title: Location of death (in-hospital or out-of-hospital) and type of death (arrhythmic, nonarrhythmic, noncardiac) after inducible sustained ventricular tachyarrhythmias after syncope, sustained ventricular tachycardia, or nonfatal cardiac arrest (the ESVEM trial).
abstract: The ESVEM Trial evaluated methods to guide antiarrhythmic drug use in patients with spontaneous, inducible sustained tachyarrhythmias at electrophysiologic testing and frequent ventricular premature complexes (VPCs) per hour (>/=10). We assessed the relation between location (in-hospital or out-of-hospital) and classification of death (arrhythmic, nonarrhythmic, cardiac and/or noncardiac) for 486 randomized patients. Deaths were classified as out-of-hospital arrhythmic deaths if arrhythmic death occurred out-of-hospital, or if an arrhythmia preceded hospital admission and directly caused death. Of the 486 randomized patients, 188 (39%) died during 6 years of follow-up. The location and type of death could be determined clearly in 171 patients (91%). Ninety-one deaths were in-hospital (53%); 80 were out-of-hospital (47%). Arrhythmic deaths occurred in 85% out-of-hospital patients and in 30% in-hospital patients (p <0.001). Baseline characteristics were comparable for patients with out-of-hospital and in-hospital arrhythmic deaths. Twenty-seven of 95 arrhythmic deaths occurred in-hospital (28%); 72% occurred out-of-hospital. Out-of-hospital arrhythmic death accounted for 40% of deaths for which location and type of information were available. The 1- and 4-year actuarial out-of-hospital arrhythmic death rates were 9% and 18%, respectively. Of nonarrhythmic cardiac deaths, 91% were in-hospital and 9% were out-of-hospital. Of noncardiac deaths, 74% were in-hospital and 26% were out-of-hospital. Similar results were seen in the 296 patients for whom a drug was considered to be effective. Thus, over half the deaths in the ESVEM trial occurred in-hospital. The long-term actuarial risk of out-of-hospital arrhythmic death in ESVEM was unexpectedly low.
authors.affiliation: University of Iowa Hospitals, Iowa City, Iowa, USA. brian-olshansky@uiowa.edu
authors.forename: B
authors.initials: B
authors.lastname: Olshansky
authors.forename: V
authors.initials: V
authors.lastname: Hartz
authors.forename: E
authors.initials: E
authors.lastname: Hahn
authors.forename: J
authors.initials: J
authors.lastname: Mason
authors.forename: M D
authors.initials: MD
authors.lastname: Weaver
mesh_terms: D000206:Actuarial Analysis; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D002423:Cause of Death; D005260:Female; D006323:Heart Arrest / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D013575:Syncope / Q000401:mortality; D017180:Tachycardia, Ventricular / Q000188:drug therapy / Q000401:mortality*; D014481:United States / Q000453:epidemiology
chemical_list: D000889:Anti-Arrhythmia Agents