of resources.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Muller JE, Ludmer PL, Willich SN, Tofler GH, Aylmer G, Klangos I, Stone PH (1987) Circadian variation in the frequency of sudden cardiac death. Circulation 75:131–138

    PubMed  CAS  Google Scholar 

  2. Levine RL, Pepe PE, Fromm RE, Curka PA, Clark PA (1992) Prospective evidence of circadian rhythm for out-of-hospital cardiac arrests. JAMA 267:2935–2937

    Article  PubMed  CAS  Google Scholar 

  3. Mitler MM, Hajdukovic RM, Shafor R, Hahn PM, Kripke DF (1987) When people die. Cause of Death versus Time of Death. Am J Med 82:266–274

    Article  PubMed  CAS  Google Scholar 

  4. Kirchner T, Nelson J, Burdo H (1985) The autopsy as a measure of accuracy of the death certificate. N Engl J Med 313:1263–1269

    Article  Google Scholar 

  5. Gittelsohn A, Senning J (1979) Studies of the reliability of vital and health records. I. Comparison of cause of death and hospital record diagnoses. Am J Public Health 69:680–689

    Article  PubMed  CAS  Google Scholar 

  6. The Cerebral Resuscitation Study Group (1989) The Belgian Cardio-Pulmonary-Cerebral resuscitation registry. Form Protocol. Resuscitation 17:S5-S10

    Google Scholar 

  7. Bloomfield P (1974) Fourier Analysis of Time Series: a Introduction. Prentice-Hall, New York

    Google Scholar 

  8. SAS/STAT user's guide, vol 2, version 6, 4th edn. SAS Institute. Cary, NC, 1990

  9. Rocco MB, Barry J, Campbell S et al (1987) Circadian variation of transient myocardial ischemia in patients with coronary artery disease. Circulation 75:395–400

    PubMed  CAS  Google Scholar 

  10. Gaul G, Aldor E, Kaff A, Müllner W, Gruska M (1993) Different circadian variation of out-of-hospital cardiac arrest in men and women—evidence for different triggering mechanisms? Resuscitation 25:94

    Article  Google Scholar 

  11. Kempf F, Josephson ME (1984) Cardiac arrest recorded on ambulatory electro-cardiograms. Am J Cardiol 53:1577–1582

    Article  PubMed  Google Scholar 

  12. Lucente M, Rebuzzi AG, Lanza GA, Tamburi S, Cortellessa MC, Coppola E, Iannarelli M, Manzoli U (1988) Circadian variation of ventricular tachycardia in acute myocardial infarction. Am J Cardiol 62:670–674

    Article  PubMed  CAS  Google Scholar 

  13. de Luna AB, Coumel P, Leclercq JF (1989) Ambulatory sudden cardiac death: Mechanisms of production of fatal arrhythmia on the basis of data from 157 cases. Am Heart J 117:151–159

    Article  Google Scholar 

  14. Buff DD, Fleisher JM, Roca JA, Jaffri M, Wyrwinski PM (1992) Carcadian distribution of in-hospital cardiopulmonary arrests on the general medical ward. Arch Intern Med 152:1282–1288

    Article  PubMed  CAS  Google Scholar 

  15. Lewi PJ, Mullie A, Quets A and the The Cerebral Resuscitation Study Group (1989) Relevance and significance of pre-CPR conditions in cardio-pulmonary-cerebral resuscitation. A graphic analysis by means of Spectramap. Resuscitation 17:S35-S44

    Article  PubMed  Google Scholar 

  16. Arntz H-R, Oeff M, Völler H, Stern R, Willich SN, Depperman M, Heinzmann A, Matenaer B, Schnitzer L, Schröder R (1992) Cause of circadian variations of sudden cardiac death is age-dependent variability in ventricular fibrillation. Eur Heart J 13:S376

    Google Scholar 

  17. Oeff M, Arntz H-R, Willich S, Stern R, Schröder R (1993) Circadian variations of sudden cardiac death caused by ventricular fibrillation and its relation to the underlying disease. Resuscitation 25:89

    Article  Google Scholar 

  18. Siscovick DS (1993) Challenges in cardiac arrest research: data collection to assess outcome. Ann Emerg Med 22:92–98

    Article  PubMed  CAS  Google Scholar 

  19. American Heart Association (1989) Heart facts. AHA, Dallas, 22:1988

    Google Scholar 

  20. Becker LB, Smith DW, Rhodes KV (1993) Incidence of cardiac arrest: a neglected factor in evaluating survival rates. Ann Emerg Med 22:86–91

    Article  PubMed  CAS  Google Scholar 

  21. Becker LB, Han BH, Meyer PM, Wright FA, Rhodes KV, Smith DV, Barrett J and the CPR Chicago Project (1993) Racial differences in the incidence of cardiac arrest and subsequent survival. N Engl J Med 329:600–606

    Article  PubMed  CAS  Google Scholar 

  22. Obraztsov VP, Strazhesko ND (1910) The symptomatology and diagnosis of coronary thrombosis. In: Vorobeva VA, Konchalovski MP (eds) Works of the First Congress of Russian Therapists, pp 26–43

  23. Somers VK, Dyken ME, Mark AL, Abboud FM (1993) Sympathetic-nerve activity during sleep in normal subjects. N Engl J Med 328:303–307

    Article  PubMed  CAS  Google Scholar 

  24. Couch RD (1990) Travel, time zones, and sudden cardiac death, emporiatric pathology. Am J Forensic Med Pathol 11:106–111

    Article  PubMed  CAS  Google Scholar 

  25. Otto W, Hempel W-E, Wagner C-U, Best A (1982) Einige periodische und aperiodische Variationen der Herzin-farktsterblichkeit in der DDR. Z Gesamte Innere Med 37:756–763

    CAS  Google Scholar 

  26. Pepine CJ (1991) Circadian variations in myocardial ichemia — Implications for management. JAMA 265:386–390

    Article  PubMed  CAS  Google Scholar 

  27. Fromm RE, Levine RL, Pepe PE (1992) Circadian variation in the time of request for helicopter transport of cardiac patients. Ann Emerg Med 21: 1196–1199

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Consortia

Additional information

The Cerebral Resuscitation Study Group of the Belgian Society for Intensive Care & Emergency Medicine: P. Martens, A. Mullie: Department of Critical Care Medicine, Algemeen Ziekenhuis Sint Jan, Brugge; W. Buylaert, P. Calle, O. Vanhaute: Department of Emergency Medicine, Universitair Ziekenhuis Gent; L. Corne, D. Lauwaert: Department of Emergency Medicine, Akademisch Ziekenhuis Vrije Universiteit, Brussels; H. Delooz: Department of Emergency Medicine, Universitair Ziekenhuis St Rafael-Gasthuisberg, Leuven; M. Weeghmans: Department of Emergency Medicine, Imeldaziekenhuis, Bonheiden; L. Bossaert, K. Monsieurs: Department of Intensive Care UIA, Universitair Ziekenhuis, Antwerpen; P. Lewi, B. Van den Poel: Department of Information Sciences, Janssen Research Foundation, Beerse; P. Mols, E. Baucarne: Hôpital Universitaire St.-Pierre, Brussels; G. Nollet: O. L. Vrouw Ziekenhuis, Aalst

Rights and permissions

Reprints and permissions

About this article

Cite this article

Martens, P.R., Calle, P., Van den Poel, B. et al. Further prospective evidence of a circadian variation in the frequency of call for sudden cardiac death. Intensive Care Med 21, 45–49 (1995). https://doi.org/10.1007/BF02425153

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02425153

Key words

Navigation