The 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
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-cases with T2D from the AmsteRdam REsuscitation STtudies (ARREST) registry of out-of-hospital resuscitation attempts in the Dutch Noord-Holland region (2010-2020) and up to five matched (age, sex, T2D, General Practitioner (GP) practice) non-SCA-controls. We collected 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-cases and 3,230 non-SCA-controls. In multivariable models, low fasting glucose (<4.5mmol/mol: 1.91 (1.00-3.64), anti-hypertensive (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 & 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), anti-psychotic 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 anti-psychotic (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 anti-psychotic medication use and a history of heart failure are associated with SCA-risk. Subgroup analyses indicate antibiotic and anti-psychotic medication use increases SCA-risk specifically in those without CVD.
