Etiology of sudden death in the community: Results of anatomical, metabolic, and genetic evaluation

Adabag, Selçuk; Peterson, Garry; Apple, Fred S.; Titus, Jack L.; King, Richard; Luepker, Russell V.

doi:10.1016/j.ahj.2009.10.019

Cited by 120 publications

(94 citation statements)

References 41 publications

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“…A recent US series of unselected cases who died unexpectedly found severe subclinical CHD in Ͼ80%. 32 The most striking finding from the present study was that nearly 9 of 10 deaths among younger victims from the most recent period occurred out of the hospital. Bearing in mind that the autopsy rates for the present study population were quite high among persons with out-of-hospital deaths who were less than 65 years old, misclassification of noncoronary deaths as CHD deaths is probably relatively minor but may obviously be higher among older persons, for whom autopsy rates were low.…”

Section: Methodological Considerationssupporting

confidence: 53%

Trends in Out-of-Hospital Deaths Due to Coronary Heart Disease in Sweden (1991 to 2006)

et al. 2011

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Background-Case fatality associated with a first coronary event is often underestimated when only those who survive to reach a hospital are considered. Few studies have examined long-term trends in case fatality associated with a major coronary event that occurs out of the hospital. Methods and Results-Record linkage documented all case subjects 35 to 84 years of age in Sweden during 1991 to 2006 with a first major coronary event (out-of-hospital coronary death or hospitalization for acute myocardial infarction). Of the 384 597 cases identified, 111 319 (28.9%) died out of the hospital, and another 36 552 (9.5%) died in the hospital or within 28 days of hospitalization. From 1991 to 2006, out-of hospital deaths as a proportion of all major coronary events declined from 30.5% to 25.6% (adjusted mean annual decrease 2.2%, 95% confidence interval 2.1% to 2.4%), however, with a larger decline in 28-day case fatality in hospitalized cases (adjusted mean annual decrease 5.8%, 95% confidence interval 5.5% to 6.0%). As a result of the faster decline in in-hospital deaths, the relative contribution of out-of-hospital deaths to overall case fatality increased, particularly among younger individuals (eg, among those 35 to 54 years of age, no more than 10.8% of all deaths occurred in hospitalized cases during [2003][2004][2005][2006]. Although female sex (odds ratio 0.85, 95% confidence interval 0.83 to 0.87) and older age (odds ratio 0.972, 95% confidence interval 0.971 to 0.974 per year) were associated with lower risk for initial out-of-hospital death, each successive calendar year was associated with increased risk (odds ratio 1.041, 95% confidence interval 1.038 to 1.044). Conclusions-The great majority of all fatal coronary events occur outside the hospital, and this proportion is increasing, particularly among younger individuals. (Circulation. 2011;123:46-52.)

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Section: Methodological Considerationssupporting

confidence: 53%

Trends in Out-of-Hospital Deaths Due to Coronary Heart Disease in Sweden (1991 to 2006)

et al. 2011

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“…Thus, sudden death is a preventable condition. 18,19 We found that cardiovascular risk factors had different impacts on subtypes of CHD, suggesting that the spectrum of CHD manifestations among populations and over time may differ, depending on the relative prevalence of the risk factors. Our findings suggest that reduced prevalences of hypercholesterolemia and smoking are major driving forces for the decline in the incidence of STEMI, indicating that primary prevention efforts result in fewer severe events.…”

mentioning

confidence: 96%

“…This can lead to misclassifications even if the predominant cause of sudden death is CHD. 18,27,28 In addition, the true effect of changes in diagnostic sensitivity of biomarkers could not be fully quantified. The potential bias from this would be an overestimation of the incidence of MI in later years.…”

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confidence: 99%

Trends in Modifiable Risk Factors Are Associated With Declining Incidence of Hospitalized and Nonhospitalized Acute Coronary Heart Disease in a Population

et al. 2016

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Both changes in the rates of out-of-hospital CHD deaths and hospitalization rates and the outcome of myocardial infarction (MI) with ST-segment elevation (STEMI) and non-ST-segment elevation (non-STEMI) will affect mortality. Editorial see p 8 Clinical Perspective on p 81It has been suggested that 45% to 75% of the decrease in deaths from CHD can be attributed to decreases in smoking, blood pressure, and cholesterol. [4][5][6][7][8] These studies based their estimates on ecological data or mathematical modeling of aggregate data. Few studies used individual person data, 9,10 and the studies were limited to population subgroups and did not study out-of-hospital CHD or subtypes of MI.We used individual person data from repeated surveys of a general population to study the rates of out-of-hospital CHD; the incidence, treatment, and outcome of hospitalized STEMI and non-STEMI; and the impact of changes in coronary risk factor levels during the years 1995 to 2010. Methods Study PopulationThe Tromsø Study is a population-based, prospective study of various health issues and chronic diseases. It consists of 6 surveys of both sexes conducted in the municipality of Tromsø, Norway, from Background-Few studies have used individual person data to study whether contemporary trends in the incidence of coronary heart disease are associated with changes in modifiable coronary risk factors. Methods and Results-We identified 29 582 healthy men and women ≥25 years of age who participated in 3 population surveys conducted between 1994 and 2008 in Tromsø, Norway. Age-and sex-adjusted incidence rates were calculated for coronary heart disease overall, out-of-hospital sudden death, and hospitalized ST-segment-elevation and non-STsegment-elevation myocardial infarction. We measured coronary risk factors at each survey and estimated the relationship between changes in risk factors and changes in incidence trends. A total of 1845 participants had an incident acute coronary heart disease event during 375 064 person-years of follow-up from 1994 to 2010. The age-and sex-adjusted incidence of total coronary heart disease decreased by 3% (95% confidence interval, 2.0-4.0; P<0.001) each year. This decline was driven by decreases in out-of-hospital sudden death and hospitalized ST-segment-elevation myocardial infarction. Changes in coronary risk factors accounted for 66% (95% confidence interval, 48-97; P<0.001) of the decline in total coronary heart disease. Favorable changes in cholesterol contributed 32% to the decline, whereas blood pressure, smoking, and physical activity each contributed 14%, 13%, and 9%, respectively. Conclusions-We observed a substantial decline in the incidence of coronary heart disease that was driven by reductions in out-of-hospital sudden death and hospitalized ST-segment-elevation myocardial infarction. Changes in modifiable coronary risk factors accounted for 66% of the decline in coronary heart disease events.

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“…Coronary artery disease is the predominant cause of sudden cardiac death in older persons, 1 whereas among persons 1 to 35 years of age, sudden cardiac death is more often caused by structural heart disease, including hypertrophic cardiomyopathy, dilated cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, myocarditis, and primary arrhythmogenic disorders (such as the congenital long-QT syndrome, the Brugada syndrome, and catecholaminergic polymorphic ventricular tachycardia). [2][3][4][5] Many of these cardiac causes of sudden cardiac death among children and young adults have an underlying genetic basis.…”

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confidence: 99%

A Prospective Study of Sudden Cardiac Death among Children and Young Adults

et al. 2016

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Etiology of sudden death in the community: Results of anatomical, metabolic, and genetic evaluation

Abstract: Background-Identifying persons at risk for sudden cardiac death (SCD) is challenging. A comprehensive evaluation may reveal clues about the clinical, anatomic, genetic and metabolic risk factors for SCD.

Cited by 120 publications

References 41 publications

Trends in Out-of-Hospital Deaths Due to Coronary Heart Disease in Sweden (1991 to 2006)

Trends in Out-of-Hospital Deaths Due to Coronary Heart Disease in Sweden (1991 to 2006)

Trends in Modifiable Risk Factors Are Associated With Declining Incidence of Hospitalized and Nonhospitalized Acute Coronary Heart Disease in a Population

A Prospective Study of Sudden Cardiac Death among Children and Young Adults

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