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The need for consistent and current data describing the true incidence of SCA and/or SCD was highlighted during the most recent Sudden Cardiac Arrest Thought Leadership Alliance’s (SCATLA) Think Tank meeting of national experts with broad representation of key stakeholders including thought leaders and representatives from the American College of Cardiology, American Heart Association, and the Heart Rhythm Society. As such, to evaluate the true magnitude of this public health problem, we performed a systematic literature search in MEDLINE using the MeSH headings, “death, sudden” OR the terms “sudden cardiac death” OR “sudden cardiac arrest” OR “cardiac arrest” OR “cardiac death” OR “sudden death” OR “arrhythmic death.” Study selection criteria included peer-reviewed publications of primary data used to estimate SCD incidence in the U.S. We used Web of Science®’s Cited Reference Search to evaluate the impact of each primary estimate on the medical literature by determining the number of times each “primary source” has been cited. The estimated U.S. annual incidence of SCD varied widely from 180,000 to > 450,000 among 6 included studies. These different estimates were in part due to different data sources (with data age ranging from 1980 to 2007), definitions of SCD, case ascertainment criteria, methods of estimation/extrapolation, and sources of case ascertainment. The true incidence of SCA and/or SCD in the U.S. remains unclear with a wide range in the available estimates, which are badly dated. As reliable estimates of SCD incidence are important for improving risk stratification and prevention, future efforts are clearly needed to establish uniform definitions of SCA and SCD and then to prospectively and precisely capture cases of SCA and SCD in the overall U.S. population.

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Background: Cardiovascular disease (CVD) is the leading cause of death among American Indians and Alaska Natives. Over the past 50 years, the prevalence of CVD has been rising among American Indians and Alaska Natives. The objective of this statement is to summarize population-level risk factors and management techniques tailored for the American Indian and Alaska Native populations. Methods: PubMed/MEDLINE, the Centers for Disease Control and Prevention, and the annual Heart Disease and Stroke Statistics report from the American Heart Association were used to identify risk factors and interventions specific to American Indians and Alaska Natives. Results: Diabetes mellitus is a major contributor to disproportionately higher rates of coronary heart disease among American Indians and Alaska Natives compared with other racial and ethnic groups. Additional risk factors for CVD include low-density lipoprotein cholesterol levels, hypertension, renal disease, age, and sex. Smoking and exposure to toxic metals are risk factors for some subpopulations. A quarter of American Indians live below the federal poverty line, and thus, low socioeconomic status is an important social determinant of cardiovascular health. Community-based interventions have reduced CVD risk in American Indians and Alaska Natives. Underreporting of American Indian and Alaska Native race could underestimate the extent of CVD in this population. Conclusions: Prevention and treatment of CVD in American Indians and Alaska Natives should focus on control of risk factors and community-based interventions that address social determinants of health, particularly among individuals with diabetes mellitus. Accurate reporting of race/ethnicity is encouraged to address race-specific risk factors.

Background Post-operative atrial fibrillation (POAF) is a well-recognized complication of cardiac surgery, however, its management remains a challenge and the implementation and outcomes of various strategies in clinical practice remain unclear. Methods We compared patient characteristics, operative procedures, post-operative management, and outcomes between patients with and without POAF following coronary artery bypass grafting (CABG) in the Society for Thoracic Surgery multicenter CAPS-Care registry (2004–2005). Results Of 2,390 patients who underwent CABG, 676 (28%) had POAF. Compared with patients without POAF, those with POAF were older (median age 74 vs. 71, p<0.0001), more likely to have hypertension (86% vs. 83%, p=0.04), and impaired renal function (median estimated glomerular filtration rate, 56.9 vs. 58.6 mL/min/1.73m2, p=0.0001). A majority of patients with POAF were treated with amiodarone (77%) and beta-blockers (68%); few underwent cardioversion (9.9%). Patients with POAF were more likely to experience complications (57% vs.41%, p<0.0001), including acute limb ischemia (1.0% vs. 0.4%, p=0.03), stroke (4% vs. 1.9%, p=0.002), and reoperation (13% vs. 7.9%, p<0.0001). Length of stay (median 8 days vs. 6 days, p<0.0001), in-hospital mortality (6.8% vs. 3.7%, p=0.001), and 30-day mortality (7.8 vs. 3.9, p<0.0001) were all worse for patients with POAF. In adjusted analyses, POAF remained associated with increased length of stay following surgery (adjusted ratio of the mean 1.27, 95% CI 1.2–1.34, p<0.0001). Conclusions In conclusion, post-operative AF is common following CABG, and such patients continue to have higher rates of post-operative complications. Post-operative AF is significantly associated with increased length of stay following surgery.

The objective of this study was to assess the frequency of testicular microlithiasis (TM) in infertile men who underwent testicular ultrasound and to determine any causative or associated factors. The case notes of 159 consecutive patients who were referred for testicular ultrasound in the investigation of male factor infertility were reviewed. Microcalcification was found in 10 cases (6.2%). This was unilateral in all cases and six patients had clinical evidence of a varicocele. Five cases had minimal calcification and five had marked TM. On patient had a past history of testicular maldescent and another of testicular torsion. Sperm function (as assessed by sperm count, motility and the sperm migration test) was variable within the 10 patients and there was no correlation with hormone profiles or testicular size. There was a statistical difference between a number of investigations in those patients with minimal degrees of calcification and those with TM (sperm migration test (SMT), namely sperm migration and sperm motility (p < 0.05, Mann-Whitney U test)). The results showed a higher than expected incidence of TM. Patients with marked TM seemed to have poorer sperm function than those with minimal calcification. There was a high incidence of co-existing pathology, for instance scrotal varicocele and cryptorchidism, although the numbers in this study were small and further studies need to be carried out to determine the exact nature and significance of this condition.

Background Prior studies have demonstrated low utilization of primary prevention implantable cardioverter defibrillators (ICDs), particularly among women and blacks. The degree to which the overall use of ICD therapy and disparities in use have changed is unclear. Methods and Results We examined 11,880 unique patients with a history of heart failure (HF) and left ventricular ejection fraction (LVEF) ≤35% who are ≥ 65 years old and enrolled in the Get With The Guidelines-Heart Failure (GWTG-HF) program from January 2005 through December 2009. We determined the rate of ICD use by year for the overall population and for sex and race groups. From 2005–2007, overall ICD use increased from 30.2% to 42.4% and then remained unchanged in 2008–2009. Adjusting for potential confounders, ICD use increased significantly in the overall study population during 2005–2007 (odds ratio [OR] 1.28; 95% confidence interval [CI], 1.11, 1.48 per year; P=0.0008) and in black women (OR 1.82; 95% CI, 1.28, 2.58 per year; P=0.0008), white women (OR 1.30; 95% CI, 1.06, 1.59 per year; P=0.010), black men (OR 1.54; 95% CI, 1.19, 1.99 per year; P=0.0009), and white men (OR 1.25; 95% CI, 1.06, 1.48 per year; P=0.0072). The increase in ICD use was greatest among blacks. Conclusions In the GWTG-HF quality improvement program, a significant increase in ICD therapy use was observed over time in all sex and race groups. The previously described racial disparities in ICD use were no longer present by the end of the study period; however, sex differences persisted.