Sudden cardiac death accounts for 5.6% of annual mortality, and prospective evaluation in the general population appears to be feasible. The use of multiple sources of ascertainment and information significantly enhances phenotyping of SCD cases. Retrospective death certificate-based surveillance results in significant overestimation of SCD incidence.

In this community-wide study, only one-third of the evaluated SCD cases had severe LV dysfunction meeting current criteria for prophylactic cardioverter-defibrillator implantation. The SCD cases with normal LV function had several distinguishing clinical characteristics. These findings support the aggressive development of alternative screening methods to enhance identification of patients at risk.

Direct oral anticoagulants ( DOAC s) have quickly become attractive alternatives to the long‐standing standard of care in anticoagulation, vitamin K antagonist. DOAC s are indicated for prevention and treatment of several cardiovascular conditions. Since the first approval in 2010, DOAC s have emerged as leading therapeutic alternatives that provide both clinicians and patients with more effective, safe, and convenient treatment options in thromboembolic settings. With the expanding role of DOAC s, clinicians are faced with increasingly complex decisions relating to appropriate agent, duration of treatment, and use in special populations. This review will provide an overview of DOAC s and act as a practical reference for clinicians to optimize DOAC use among common challenging scenarios. Topics addressed include (1) appropriate indications; (2) use in patients with specific comorbidities; (3) monitoring parameters; (4) transitioning between anticoagulant regimens; (5) major drug interactions; and (6) cost considerations.

Background Sudden cardiac death (SCD) is a leading cause of death in the US, but the relative public health burden is unknown. We estimated the burden of premature death from SCD and compared it to other diseases. Methods and Results Analyses were based on the following data sources (using most recent sources that provided appropriately stratified data): 1) Leading causes of death among men and women from 2009 US death certificate reporting; 2) Individual cancer mortality rates from 2008 death certificate reporting from the CDC’s National Program of Cancer Registries; 3) County, state and national population data for 2009 from the US Census Bureau; 4) SCD rates from the Oregon Sudden Unexpected Death Study (SUDS) population-based surveillance study of SCD between 2002 and 2004. Cases were identified from multiple sources in a prospectively designed surveillance program. Incidence, counts and years of potential life lost (YPLL) for SCD and other major diseases were compared. The age-adjusted national incidence of SCD was 60 per 100,000 population (95% confidence interval = 54 – 66 per 100,000). The burden of premature death for men (2.04 million YPLL; 95% uncertainty interval 1.86 – 2.23 million) and women (1.29 million YPLL; 95% uncertainty interval 1.13 – 1.45 million) was greater for SCD than all individual cancers and most other leading causes of death. Conclusions The societal burden of SCD is high relative to other major causes of death. Improved epidemiologic surveillance of SCD and other forms of cardiovascular disease is necessary to evaluate and improve prevention and treatment.