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