Practice Update: Cardiology

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PracticeUpdate Cardiology Editor-in-Chief, Douglas Zipes MD, and Associate Editor, Joerg Herrmann MD, discuss their top stories in cardiology for 2016. Predictionmodel for SCA By Douglas Zipes MD 2016 Top stories in Cardiology

EDITORIAL Managing Editor Anne Neilson anne.neilson@elsevier.com Editor Carolyn Ng carolyn.ng@elsevier.com Designer Jana Sokolovskaja j.sokolovskaja@elsevier.com SALES Commercial Manager Fleur Gill fleur.gill@elsevier.com Account Manager Linnea Mitchell-Taverner l.mitchell-taverner@elsevier.com

C linical cardiac electrophysiology has come a long way since the early days of “His bundle studies.” With accurate mapping and catheter ablation, we’ve been able to eliminate morbidity and mortality associated with many arrhythmias. Maturation of pacemakers and implantable cardiac defibrillators (ICDs) has benefited countless patients. The arrhythmic challenges that remain include atrial fibrillation (AF) and sudden cardiac arrest (SCA). Ablation has helped many patients with AF, while ICDs have saved the lives of many thousands of patients resuscitated from SCA. Despite these advances, both arrhythmias continue to exert a major impact on the general population. An ejection fraction (EF) ≤ 35% helps identify those at risk for SCA. However, SCA remains a major clinical problem because a reduced EF is a better predictor of total mortality than of arrhythmic mortality. In fact, most SCAs occur in the general population among individuals with no past history of cardiac disease in whom the EF is not reduced. The SCA event is often the first manifestation of the presence of underlying heart disease. Therefore, predicting those at risk for SCA in the general population has been a major challenge. Yet, they represent the vast majority of the annual 350,000 sudden cardiac death (SCD) population in the US. That is why I have picked “Development and validation of a sudden cardiac death prediction model for the general population” by Deo et al ( Circulation 2016;134:806–816) as a top story for 2016. In this article, the authors analysed the records of 13,677 individuals in the Atherosclerosis Risk in Communities study (ARIC) and 4207 participants in the Cardiovascular Health Study (CHS) free of cardiovascular disease at baseline to derive a prediction model of SCD for the general population. There were 345 adjudicated SCD events in the analysis, which found 12 independent risk factors for SCD, including age, male sex, African American race, current smoking, systolic blood pressure, use of antihypertensive medication, diabetes, serum potassium, serum albumin, HDL, estimated GFR, and QTc interval. Strikingly, a reduced EF was found in only 1% of participants in an echocardiographic substudy and did not enhance risk prediction. This risk model outperformed the 2013 ACC/AHA CVD Pooled Cohort risk equations. These findings provide the first generalisable risk score to help identify people in the general population at risk for SCD. In the future, this risk score might be used to identify those in the highest- risk subgroups of the general population, who had a 5% risk of SCD over 10 years, so that therapy can be focused on this group to help prevent SCD. Clinicians need to follow future information from this study, which, hopefully, will translate into reducing SCD risk for their patients.

DISCLAIMER PracticeUpdate Cardiology provides highlights of key local and international conferences, timely and relevant news, expert opinions and journal article reviews for specialist medical professionals. The ideas and opinions expressed in this publication do not necessarily reflect those of the Publisher. Elsevier Australia will not assume responsibility for damages, loss, or claims of any kind arising from or related to the information contained in this publication, including any claims related to the products, drugs, or services mentioned herein. Because of rapid advances in the medical sciences, in particular, independent verificationofdiagnosesanddrugdosagesshould be made. Please consult the full current Product Information before prescribing any medication mentioned in this publication. Although all advertising material is expected to conform to ethical (medical) standards, inclusion in this publication does not constitute a guarantee or endorsement of the quality or value of such product or of the claims made of it by its manufacturer. ISSN 2206-4672 PracticeUpdate provides professional research, expert insights, and education resources in a single online destination PracticeUpdate content is selected by medical experts in cardiology for its relevance, timeliness, and importance. It is guided by world-renowned editorial and advisory boards that represent community practitioners and academic specialists with cross-disciplinary expertise. For in-depth insights which matter, discover PracticeUpdate.com today. Conference news, expert opinions and journal article reviews are sourced from PracticeUpdate.com

Dr Zipes is Distinguished Professor, Professor Emeritus of Medicine, Pharmacology and Toxicology, and Emeritus Director of the Division of Cardiology and Krannert Institute of Cardiology at Indiana University School of Medicine.

PracticeUpdate Cardiology is published by Elsevier Australia ABN 70 001 002 357

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