Circadian rhythm and sudden death in heart failure

Peter A. Carson, Christopher M. O'Connor, Alan B. Miller, Susan Anderson, Robert Belkin, Gerald W. Neuberg, John H. Wertheimer, David Frid, Anne Cropp, Milton Packer

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

Objective. The purpose of this study was to address the timing of sudden death in advanced heart failure patients. Background. Sudden death is a catastrophic event in cardiovascular disease. It has a circadian pattern prominent in the early AM, which has been thought to be due to a surge of sympathetic stimulation. We postulated that the distribution of events in advanced heart failure, with chronic sympathetic activation, would be more uniform implicating other potential mechanisms. Methods. We analyzed data from Prospective Randomized Amlodipine Survival Trial (PRAISE). Sudden deaths were analyzed by time of death in 4-h and 1-h blocks for uniformity of distribution in the entire cohort, and in the prespecified ischemic and nonischemic stratum. Further analyses were undertaken in the treatment groups of amlodipine and placebo, and among those receiving background therapy of aspirin and warfarin. Results. Sudden deaths in the overall cohort showed a nonuniform distribution with a PM peak but not an AM peak. The ischemic stratum also showed a PM peak, but sudden deaths within the nonischemic stratum were uniformly distributed. Neither amlodipine treatment nor aspirin or warfarin use altered the distribution. Conclusions. Sudden death in advanced heart failure did not show an AM peak, suggesting that circadian sympathetic activation did not strongly influence these events. The PM peak noted is likely complex in origin and was not affected by antiischemic or antithrombotic medications. (J Am Coll Cardiol 2000;36:541-6) (C) 2000 by the American College of Cardiology.

Original languageEnglish (US)
Pages (from-to)541-546
Number of pages6
JournalJournal of the American College of Cardiology
Volume36
Issue number2
DOIs
StatePublished - 2000

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Circadian Rhythm
Sudden Death
Heart Failure
Amlodipine
Warfarin
Aspirin
Cardiovascular Diseases
Therapeutics
Placebos
Survival

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Carson, P. A., O'Connor, C. M., Miller, A. B., Anderson, S., Belkin, R., Neuberg, G. W., ... Packer, M. (2000). Circadian rhythm and sudden death in heart failure. Journal of the American College of Cardiology, 36(2), 541-546. https://doi.org/10.1016/S0735-1097(00)00728-2

Circadian rhythm and sudden death in heart failure. / Carson, Peter A.; O'Connor, Christopher M.; Miller, Alan B.; Anderson, Susan; Belkin, Robert; Neuberg, Gerald W.; Wertheimer, John H.; Frid, David; Cropp, Anne; Packer, Milton.

In: Journal of the American College of Cardiology, Vol. 36, No. 2, 2000, p. 541-546.

Research output: Contribution to journalArticle

Carson, PA, O'Connor, CM, Miller, AB, Anderson, S, Belkin, R, Neuberg, GW, Wertheimer, JH, Frid, D, Cropp, A & Packer, M 2000, 'Circadian rhythm and sudden death in heart failure', Journal of the American College of Cardiology, vol. 36, no. 2, pp. 541-546. https://doi.org/10.1016/S0735-1097(00)00728-2
Carson PA, O'Connor CM, Miller AB, Anderson S, Belkin R, Neuberg GW et al. Circadian rhythm and sudden death in heart failure. Journal of the American College of Cardiology. 2000;36(2):541-546. https://doi.org/10.1016/S0735-1097(00)00728-2
Carson, Peter A. ; O'Connor, Christopher M. ; Miller, Alan B. ; Anderson, Susan ; Belkin, Robert ; Neuberg, Gerald W. ; Wertheimer, John H. ; Frid, David ; Cropp, Anne ; Packer, Milton. / Circadian rhythm and sudden death in heart failure. In: Journal of the American College of Cardiology. 2000 ; Vol. 36, No. 2. pp. 541-546.
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abstract = "Objective. The purpose of this study was to address the timing of sudden death in advanced heart failure patients. Background. Sudden death is a catastrophic event in cardiovascular disease. It has a circadian pattern prominent in the early AM, which has been thought to be due to a surge of sympathetic stimulation. We postulated that the distribution of events in advanced heart failure, with chronic sympathetic activation, would be more uniform implicating other potential mechanisms. Methods. We analyzed data from Prospective Randomized Amlodipine Survival Trial (PRAISE). Sudden deaths were analyzed by time of death in 4-h and 1-h blocks for uniformity of distribution in the entire cohort, and in the prespecified ischemic and nonischemic stratum. Further analyses were undertaken in the treatment groups of amlodipine and placebo, and among those receiving background therapy of aspirin and warfarin. Results. Sudden deaths in the overall cohort showed a nonuniform distribution with a PM peak but not an AM peak. The ischemic stratum also showed a PM peak, but sudden deaths within the nonischemic stratum were uniformly distributed. Neither amlodipine treatment nor aspirin or warfarin use altered the distribution. Conclusions. Sudden death in advanced heart failure did not show an AM peak, suggesting that circadian sympathetic activation did not strongly influence these events. The PM peak noted is likely complex in origin and was not affected by antiischemic or antithrombotic medications. (J Am Coll Cardiol 2000;36:541-6) (C) 2000 by the American College of Cardiology.",
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AB - Objective. The purpose of this study was to address the timing of sudden death in advanced heart failure patients. Background. Sudden death is a catastrophic event in cardiovascular disease. It has a circadian pattern prominent in the early AM, which has been thought to be due to a surge of sympathetic stimulation. We postulated that the distribution of events in advanced heart failure, with chronic sympathetic activation, would be more uniform implicating other potential mechanisms. Methods. We analyzed data from Prospective Randomized Amlodipine Survival Trial (PRAISE). Sudden deaths were analyzed by time of death in 4-h and 1-h blocks for uniformity of distribution in the entire cohort, and in the prespecified ischemic and nonischemic stratum. Further analyses were undertaken in the treatment groups of amlodipine and placebo, and among those receiving background therapy of aspirin and warfarin. Results. Sudden deaths in the overall cohort showed a nonuniform distribution with a PM peak but not an AM peak. The ischemic stratum also showed a PM peak, but sudden deaths within the nonischemic stratum were uniformly distributed. Neither amlodipine treatment nor aspirin or warfarin use altered the distribution. Conclusions. Sudden death in advanced heart failure did not show an AM peak, suggesting that circadian sympathetic activation did not strongly influence these events. The PM peak noted is likely complex in origin and was not affected by antiischemic or antithrombotic medications. (J Am Coll Cardiol 2000;36:541-6) (C) 2000 by the American College of Cardiology.

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