Metamorphosis: The natural history of coronary heart disease. Sudden death is common. Unexpected death is not
Section snippets
Patients and methods
This was a retrospective study of all patients who were known to have died from the commencement of practice in April 1978 till 31st of December 2003. All the patients had been followed regularly from their presentation until their death. The details of the practice have been described previously [2], [3]. Many patients were referred by general practitioners; others had survived hospitalisation for acute cardiac events; few were referred by other physician/cardiologists. Patients were offered
Results
This is a study of 248 patients, 199 (80%) of them men and 49 (20%) of them women.
Discussion
The major finding of this retrospective study was that unexpected death, or unexpected cardiac death was uncommon. Most of the deaths occurred in patients who were in CHF at the outset or who clinically deteriorated whilst under clinical observation. Thus, the occurrence of death, if not the timing of the death, was not unexpected. Unless it can be shown that routine revascularisation of stable patients with CHD can prevent the clinical deterioration which we have called metamorphosis,
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Natural history of coronary heart disease and heart disease of uncertain etiology: Findings from a 50-year population study
2015, International Journal of CardiologyCitation Excerpt :In comparison with relatively few population-based investigations where the quasi-extinction of the originally enrolled cohort was observed [1–8] the natural history of lifetime incident coronary and non-coronary heart diseases was even more rarely addressed giving preference to predictive analyses [1–14] and none were performed in Italy. Overall the literature offers scanty contributions to description of natural history in population studies, frequently limited to short follow-up periods [34], or based on highly selected groups of patients [35]. Due to the half a century-long follow-up, our investigation was started in a much different epoch as compared to nowadays, under health perspectives whose impact is in no way comparable to the expected one from now on.
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