News in brief: Cardiac device data can explain sudden death; 5 childhood risk factors for adults CHD; More specialists are using My Health Record


Cardiac device data can explain sudden death

Data extracted from pacemakers, defibrillators, and implantable loop recorders after death can provide important information on cause of sudden or unexplained death and other issues such as device malfunction, according to Victorian forensic scientists.

In a study of cardiac implantable electronic devices (CIED) extracted at post portem from 260 patients, interrogation of the devices with an electronic tool was able to extract data in almost all cases and it contributed useful information in about half the cases.

Based on data analysis by a cardiologist or electrophysiologist, potential CIED malfunction was identified in 8% of cases, including untreated ventricular arrhythmias and lead failures. The data showed that 28% of patients had abnormalities recorded in 30 days preceding death, including nonsustained VT, rapid atrial fibrillation and elective replacement indicator or end-of-life status Device interrogation was also useful in determining the time of death in several case where the patient was found deceased after a prolonged period.

The findings are published in JACC Clinical Electrophysiology.


5 childhood risk factors for adults CHD

Five childhood risk factors that predict stroke and heart attacks in adulthood have been identified in what is claimed to be the world’s largest international prospective cardiovascular disease study.

The z-scores for BMI, blood pressure, cholesterol, triglycerides and youth smoking, particularly in combination in early childhood, were clinically linked with cardiovascular events, from as early as 40 years of age, according to a study published in the NEJM. The analysis involved 319 fatal cardiovascular events that occurred among 38,589 participants age 3-19 at baseline who were followed up for a period of 35-50 years.

Hazard ratios for a fatal cardiovascular event in adulthood ranged from 1.30 per unit increase in the z score for total cholesterol level to 1.61. The hazard ratio with respect to the childhood combined-risk z score was 3.54 per unit increase, showing the effect of multiple risk factors.

Senior study author Professor Terence Dwyer of the from the Murdoch Children Research Institute (MCRI) said increased risk scores for adult cardiovascular events were seen in over half the children studied, with some whose risk was nine times as much as those with below average risk factors.

“Despite the effect medical and surgical care has had on treating heart disease, the major impact will depend on effective preventive strategies. This study confirms that prevention should begin in childhood,” he said.

“This new evidence justified a greater emphasis on programs to prevent the development of these risk factors in children. Clinicians and public health professionals should now start to focus on how this might best be achieved.


More specialists are using My Health Record

Use of My Health Record by specialists has increased since it became accessible through clinical software in late 2021, according to the Australian Digital Health Agency.

Its latest figures for February 2022 show that 20% of specialists have registered for the MHR and 9% have used it. In comparison 95% of public hospitals and 98% of GPs have used the MHR. While the specialist usage levels are still low they increased by 17% in January 2022, the Agency says, and the number of documents uploaded by specialists and viewed by other healthcare providers increased by 23%.

Public hospital viewing of MHR had doubled in the last year, it noted.

The Agency said the increase likely reflects the increasing proportion of clinical software products that are compatible with the MHR and have the discharge summaries and reports for diagnostic imaging and pathology.

Ongoing funding for the Agency was confirmed in the 2022 Budget, which noted total expenditure of almost $380 million for 2021-2022. The Agency was given a target of increasing provider use of the MHR by 15% a year and a 20% increase in e-prescribing.

 

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