title: Predictors of on-duty coronary events in male firefighters in the United States.
abstract: Coronary heart disease (CHD) accounts for 39% of "on-duty" deaths in firefighters in the United States. No studies have examined the factors that distinguish fatal from nonfatal work-associated CHD events. Male firefighters experiencing on-duty CHD events were retrospectively investigated to identify cardiovascular risk factors predictive of case fatality; 87 fatalities (death within 24 hours of the event) were compared with 113 survivors who retired with disability pensions for heart disease after on-duty nonfatal events. Cardiovascular risk factors were then examined for associations with case fatality. Predictors of CHD death in multivariate analyses were a previous diagnosis of CHD (or peripheral/cerebrovascular disease) (odds ratio [OR] 4.09, 95% confidence intervals [CI] 1.58 to 10.58), current smoking (OR 3.68, 95% CI 1.61 to 8.45), and hypertension (OR 4.15, 95% CI 1.83 to 9.44). Age < or =45 years, diabetes mellitus, and serum cholesterol level were not significant predictors of case fatality. In conclusion, previous CHD, current smoking, and hypertension are strong predictors of fatality in male firefighters experiencing on-duty CHD events. Accordingly, prevention efforts should include early detection and control of hypertension, smoking cessation/prohibition, and the restriction of most firefighters with significant CHD from strenuous duties.
authors.affiliation: The Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA.
authors.forename: Jesse R
authors.initials: JR
authors.lastname: Geibe
authors.forename: Jonathan
authors.initials: J
authors.lastname: Holder
authors.forename: Lynne
authors.initials: L
authors.lastname: Peeples
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Kinney
authors.forename: John W
authors.initials: JW
authors.lastname: Burress
authors.forename: Stefanos N
authors.initials: SN
authors.lastname: Kales
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D016893:Carotid Stenosis / Q000150:complications / Q000453:epidemiology; D003327:Coronary Disease / Q000453:epidemiology*; D005390:Fires / Q000517:prevention & control*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications / Q000453:epidemiology; D009784:Occupational Diseases / Q000453:epidemiology*; D016491:Peripheral Vascular Diseases / Q000150:complications / Q000453:epidemiology; D018635:Rescue Work; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D014481:United States / Q000453:epidemiology