Causes, circumstances, and potential preventability of cardiac arrest in the young: insights from a state-wide clinical and forensic registry

Abstract

Aims The causes, circumstances, and preventability of young sudden cardiac arrest remain uncertain. Methods and results A prospective state-wide multi-source registry identified all out-of-hospital cardiac arrests (OHCAs) in 1–50 year olds in Victoria, Australia, from 2019 to 2021. Cases were adjudicated using hospital and forensic records, clinic assessments and interviews of survivors and family members. For confirmed cardiac causes of OHCA, circumstances and cardiac history were collected. National time-use data was used to contextualize circumstances. 1319 OHCAs were included. 725 (55.0%) cases had a cardiac aetiology of OHCA, with coronary disease (n = 314, 23.8%) the most common pathology. Drug toxicity (n = 226, 17.1%) was the most common non-cardiac cause of OHCA and the second-most common cause overall. OHCAs were most likely to occur in sleep (n = 233, 41.2%). However, when compared to the typical Australian day, OHCAs occurred disproportionately more commonly during exercise (9% of patients vs. 1.3% of typical day, P = 0.018) and less commonly while sedentary (39.6 vs. 54.6%, P = 0.047). 38.2% of patients had known standard modifiable cardiovascular risk factors. 77% of patients with a cardiac cause of OHCA had not reported cardiac symptoms nor been evaluated by a cardiologist prior to their OHCA. Conclusion Approximately half of OHCAs in the young have a cardiac cause, with coronary disease and drug toxicity dominant aetiologies. OHCAs disproportionately occur during exercise. Of patients with cardiac cause of OHCA, almost two-thirds have no standard modifiable cardiovascular risk factors, and more than three-quarters had no prior warning symptoms or interaction with a cardiologist.

No Association Between Out-of-Hospital Cardiac Arrest and COVID-19 Vaccination

“…The EndUCD registry investigates all OHCAs occurring in individuals 1 to 50 years of age in Victoria (the second-largest state of Australia; population, 6.5 million people 3 ). It holds overarching ethical approval from the Alfred Hospital ethics committee.…”

“…The secondary outcome was causes of young sudden death within 30 days of COVID-19 vaccination, with reference to age-matched normative Australian data. 3 …”

“…No difference was seen in underlying causes of sudden death compared with previously published age-matched data ( P =0.235; Figure [B]). 3 …”

“…The secondary outcome was causes of young sudden death within 30 days of COVID-19 vaccination, with reference to agematched normative Australian data. 3 Kruskal-Wallis analysis compared monthly rates of OHCA, OHCA attributable to myocarditis, or unascertained OHCA against time periods. Fisher exact test compared frequency of sudden death causes with baseline controls.…”

Defibrillator access across Australia: the first step in avoiding a chain of fatality

“…Cardiac arrest is the cessation of cardiac activity requiring resuscitative measures. There is a wide range of underlying conditions that are associated with cardiac arrest in younger people, but in those aged over 50 years, it is almost always due to coronary heart disease 6 …”