Sudden Cardiac Death SymposiumEpidemiology of Sudden Cardiac Death: Clinical and Research Implications
Section snippets
Definition and Current Burden of Sudden Cardiac Death in the Community
The first stage in the process of confronting any community-wide disease condition is the definition of the problem. In essence, the individual we would like to identify is one who has a sudden, unexpected pulseless condition of cardiac etiology. Most of these patients are going to have a sudden arrhythmic death. For several reasons, assessment of sudden cardiac death has been difficult to accomplish, the first of which being that the condition is a dynamic event that occurs in the general
Age and Sex Trends
There are 2 well-established peaks in the age-related prevalence of sudden cardiac death, one during infancy representing the sudden infant death syndrome and the second in the geriatric age group, between ages 75 and 85 years. These trends continue to persist (Fig 2, Fig 3). However, the sex-related trends appear to have shifted, with an increase in the proportion of females who have sudden cardiac death. Earlier studies had reported a 25:75 ratio of females to males. The Oregon experience
Spectrum of Etiologies of Sudden Cardiac Death
The most common clinical finding associated with sudden cardiac death is coronary artery disease (Fig 4) and approximately 80% of sudden cardiac deaths are attributed to this disease condition.5, 8, 21, 22 Based on prevaling knowledge of the natural history of coronary artery disease, there are 2 major mechanisms of fatal ventricular arrhythmias. Acute coronary ischemia usually associated with plaque rupture and occlusion of one or more major coronary arteries is more likely to result in
Presenting Arrhythmia in Patients Who Suffer Sudden Cardiac Arrest: Altered Trends
Despite the spectrum of etiologic conditions, in the overwhelming majority of cases, sudden cardiac death results from a fatal cardiac arrhythmia, either ventricular tachycardia/fibrillation or severe bradycardia/pulseless electrical activity.27, 28 In the last 2 decades, there have been important alterations in the prevalence trends of each of these presenting arrhythmias. Early studies reported that ventricular fibrillation (VF) was the initial rhythm in most sudden cardiac death cases; 75%
Findings From Population-Based Studies
There are important reasons to make a distinction between subjects who experience sudden cardiac arrest after having previously identified heart disease vs those that do not have previously identified heart disease. Among the latter group, there are many who may have never had symptoms suggestive of heart disease or were not evaluated for other reasons, such as disparate access to health care. Recent observations such as the recently reported Home Automated External Defibrillation trial37 have
Clinical and Research Implications
The current annual incidence of sudden cardiac death in the United States is likely to be in the range of 180 000 to 250 000 per year. An estimate for global annual incidence of sudden cardiac death would be in the range of 4 to 5 million cases per year. Coinciding with the decreased mortality from coronary artery disease, there is evidence pointing toward a significant decrease in rates of sudden cardiac death in the United States during the second half of the 20th century. This has likely
Acknowledgments
This work was funded by grant R01HL088416 from the National Heart Lung and Blood Institute (Bethesda, Maryland) and a Hopkins-Reynolds Clinical Cardiovascular Research Center Grant (Las Vegas, Nevada) to Dr Sumeet S. Chugh.
References (95)
- et al.
Alternative projections of mortality and disability by cause 1990-2020: Global Burden of Disease Study
Lancet
(1997) - et al.
Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study
Lancet
(1997) - et al.
Mortality by cause for eight regions of the world: Global Burden of Disease Study
Lancet
(1997) - et al.
Coronary artery disease in the developing world
Am Heart J
(2004) - et al.
Current burden of sudden cardiac death: Multiple source surveillance versus retrospective death certificate–based review in a large U.S. community
J Am Coll Cardiol
(2004) - et al.
One-year survival after prehospital cardiac arrest: the Utstein style applied to a rural-suburban system
Am J Emerg Med
(1994) - et al.
Out-of-hospital cardiac arrest in the 1990's: a population-based study in the Maastricht area on incidence, characteristics and survival
J Am Coll Cardiol
(1997) - et al.
Population-based analysis of sudden cardiac death with and without left ventricular systolic dysfunction: two-year findings from the Oregon Sudden Unexpected Death Study
J Am Coll Cardiol
(2006) - et al.
Cardiological assessment of first-degree relatives in sudden arrhythmic death syndrome
Lancet
(2003) - et al.
Cardiac pathologic findings reveal a high rate of sudden cardiac death of undetermined etiology in younger women
Am Heart J
(2003)
Causes of sudden death in young female military recruits
Am J Cardiol
Predicting survival, in-hospital cardiac arrests: resuscitation survival variables and training effectiveness
Resuscitation
Success changes the problem: Why ventricular fibrillation is declining, why pulseless electrical activity is emerging, and what to do about it
Resuscitation
Sudden death risk in overt coronary heart disease: The Framingham Study
Am Heart J
Pathogenesis of atherosclerosis
J Am Coll Cardiol
Short- and long-term risk factors for sudden death in patients with stable angina
Int J Cardiol
From vulnerable plaque to vulnerable patient: The search for biomarkers of plaque destabilization
Trends Cardiovasc Med
Diabetes as a risk factor for sudden death
Lancet
Impaired myocardial functional reserve in hypertension and diabetes mellitus without coronary artery disease: searching for the possible link with congestive heart failure in the Myocardial Doppler in Diabetes (MYDID) Study II
Am J Hypertens
A molecular basis for cardiac arrhythmia: HERG mutations cause long QT syndrome
Cell
Molecular and cellular mechanisms of cardiac arrhythmias
Cell
Prolonged QTc interval and risk of sudden cardiac death in a population of older adults
J Am Coll Cardiol
Duration of the QT interval and total and cardiovascular mortality in healthy persons (The Framingham Heart Study experience)
Am J Cardiol
Incidence of sudden cardiac arrest is higher in areas of low socioeconomic status: A prospective two year study in a large United States community
Resuscitation
The epidemiology, pathophysiology, and management of psychosocial risk factors in cardiac practice: The emerging field of behavioral cardiology
J Am Coll Cardiol
Geographical distribution of cardiac arrest in Nottinghamshire
Resuscitation
Scientific gaps in the prediction and prevention of sudden cardiac death
J Cardiovasc Electrophysiol
Cardiac Arrest and Sudden Cardiac Death
Genomics in sudden cardiac death
Circ Res
Sudden cardiac death in the United States, 1989 to 1998
Circulation
Changing incidence of out-of-hospital ventricular fibrillation, 1980-2000
JAMA
Outcome of out-of-hospital cardiac arrest in New York City. The Pre-Hospital Arrest Survival Evaluation (PHASE) Study
JAMA
Out-of-hospital cardiac arrests: an 8-year New York City experience
Am J Emerg Med
Sudden death in the general population in Okinawa: incidence and causes of death
Jpn Circ J
Multiple source surveillance incidence and aetiology of out-of-hospital sudden cardiac death in a rural population in the West of Ireland
Eur Heart J
Cardiac arrest care and emergency medical services in Canada
Can J Cardiol
Secular trends in deaths from cardiovascular diseases: a 25-year community study
Circulation
Sudden cardiac death with apparently normal heart
Circulation
Sudden death due to cardiac arrhythmias
N Engl J Med
Sudden cardiac death in 15-35-year olds in Sweden during 1992-99
J Intern Med
Cardiac arrest and sudden cardiac death
Sudden cardiac death
Circulation
Sudden arrhythmic cardiac death—mechanisms, resuscitation and classification: the Seattle perspective
Am J Cardiol
Ambulatory sudden cardiac death: mechanisms of production of fatal arrhythmia on the basis of data from 157 cases
Am Heart J
Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillation
JAMA
Amiodarone as compared with lidocaine for shock-resistant ventricular fibrillation
N Engl J Med
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