Epidemiology and Genetics of Sudden Cardiac Death

Deo, Rajat; Chen, Albert

doi:10.1161/circulationaha.111.023838

Cited by 530 publications

(360 citation statements)

References 224 publications

(252 reference statements)

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“…In our study, women were less likely to have a shockable heart rhythm even when subsetting the analysis to patients with a witnessed arrest and bystander CPR, indicating a different underlying pathophysiology of cardiac arrest. The vast majority of men suffer cardiac arrest because of coronary artery disease and acute myocardial infarction, whereas women are more likely to have other underlying pathophysiology such as cardiomyopathies 9. The mechanism of cardiac arrest in the absence of an acute myocardial infarction is believed to be an electric event caused by ventricular arrhythmia in the setting of a chronically diseased heart, which is more likely to occur among women who are typically older and have more comorbidities 2.…”

Section: Discussionmentioning

confidence: 99%

“…For example, women with out‐of‐hospital cardiac arrest are more likely to have advanced age, chronic health comorbidities, noncardiac etiology, unwitnessed cardiac arrest, and initial nonshockable heart rhythm, and to live alone, all of which have been associated with worse outcomes 2, 5, 8, 9, 10, 11. While these characteristics are important to understand differences in outcomes, they are unlikely to be modifiable.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Association of Bystander and First‐Responder Efforts and Outcomes According to Sex: Results From the North Carolina HeartRescue Statewide Quality Improvement Initiative

Hansen

Kragholm

Dupre

et al. 2018

JAHA

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BackgroundThe Institute of Medicine has called for actions to understand and target sex‐related differences in care and outcomes for out‐of‐hospital cardiac arrest patients. We assessed changes in bystander and first‐responder interventions and outcomes for males versus females after statewide efforts to improve cardiac arrest care.Methods and ResultsWe identified out‐of‐hospital cardiac arrests from North Carolina (2010–2014) through the CARES (Cardiac Arrest Registry to Enhance Survival) registry. Outcomes for men versus women were examined through multivariable logistic regression analyses adjusted for (1) nonmodifiable factors (age, witnessed status, and initial heart rhythm) and (2) nonmodifiable plus modifiable factors (bystander cardiopulmonary resuscitation and defibrillation before emergency medical services), including interactions between sex and time (ie, year and year2). Of 8100 patients, 38.1% were women. From 2010 to 2014, there was an increase in bystander cardiopulmonary resuscitation (men, 40.5%–50.6%; women, 35.3%–51.8%; P for each <0.0001) and in the combination of bystander cardiopulmonary resuscitation and first‐responder defibrillation (men, 15.8%–23.0%, P=0.007; women, 8.5%–23.7%, P=0.004). From 2010 to 2014, the unadjusted predicted probability of favorable neurologic outcome was higher and increased more for men (men, from 6.5% [95% confidence interval (CI), 5.1–8.0] to 9.7% [95% CI, 8.1–11.3]; women, from 6.3% [95% CI, 4.4–8.3] to 7.4% [95% CI, 5.5–9.3%]); while adjusted for nonmodifiable factors, it was slightly higher but with a nonsignificant increase for women (from 9.2% [95% CI, 6.8–11.8] to 10.2% [95% CI, 8.0–12.5]; men, from 5.8% [95% CI, 4.6–7.0] to 8.4% [95% CI, 7.1–9.7]). Adding bystander cardiopulmonary resuscitation and defibrillation before EMS (modifiable factors) did not substantially change the results.ConclusionsBystander and first‐responder interventions increased for men and women, but outcomes improved significantly only for men. Additional strategies may be necessary to improve survival among female cardiac arrest patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association of Bystander and First‐Responder Efforts and Outcomes According to Sex: Results From the North Carolina HeartRescue Statewide Quality Improvement Initiative

Hansen

Kragholm

Dupre

et al. 2018

JAHA

View full text Add to dashboard Cite

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“…Rather, the presence of calcified plaque likely represents an increased global burden of atherosclerosis. In ≈50% of SCD victims with CHD, autopsies reveal only stable plaques and chronic changes 2, 22. In these cases, the mechanism of SCD may be ventricular arrhythmia triggered by acute ischemia or related to structural alterations secondary to chronic ischemia or prior myocardial infarction 2, 23.…”

Section: Discussionmentioning

confidence: 99%

“…Although firefighters face numerous occupational hazards, the leading cause of duty‐related death among firefighters in the United States is sudden cardiac death (SCD), accounting for ≈42% of duty‐related fatalities annually 1. In the general population2, 3, 4 and the fire service,5, 6 coronary heart disease (CHD) has long been the predominant disease condition associated with SCD. Overt CHD is a strong independent predictor of SCD, conveying a 3‐ to 5‐fold increase in the risk of SCD in a large epidemiological study 7.…”

Section: Introductionmentioning

confidence: 99%

“…Among firefighters, a prior diagnosis of CHD or other clinical evidence of arterial–occlusive disease is associated with a 16‐fold increased risk of duty‐related death from CHD after adjustment for comorbid risk factors 6. Importantly, CHD frequently goes undetected, and SCD is often the first manifestation of the disease 2, 3, 4. This is particularly problematic in the case of first responders, whose sudden incapacitation can have ramifications far beyond the individual who experiences a cardiac event.…”

Section: Introductionmentioning

confidence: 99%

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Pathoanatomic Findings Associated With Duty‐Related Cardiac Death in US Firefighters: A Case–Control Study

Smith

Haller

Korre

et al. 2018

JAHA

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BackgroundSudden cardiac death accounts for the greatest proportion of duty‐related deaths among US firefighters. Increased understanding of the pathoanatomic causes of sudden cardiac death and the risk associated with underlying cardiac pathologies is needed to develop evidence‐based screening recommendations.Methods and ResultsUsing autopsy data for duty‐related firefighter fatalities occurring between 1999 and 2014, this retrospective case–control study compared cardiac findings of male firefighters aged 18 to 65 years who died on duty of cardiac‐related causes with those who died of noncardiac trauma‐related causes. Data from 276 cardiac cases and 351 noncardiac trauma controls were analyzed. Among cardiac cases, the most prevalent (82%) underlying pathoanatomic substrate was comorbid coronary heart disease and cardiomegaly/left ventricular hypertrophy. Cardiac cases had a higher prevalence of cardiomegaly (heart weight >450 g), left ventricular hypertrophy (left ventricular wall thickness ≥1.2 cm), and severe coronary artery stenosis (≥75%) than trauma controls (all P<0.001). In multivariate analyses, heart weight >450 g, coronary artery stenosis ≥75%, and evidence of a prior myocardial infarction were strong independent predictors of cardiac death, with odds ratios of 6.1 (95% confidence interval, 3.6–10.4), 9.3 (95% confidence interval, 5.3–16.1), and 6.2 (95% confidence interval, 3.4–11.3), respectively.ConclusionsThe majority of cardiac fatalities had evidence of both coronary heart disease and increased heart mass, and each condition was independently associated with a markedly elevated risk of cardiac death. Targeted screening for coronary heart disease, increased heart mass, and evidence of prior myocardial infarction should be considered to reduce duty‐related cardiac deaths among firefighters.

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Genetic Variants Associated With Unexplained Sudden Cardiac Death in Adult White and African American Individuals

et al. 2021

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IMPORTANCEUnexplained sudden cardiac death (SCD) describes SCD with no cause identified. Genetic testing helps to diagnose inherited cardiac diseases in unexplained SCD; however, the associations between pathogenic or likely pathogenic (P/LP) variants of inherited cardiomyopathies (CMs) and arrhythmia syndromes and the risk of unexplained SCD in both White and African American adults living the United States has never been systematically examined.OBJECTIVE To investigate cases of unexplained SCD to determine the frequency of P/LP genetic variants of inherited CMs and arrhythmia syndromes. DESIGN, SETTING, AND PARTICIPANTSThis genetic association study included 683 African American and White adults who died of unexplained SCD and were included in an autopsy registry. Overall, 413 individuals had DNA of acceptable quality for genetic sequencing. Data were collected from January 1995 to December 2015. A total of 30 CM genes and 38 arrhythmia genes were sequenced, and variants in these genes, curated as P/LP, were examined to study their frequency. Data analysis was performed from June 2018 to March 2021. MAIN OUTCOMES AND MEASURESThe frequency of P/LP variants for CM or arrhythmia in individuals with unexplained SCD. RESULTSThe median (interquartile range) age at death of the 413 included individuals was 41 (29-48) years, 259 (62.7%) were men, and 208 (50.4%) were African American adults. A total of 76 patients (18.4%) with unexplained SCD carried variants considered P/LP for CM and arrhythmia genes. In total, 52 patients (12.6%) had 49 P/LP variants for CM, 22 (5.3%) carried 23 P/LP variants for arrhythmia, and 2 (0.5%) had P/LP variants for both CM and arrhythmia. Overall, 41 P/LP variants for hypertrophic CM were found in 45 patients (10.9%), 9 P/LP variants for dilated CM were found in 11 patients (2.7%), and 10 P/LP variants for long QT syndrome were found in 11 patients (2.7%). No significant difference was found in clinical and heart characteristics between individuals with or without P/LP variants. African American and White patients were equally likely to harbor P/LP variants. CONCLUSIONS AND RELEVANCEIn this large genetic association study of community cases of unexplained SCD, nearly 20% of patients carried P/LP variants, suggesting that genetics may contribute to a significant number of cases of unexplained SCD. Our findings regarding both the association of unexplained SCD with CM genes and race-specific genetic variants suggest new avenues of study for this poorly understood entity.

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Epidemiology and Genetics of Sudden Cardiac Death

Cited by 530 publications

References 224 publications

Association of Bystander and First‐Responder Efforts and Outcomes According to Sex: Results From the North Carolina HeartRescue Statewide Quality Improvement Initiative

Association of Bystander and First‐Responder Efforts and Outcomes According to Sex: Results From the North Carolina HeartRescue Statewide Quality Improvement Initiative

Pathoanatomic Findings Associated With Duty‐Related Cardiac Death in US Firefighters: A Case–Control Study

Genetic Variants Associated With Unexplained Sudden Cardiac Death in Adult White and African American Individuals

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