Circadian Rhythms in Sudden Cardiac Arrest

A Review

Tran, Dieu-My T.; St. Pierre Schneider, Barbara; McGinnis, Graham R.

Dieu-My T. Tran, PhD, RN, CNE, is Assistant Professor, School of Nursing, University of Nevada, Las Vegas.

Barbara St. Pierre Schneider, PhD, RN, FAAN, is Professor, School of Nursing, University of Nevada, Las Vegas.

Graham R. McGinnis, PhD, is Assistant Professor, Department of Kinesiology and Nutrition Sciences, School of Integrated Health Sciences, University of Nevada, Las Vegas.

Accepted for publication January 23, 2021.

Institutional review board was not sought as this is a review.

The authors have no conflicts of interest to report

Corresponding author: Graham Ripley McGinnis, PhD, University of Nevada, Las Vegas, 4505 S. Maryland Pkwy, Box 453034 Las Vegas, NV 89154-3034 (e-mail[email protected]).

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.nursingresearchonline.com).

Nursing Research70(4):p 298-309, 7/8 2021. |DOI:10.1097/NNR.0000000000000512

Abstract

Background

Sudden cardiac arrest (SCA) is a serious public health issue caused by the cessation of cardiac electrical and mechanical activity. Despite advances in pedestrian lifesaving technologies like defibrillators, the SCA mortality rate remains high, and survivors are at risk of suffering ischemic injury to various organs. Understanding the contributing factors for SCA is essential for improving morbidity and mortality. One factor capable of influencing SCA incidence and survival is the time of day at which SCA occurs.

Objectives

This review focused on the effect of time of day on SCA incidence, survival rate, and survival to discharge over the past 30 years and the role of age, sex, and SCA location in modulating the timing of SCA.

Methods

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews criteria guided this review. Four databases (PubMed, Cochrane Libraries, Scopus, and Cumulative Index to Nursing and Allied Health Literature) were queried for research reports or articles addressing time of day and cardiac arrest, which were subsequently screened by the authors for inclusion in this analysis.

Results

A total of 48 articles were included in the final analysis. This analysis showed a bimodal SCA distribution with a primary peak in the morning and a secondary peak in the afternoon; these peaks were dependent on age (older persons), sex (more frequent in males), and the location of occurrence (out-of-hospital cardiac arrest vs. in-hospital cardiac rest). Survival following SCA was lowest between midnight and 06:00 a.m.

Discussion

The circadian rhythm likely plays an important role in the time-of-day-dependent pattern that is evident in both the incidence of and survival following SCA. There is a renewed call for nursing research to examine or address circadian rhythm as an element in studies involving older adults and activities affecting cardiovascular or respiratory parameters.