Associations of Clinical Characteristics With Sudden Cardiac Arrest in People With Type 2 Diabetes With and Without Cardiovascular Disease: A Longitudinal Case-Control Study Using Routine Primary Care Data

RESCUED Investigators

doi:10.2337/dc24-0715

Associations of Clinical Characteristics With Sudden Cardiac Arrest in People With Type 2 Diabetes With and Without Cardiovascular Disease: A Longitudinal Case-Control Study Using Routine Primary Care Data

RESCUED Investigators

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Abstract

OBJECTIVE To assess longitudinal associations with sudden cardiac arrest (SCA) of clinical characteristics recorded in primary care in people with type 2 diabetes (T2D), both with and without cardiovascular disease (CVD).

RESEARCH DESIGN AND METHODS We performed a case-control study, with SCA case subjects with T2D from the Amsterdam Resuscitation Studies (ARREST) registry of out-of-hospital resuscitation at-tempts in the Dutch Noord-Holland region (2010–2020) and up to five matched (age, sex, T2D, general practitioner [GP] practice) non-SCA control subjects. We col-lected relevant clinical measurements, medication use, and medical history from GPs’ electronic health care records. We analyzed the associations of clinical characteristics and medication use with SCA in the total sample and in subgroups with or without CVD using multivariable time-dependent Cox regression (hazard ratios, 95% confidence intervals).

RESULTS We included 689 SCA case subjects and 3,230 non-SCA control subjects. In multivariable models, low fasting glucose (<4.5 mmol/mol: 1.91 [1.00–3.64]), antihypertensive (1.80 [1.39–2.33]), glucose lowering (oral only: 1.32 [1.06–1.63]; insulin only: 2.31 [1.71–3.12]; oral and insulin: 1.64 [1.21–2.22]), heart failure (1.91 [1.55–2.35]), and QTc-prolonging prokinetic (1.78 [1.27–2.50]), antibiotic (1.35 [1.05–1.73]), and antipsychotic (2.10 [1.42–3.09]) medication were associated with SCA in the total sample. In subgroup effect modification analyses, QTc-prolonging antibiotic (1.82 [1.26–2.63]) and antipsychotic (3.10 [2.09–4.59]) medication use were associated with SCA only in those without CVD.

CONCLUSIONS In people with T2D, low fasting glucose and QTc-prolonging prokinetic, antibiotic, or antipsychotic medication use and a history of heart failure are associated with SCA risk. Subgroup analyses indicate antibiotic and antipsychotic medication use increases SCA risk specifically in those without CVD.

Original language	English
Pages (from-to)	125-135
Number of pages	11
Journal	Diabetes care
Volume	48
Issue number	1
Early online date	18 Nov 2024
DOIs	https://doi.org/10.2337/dc24-0715
Publication status	Published - Jan 2025

Bibliographical note

Publisher Copyright:
© 2024 by the American Diabetes Association.

Funding

This work was supported with funding by Dutch Heart Foundation grant CVON2017-15 RESCUED, the European Union’s Horizon 2020 research and innovation program under acronym European Sudden Cardiac Arrest Network: To-wards Prevention, Education, New Effective Treatment (ESCAPE-NET) (registered under grant agreement no. 733381), COST Action PARC under grant agreement no. CA19137 supported by COST (European Cooperation in Science and Technology), and Amsterdam University Medical Centers. The ARREST registry is supported by an unconditional grant of Stryker, Emergency Care, Redmond, WA. The study funders were not involved in the design of the study; the collection, analysis, and interpretation of data; or writing the report. made possible by collaboration with the ARREST study, STIZON, ZorgTTP Foundation, the PHARMO Institute, and ANHA. The authors thank participants of the ARREST study as well as the collaboration partners. From ARREST: the authors thank C.M. de Haas, V. van Eeden, R. Stieglis, and L.A.E. Bijman, Department of Clinical and Experimental Cardiology, University of Amsterdam, Amsterdam, the Netherlands, for data management and R.W. Koster, Department of Clinical and Experimental Cardiology, University of Amsterdam, Amsterdam, the Netherlands, for management of the ARREST project. Moreover, the authors are greatly thankful for all the students for collecting data, and for the participation of all EMS dispatch centers (Amsterdam, Haarlem, Alk-maar), regional ambulance services (Ambulance Amsterdam, GGD Kennemerland, Witte Kruis, Ambulancezorg Veiligheidsregio Noord-Holland Noord), fire brigades, and police departments, as well as general practitioners and hospitals in the study region. From STIZON and ZorgTTP: the authors thank all involved staff for judiciously linking the ARREST participants with their GP electronic health care records. From the PHARMO Institute and ANHA: the authors thank everybody involved in building, managing, and maintaining these databases. Special thanks go to Hanna H.K. Joosten and Pauline Slottje, Department of General Practice Medicine, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands, from ANHA for their assistance with the (privacy legislation related) practicalities of data amalgamation, development of the algorithm used for the matching of case subjects and control subjects, and assembly of the raw ANHA data sets used for this study. Funding. This work was supported with funding by Dutch Heart Foundation grant CVON2017-15 RESCUED, the European Union’s Horizon 2020 research and innovation program under acronym European Sudden Cardiac Arrest Network: Towards Prevention, Education, New Effective Treatment (ESCAPE-NET) (registered under grant agreement no. 733381), COST Action PARC under grant agreement no. CA19137 supported by COST (European Cooperation in Science and Technology), and Amsterdam University Medical Centers. The ARREST registry is supported by an unconditional grant of Stryker, Emergency Care, Redmond, WA.

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Associations of Clinical Characteristics With Sudden Cardiac Arrest in People With Type 2 Diabetes With and Without Cardiovascular Disease A Longitudinal Case-Control Study Using Routine Primary Care DataFinal published version, 659 KBLicence: Article 25fa Dutch Copyright Act

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@article{d3dd25f97715469a852a2a531d159f15,

title = "Associations of Clinical Characteristics With Sudden Cardiac Arrest in People With Type 2 Diabetes With and Without Cardiovascular Disease: A Longitudinal Case-Control Study Using Routine Primary Care Data",

abstract = "OBJECTIVE To assess longitudinal associations with sudden cardiac arrest (SCA) of clinical characteristics recorded in primary care in people with type 2 diabetes (T2D), both with and without cardiovascular disease (CVD).RESEARCH DESIGN AND METHODS We performed a case-control study, with SCA case subjects with T2D from the Amsterdam Resuscitation Studies (ARREST) registry of out-of-hospital resuscitation at-tempts in the Dutch Noord-Holland region (2010–2020) and up to five matched (age, sex, T2D, general practitioner [GP] practice) non-SCA control subjects. We col-lected relevant clinical measurements, medication use, and medical history from GPs{\textquoteright} electronic health care records. We analyzed the associations of clinical characteristics and medication use with SCA in the total sample and in subgroups with or without CVD using multivariable time-dependent Cox regression (hazard ratios, 95\% confidence intervals).RESULTS We included 689 SCA case subjects and 3,230 non-SCA control subjects. In multivariable models, low fasting glucose (<4.5 mmol/mol: 1.91 [1.00–3.64]), antihypertensive (1.80 [1.39–2.33]), glucose lowering (oral only: 1.32 [1.06–1.63]; insulin only: 2.31 [1.71–3.12]; oral and insulin: 1.64 [1.21–2.22]), heart failure (1.91 [1.55–2.35]), and QTc-prolonging prokinetic (1.78 [1.27–2.50]), antibiotic (1.35 [1.05–1.73]), and antipsychotic (2.10 [1.42–3.09]) medication were associated with SCA in the total sample. In subgroup effect modification analyses, QTc-prolonging antibiotic (1.82 [1.26–2.63]) and antipsychotic (3.10 [2.09–4.59]) medication use were associated with SCA only in those without CVD.CONCLUSIONS In people with T2D, low fasting glucose and QTc-prolonging prokinetic, antibiotic, or antipsychotic medication use and a history of heart failure are associated with SCA risk. Subgroup analyses indicate antibiotic and antipsychotic medication use increases SCA risk specifically in those without CVD.",

author = "Harms, \{Peter P.\} and \{van Dongen\}, \{Laura H.\} and Frank Bennis and Swart, \{Karin M.A.\} and Mark Hoogendoorn and Beulens, \{Joline W.J.\} and Tan, \{Hanno L.\} and Elders, \{Petra P.J.M.\} and Blom, \{Marieke T.\} and \{RESCUED Investigators\}",

note = "Publisher Copyright: {\textcopyright} 2024 by the American Diabetes Association.",

year = "2025",

month = jan,

doi = "10.2337/dc24-0715",

language = "English",

volume = "48",

pages = "125--135",

journal = "Diabetes care",

issn = "0149-5992",

publisher = "American Diabetes Association Inc.",

number = "1",

}

TY - JOUR

T1 - Associations of Clinical Characteristics With Sudden Cardiac Arrest in People With Type 2 Diabetes With and Without Cardiovascular Disease

T2 - A Longitudinal Case-Control Study Using Routine Primary Care Data

AU - Harms, Peter P.

AU - van Dongen, Laura H.

AU - Bennis, Frank

AU - Swart, Karin M.A.

AU - Hoogendoorn, Mark

AU - Beulens, Joline W.J.

AU - Tan, Hanno L.

AU - Elders, Petra P.J.M.

AU - Blom, Marieke T.

AU - RESCUED Investigators

PY - 2025/1

Y1 - 2025/1

N2 - OBJECTIVE To assess longitudinal associations with sudden cardiac arrest (SCA) of clinical characteristics recorded in primary care in people with type 2 diabetes (T2D), both with and without cardiovascular disease (CVD).RESEARCH DESIGN AND METHODS We performed a case-control study, with SCA case subjects with T2D from the Amsterdam Resuscitation Studies (ARREST) registry of out-of-hospital resuscitation at-tempts in the Dutch Noord-Holland region (2010–2020) and up to five matched (age, sex, T2D, general practitioner [GP] practice) non-SCA control subjects. We col-lected relevant clinical measurements, medication use, and medical history from GPs’ electronic health care records. We analyzed the associations of clinical characteristics and medication use with SCA in the total sample and in subgroups with or without CVD using multivariable time-dependent Cox regression (hazard ratios, 95% confidence intervals).RESULTS We included 689 SCA case subjects and 3,230 non-SCA control subjects. In multivariable models, low fasting glucose (<4.5 mmol/mol: 1.91 [1.00–3.64]), antihypertensive (1.80 [1.39–2.33]), glucose lowering (oral only: 1.32 [1.06–1.63]; insulin only: 2.31 [1.71–3.12]; oral and insulin: 1.64 [1.21–2.22]), heart failure (1.91 [1.55–2.35]), and QTc-prolonging prokinetic (1.78 [1.27–2.50]), antibiotic (1.35 [1.05–1.73]), and antipsychotic (2.10 [1.42–3.09]) medication were associated with SCA in the total sample. In subgroup effect modification analyses, QTc-prolonging antibiotic (1.82 [1.26–2.63]) and antipsychotic (3.10 [2.09–4.59]) medication use were associated with SCA only in those without CVD.CONCLUSIONS In people with T2D, low fasting glucose and QTc-prolonging prokinetic, antibiotic, or antipsychotic medication use and a history of heart failure are associated with SCA risk. Subgroup analyses indicate antibiotic and antipsychotic medication use increases SCA risk specifically in those without CVD.

AB - OBJECTIVE To assess longitudinal associations with sudden cardiac arrest (SCA) of clinical characteristics recorded in primary care in people with type 2 diabetes (T2D), both with and without cardiovascular disease (CVD).RESEARCH DESIGN AND METHODS We performed a case-control study, with SCA case subjects with T2D from the Amsterdam Resuscitation Studies (ARREST) registry of out-of-hospital resuscitation at-tempts in the Dutch Noord-Holland region (2010–2020) and up to five matched (age, sex, T2D, general practitioner [GP] practice) non-SCA control subjects. We col-lected relevant clinical measurements, medication use, and medical history from GPs’ electronic health care records. We analyzed the associations of clinical characteristics and medication use with SCA in the total sample and in subgroups with or without CVD using multivariable time-dependent Cox regression (hazard ratios, 95% confidence intervals).RESULTS We included 689 SCA case subjects and 3,230 non-SCA control subjects. In multivariable models, low fasting glucose (<4.5 mmol/mol: 1.91 [1.00–3.64]), antihypertensive (1.80 [1.39–2.33]), glucose lowering (oral only: 1.32 [1.06–1.63]; insulin only: 2.31 [1.71–3.12]; oral and insulin: 1.64 [1.21–2.22]), heart failure (1.91 [1.55–2.35]), and QTc-prolonging prokinetic (1.78 [1.27–2.50]), antibiotic (1.35 [1.05–1.73]), and antipsychotic (2.10 [1.42–3.09]) medication were associated with SCA in the total sample. In subgroup effect modification analyses, QTc-prolonging antibiotic (1.82 [1.26–2.63]) and antipsychotic (3.10 [2.09–4.59]) medication use were associated with SCA only in those without CVD.CONCLUSIONS In people with T2D, low fasting glucose and QTc-prolonging prokinetic, antibiotic, or antipsychotic medication use and a history of heart failure are associated with SCA risk. Subgroup analyses indicate antibiotic and antipsychotic medication use increases SCA risk specifically in those without CVD.

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UR - https://www.scopus.com/pages/publications/85213596824#tab=citedBy

U2 - 10.2337/dc24-0715

DO - 10.2337/dc24-0715

M3 - Article

C2 - 39556475

AN - SCOPUS:85213596824

SN - 0149-5992

VL - 48

SP - 125

EP - 135

JO - Diabetes care

JF - Diabetes care

IS - 1

ER -

Associations of Clinical Characteristics With Sudden Cardiac Arrest in People With Type 2 Diabetes With and Without Cardiovascular Disease: A Longitudinal Case-Control Study Using Routine Primary Care Data

Abstract

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