在职职业消防员中心血管死亡的临床和心电图危险因素的患病率
The Prevalence of Clinical and Electrocardiographic Risk Factors of Cardiovascular Death Among On-duty Professional Firefighters.
作者信息
Al-Zaiti Salah S, Carey Mary G
机构信息
Salah S. Al-Zaiti, PhD, RN, CRNP Assistant Professor, School of Nursing, University of Pittsburgh, Pennsylvania. Mary G. Carey, PhD, RN, CNS, FAHA Associate Director, Clinical Nursing Research Center, Strong Memorial Hospital, and Associate Professor, School of Nursing, University of Rochester Medical Center, New York.
出版信息
J Cardiovasc Nurs. 2015 Sep-Oct;30(5):440-6. doi: 10.1097/JCN.0000000000000165.
BACKGROUND
Firefighters have twice as many cardiovascular deaths as police officers and 4 times as many as emergency medical responders. The etiology for this high rate of mortality remains unknown. The electrocardiogram (ECG) is a widely used tool to screen populations at risk, yet there are no available on-duty, high-resolution ECG recordings from firefighters.
OBJECTIVE
We sought to evaluate the prevalence of clinical and ECG risk factors among on-duty professional firefighters during 12-lead ECG holter monitoring and exercise stress testing.
METHODS
Firefighters were recruited from Surveying & Assessing Firefighters Fitness & Electrocardiogram (SAFFE) study. This descriptive study recruited firefighters from 7 firehouses across Upstate New York who completed on-duty 24-hour Holter ECG monitoring and a standard exercise stress test. All analyses were completed by a reviewer blinded to all clinical data.
RESULTS
A total of 112 firefighters (mean [SD] age, 44 [8] years; mostly white men) completed the study. Although all firefighters were in normal sinus rhythm, more than half of them had at least 1 high-risk ECG risk factor present, including abnormal sympathetic tone (elevated heart rate, 54%), abnormal repolarization (wide QRS-T angle, 25%), myocardial scarring (fragmented QRS, 24%), and myocardial ischemia (ST depression, 24%). Most firefighters tolerated the treadmill exercise stress test well (metabolic equivalent tasks, 11.8 + 2.5]); however, almost one-third had abnormal results of stress tests that required further evaluation to rule out subclinical coronary artery disease.
CONCLUSIONS
Among on-duty professional firefighters, high-risk ECG markers of fatal cardiac events and abnormal stress test results that warrant further evaluation are prevalent. Annual physical checkups with routine 12-lead ECG can identify those who might benefit from preventive cardiovascular services.
背景
消防员的心血管疾病死亡人数是警察的两倍，是急救人员的四倍。这种高死亡率的病因尚不清楚。心电图（ECG）是一种广泛用于筛查高危人群的工具，但目前尚无消防员在执勤时的高分辨率心电图记录。
目的
我们试图评估在职专业消防员在12导联心电图动态监测和运动负荷试验期间临床和心电图危险因素的患病率。
方法
消防员来自“测量与评估消防员健康与心电图”（SAFFE）研究。这项描述性研究招募了纽约州北部7个消防站的消防员，他们完成了24小时的执勤动态心电图监测和标准运动负荷试验。所有分析均由对所有临床数据不知情的审阅者完成。
结果
共有112名消防员（平均[标准差]年龄，44[8]岁；大多数为白人男性）完成了研究。尽管所有消防员均为正常窦性心律，但其中一半以上至少存在1种高危心电图危险因素，包括异常交感神经张力（心率升高，54%）、复极异常（QRS-T波宽大，25%）、心肌瘢痕（碎裂QRS波，24%）和心肌缺血（ST段压低，24%）。大多数消防员能很好地耐受跑步机运动负荷试验（代谢当量任务，11.8 + 2.5]）；然而，近三分之一的消防员运动试验结果异常，需要进一步评估以排除亚临床冠状动脉疾病。
结论
在职专业消防员中，致命心脏事件的高危心电图标志物和需要进一步评估的异常运动试验结果很普遍。每年进行常规12导联心电图体检可以识别那些可能从预防性心血管服务中受益的人。
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