{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T22:22:46Z","timestamp":1793398966342,"version":"4.5.0"},"reference-count":45,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"18","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2018,9,18]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Sudden cardiac death accounts for the greatest proportion of duty\u2010related deaths among US firefighters. Increased understanding of the pathoanatomic causes of sudden cardiac death and the risk associated with underlying cardiac pathologies is needed to develop evidence\u2010based screening recommendations.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Using autopsy data for duty\u2010related firefighter fatalities occurring between 1999 and 2014, this retrospective case\u2013control study compared cardiac findings of male firefighters aged 18 to 65\u00a0years who died on duty of cardiac\u2010related causes with those who died of noncardiac trauma\u2010related causes. Data from 276 cardiac cases and 351 noncardiac trauma controls were analyzed. Among cardiac cases, the most prevalent (82%) underlying pathoanatomic substrate was comorbid coronary heart disease and cardiomegaly\/left ventricular hypertrophy. Cardiac cases had a higher prevalence of cardiomegaly (heart weight &gt;450\u00a0g), left ventricular hypertrophy (left ventricular wall thickness \u22651.2\u00a0cm), and severe coronary artery stenosis (\u226575%) than trauma controls (all\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). In multivariate analyses, heart weight &gt;450\u00a0g, coronary artery stenosis \u226575%, and evidence of a prior myocardial infarction were strong independent predictors of cardiac death, with odds ratios of 6.1 (95% confidence interval, 3.6\u201310.4), 9.3 (95% confidence interval, 5.3\u201316.1), and 6.2 (95% confidence interval, 3.4\u201311.3), respectively.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">The majority of cardiac fatalities had evidence of both coronary heart disease and increased heart mass, and each condition was independently associated with a markedly elevated risk of cardiac death. Targeted screening for coronary heart disease, increased heart mass, and evidence of prior myocardial infarction should be considered to reduce duty\u2010related cardiac deaths among firefighters.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.118.009446","type":"journal-article","created":{"date-parts":[[2018,9,16]],"date-time":"2018-09-16T15:02:17Z","timestamp":1537110137000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":48,"title":["Pathoanatomic Findings Associated With Duty\u2010Related Cardiac Death in US Firefighters: A Case\u2013Control Study"],"prefix":"10.1161","volume":"7","author":[{"given":"Denise L.","family":"Smith","sequence":"first","affiliation":[{"name":"Department of Health and Human Physiological Sciences Skidmore College Saratoga Springs NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeannie M.","family":"Haller","sequence":"additional","affiliation":[{"name":"Department of Health and Human Physiological Sciences Skidmore College Saratoga Springs NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Korre","sequence":"additional","affiliation":[{"name":"Environmental and Occupational Medicine and Epidemiology Program Department of Environmental Health Harvard T.H. Chan School of Public Health Boston MA"},{"name":"Cambridge Health Alliance Harvard Medical School Cambridge MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia C.","family":"Fehling","sequence":"additional","affiliation":[{"name":"Department of Health and Human Physiological Sciences Skidmore College Saratoga Springs NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantina","family":"Sampani","sequence":"additional","affiliation":[{"name":"Environmental and Occupational Medicine and Epidemiology Program Department of Environmental Health Harvard T.H. Chan School of Public Health Boston MA"},{"name":"Beetham Eye Institute Joslin Diabetes Center Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luiz Guilherme","family":"Grossi Porto","sequence":"additional","affiliation":[{"name":"Environmental and Occupational Medicine and Epidemiology Program Department of Environmental Health Harvard T.H. Chan School of Public Health Boston MA"},{"name":"Faculty of Physical Education and Cardiovascular Laboratory of the Faculty of Medicine University of Brasilia Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Costas A.","family":"Christophi","sequence":"additional","affiliation":[{"name":"Environmental and Occupational Medicine and Epidemiology Program Department of Environmental Health Harvard T.H. Chan School of Public Health Boston MA"},{"name":"Cyprus International Institute for Environmental and Public Health Cyprus University of Technology Limassol Cyprus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefanos N.","family":"Kales","sequence":"additional","affiliation":[{"name":"Environmental and Occupational Medicine and Epidemiology Program Department of Environmental Health Harvard T.H. Chan School of Public Health Boston MA"},{"name":"Cambridge Health Alliance Harvard Medical School Cambridge MA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","volume-title":"Firefighter Fatalities in the United States\u20142016","author":"Fahy RF","year":"2017","unstructured":"Fahy RF, LeBlanc PR, Molis JL. Firefighter Fatalities in the United States\u20142016. Quincy, MA: National Fire Protection Association; 2017."},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.111.023838"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9149(97)00477-3"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.98.21.2334"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2007.10.017"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1186\/1476-069X-2-14"},{"key":"e_1_3_2_8_2","first-page":"I11","article-title":"Long\u2010 and short\u2010term risk of sudden coronary death","volume":"85","author":"Cupples LA","year":"1992","unstructured":"Cupples LA, Gagnon DR, Kannel WB. Long\u2010 and short\u2010term risk of sudden coronary death. Circulation. 1992;85:I11\u2013I18.","journal-title":"Circulation"},{"key":"e_1_3_2_9_2","first-page":"175","article-title":"Cardiac ischemia and cardiac hypertrophy. An autopsy study","volume":"104","author":"Dean JH","year":"1980","unstructured":"Dean JH, Gallagher PJ. Cardiac ischemia and cardiac hypertrophy. An autopsy study. Arch Pathol Lab Med. 1980;104:175\u2013178.","journal-title":"Arch Pathol Lab Med"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0733-8651(18)30187-5"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.94.12.3138"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1097\/PAT.0b013e3283513f54"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2013.08.029"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2016.08.058"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(98)00407-0"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2011.02.037"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1093\/occmed\/kqu102"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa060357"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.45.1.88"},{"key":"e_1_3_2_20_2","first-page":"I19","article-title":"Anatomic features in victims of sudden coronary death. Coronary artery pathology","volume":"85","author":"Davies MJ","year":"1992","unstructured":"Davies MJ. Anatomic features in victims of sudden coronary death. Coronary artery pathology. Circulation. 1992;85:I19\u2013I24.","journal-title":"Circulation"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0046-8177(87)80033-3"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehs411"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.116.304521"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra000650"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.92.7.1701"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.49.5.790"},{"key":"e_1_3_2_27_2","first-page":"III27","article-title":"Arteriosclerosis of coronary arteries in sudden, unexpected deaths","volume":"52","author":"Perper JA","year":"1975","unstructured":"Perper JA, Kuller LH, Cooper M. Arteriosclerosis of coronary arteries in sudden, unexpected deaths. Circulation. 1975;52:III27\u2013III33.","journal-title":"Circulation"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(84)90305-9"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.4172\/2155-9880.1000459"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(10)80135-4"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2014.07.015"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1053\/eupc.2000.0110"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.117.027018"},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.1186\/2046-7648-2-6"},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.1249\/JES.0000000000000081"},{"key":"e_1_3_2_36_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.116.025711"},{"key":"e_1_3_2_37_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(90)90807-D"},{"key":"e_1_3_2_38_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.110.968776"},{"key":"e_1_3_2_39_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(76)90427-6"},{"key":"e_1_3_2_40_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jelectrocard.2014.07.003"},{"key":"e_1_3_2_41_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0895-7061(03)01018-5"},{"key":"e_1_3_2_42_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.106.666594"},{"key":"e_1_3_2_43_2","doi-asserted-by":"publisher","DOI":"10.1097\/JOM.0b013e31822c9e47"},{"key":"e_1_3_2_44_2","doi-asserted-by":"publisher","DOI":"10.1249\/MSS.0b013e318215cf25"},{"key":"e_1_3_2_45_2","doi-asserted-by":"publisher","DOI":"10.1097\/JOM.0b013e31820af362"},{"key":"e_1_3_2_46_2","doi-asserted-by":"publisher","DOI":"10.1093\/occmed\/kqu040"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.118.009446","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T11:20:54Z","timestamp":1715599254000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.118.009446"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,9,18]]},"references-count":45,"journal-issue":{"issue":"18","published-print":{"date-parts":[[2018,9,18]]}},"alternative-id":["10.1161\/JAHA.118.009446"],"URL":"https:\/\/doi.org\/10.1161\/jaha.118.009446","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,9,18]]},"assertion":[{"value":"2018-04-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-07-12","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-09-05","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e009446"}}