Elsevier

Progress in Cardiovascular Diseases

Volume 51, Issue 3, November–December 2008, Pages 213-228
Progress in Cardiovascular Diseases

Sudden Cardiac Death Symposium
Epidemiology of Sudden Cardiac Death: Clinical and Research Implications

https://doi.org/10.1016/j.pcad.2008.06.003Get rights and content

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. 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. However, the alarming rise in prevalence of obesity and diabetes in the first decade of the new millennium both in the United States and worldwide, would indicate that this favorable trend is unlikely to persist. We are likely to witness a resurgence of coronary artery disease and heart failure, as a result of which sudden cardiac death will have to be confronted as a shared and indiscriminate, worldwide public health problem. There is also increasing recognition of the fact that discovery of meaningful and relevant risk stratification and prevention methodologies will require careful prospective community-wide analyses, with access to large archives of DNA, serum, and tissue that link with well-phenotyped databases. The purpose of this review is to summarize current knowledge of sudden cardiac death epidemiology. We will discuss the significance and strengths of community-wide evaluations of sudden cardiac death, summarize recent observations from such studies, and finally highlight specific potential predictors that warrant further evaluation as determinants of sudden cardiac death in the general population.

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.

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