Epidemiology of sudden cardiac death in Cameroon: the first population-based cohort survey in sub-Saharan Africa

Abstract

BackgroundIncidence estimates of sudden cardiac death (SCD) in sub-Saharan Africa (SSA) are unknown.MethodOver 12 months, the household administrative office and health community committee within neighbourhoods in two health areas of Douala, Cameroon, registered all deaths among 86 188 inhabitants aged >18 years. As part of an extended multi-source surveillance system, the Emergency Medical Service (EMS), local medical examiners and district hospital mortuaries were also surveyed. Whereas two physicians investigated every natural death, two cardiologists reviewed all unexpected natural deaths.ResultsThere were 288 all-cause deaths and 27 (9.4%) were SCD. The crude incidence rate was 31.3 [95% confidence interval (CI): 20.3–40.6]/100 000 person-years. The age-standardized rate by the African standard population was 33.6 (95% CI: 22.4–44.9)/100 000 person-years. Death occurred at night in 37% of cases, including 11% of patients who died while asleep. Out-of-hospital sudden cardiac arrest occurred in 63% of cases, 55.5% of which occurred at home. Of the 88.9% cases of witnessed cardiac arrest, 63% occurred in the presence of a family member and cardiopulmonary resuscitation was attempted only in 3.7%.ConclusionThe burden of SCD in this African population is heavy with distinct characteristics, whereas awareness of SCD and prompt resuscitation efforts appear suboptimal. Larger epidemiological studies are required in SSA in order to implement preventive measures, especially in women and young people.

Epidemiology of Sudden Cardiac Death: Global and Regional Perspectives

“…Other studies from Europe report similar figures; the EuReCa ONE Study included data from 27 countries in October 2014 and estimated an overall annual incidence of 84.0 per 100,000 [31]. We are aware of one prospective report from sub-Saharan Africa; in Douala, Cameroon, it was estimated that SCD incidence was 33.6 per 100,000 through a three-level case reporting and ascertainment system [32]. There is a paucity of data from other less developed regions of the world; although there are some reports on SCD using autopsy, inhospital, and defibrillator information, these are insufficient to estimate the true incidence of SCD in these regions [33,34].…”

A Systematic Review of the Spectrum of Cardiac Arrhythmias in Sub-Saharan Africa

“…The key finding of this systematic review is the sparsity of studies on SCA/SCD in this region. Table 2 depicts the few studies on SCA/SCD in SSA [57][58][59][60][61][62][63][64][65][66][67][68][69][70]. From the published studies, one of the salient findings is the low mean age of SCA/SCD with a range of 35-60 years across studies among adults, with higher rates in males compared to females in majority of studies.…”

“…In patients with peripartum cardiomyopathy, prolonged corrected non-congenital QT interval and sinus tachycardia on baseline ECG were independent predictors of poor composite outcome which included death during follow-up [90]. Cardiomyopathies [58,61] Hypertensive heart disease [58,62,67] Coronary artery disease [58,59,61,64,69] Rheumatic heart disease [61,69] Congenital heart disease [96] Arrhythmogenic right ventricular cardiomyopathy [76,77] Hypertrophic cardiomyopathy [74,75] Brugada syndrome [78,79] Congenital Long QT syndrome (seen only in non-Black populations) [74,88,101] Ventricular non-compaction [84] Pulmonary embolism [62,91] Endomyocardial fibrosis [95] Pulmonary hypertension [61] Pericarditis (mainly tuberculous) [92] Aortic dissection/rupture [64] Endemic parasitic infections like trypanosomiasis & schistosomiasis [9,59,93] Sarcoidosis [102][103][104] Respiratory disease [58,62,64] Septicemia [58,66] HIV/AIDS [58,…”

Risk of sudden unexplained death after use of dihydroartemisinin–piperaquine for malaria: a systematic review and Bayesian meta-analysis

“…Although information from tropical areas is scarce, the overall incidence rate of sudden cardiac death (ie, sudden death from any cardiac cause) is estimated to be less than 1 to 11·9 per 100 000 person-years in the population younger than 35 years. 22 , 23 , 24 The incidence of sudden cardiac death in young people is one to two orders of magnitude lower than that in older adults 22 and in infants younger than 1 year (which is around 96 per 100 000 person-years when deaths attributed to the sudden infant death syndrome are included). 59 There is insufficient clinical or statistical evidence to suggest that this one case of sudden unexplained death represented a higher-than-expected rate of sudden cardiac death in our study population.…”

“…In recognition of the young populations of malaria-endemic regions, and that most individuals who have received dihydroartemisinin–piperaquine in clinical studies did so as part of mass drug administration programmes with participant age structures similar to that of the general population, the posterior probability distribution of the risk of sudden unexplained death after dihydroartemisinin–piperaquine and its 95% credible interval were compared with reported global surveillance rates of sudden cardiac death in the population aged younger than 35 years (0·7–11·9 per 100 000 person-years scaled to 30-day risks; appendix p 3 ). 22 , 23 , 24 Risk of bias of individual studies at the outcome level was assessed using the PROTECT checklist for systematic reviews of drug adverse events. 25 …”