Epidemiology of Sudden Cardiac Death: Global and Regional Perspectives

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Despite advancements in prevention and treatment, sudden cardiac death (SCD) remains a leading cause of mortality and is responsible for approximately half of all deaths from cardiovascular disease. Outcomes continue to remain poor following a sudden cardiac arrest, with most individuals not surviving. Although coronary heart disease remains the dominant underlying condition, our understanding of SCD is improving through greater knowledge of clinical risk factors, cardiomyopathies, and primary arrhythmic disorders. However, despite a growing wealth of information from studies in North America, Europe, and Japan, data from other global regions (and particularly from low-and middle-income countries) remains scarce.

Introduction

Sudden cardiac death (SCD) is a leading cause of mortality and responsible for approximately half of all deaths from cardiovascular disease [1]. It is generally accepted that SCD refers to an unexpected death or arrest from a cardiovascular cause. Most studies refer to SCD as a sudden death from a cardiovascular cause which occurs within one hour of symptom onset when witnessed, or if not witnessed, an unexpected death from a cardiovascular cause where the individual was observed to be alive within the previous 24 hours. However, non-cardiac causes such as pulmonary embolism, stroke, and aortic syndromes can also lead to rapid death and should be considered as alternate pathologies.

Despite its importance and societal burden, our understanding of SCD epidemiology is limited. The epidemiological study of SCD has been particularly hampered by definitional and methodological challenges. Although much progress has been made through implantable cardioverter defibrillators, community-based cardiopulmonary resuscitation, and coronary heart disease (CHD) management, SCD still remains the cause of 15–20% of deaths in Western societies [2]. Furthermore, there is a comparative dearth of information on SCD from other global regions, particularly low and-middle income countries. In this manuscript, we review the epidemiology of SCD focussing on both global and available regional data, with detail on specific conditions, risk prediction, and intervention included elsewhere in this Special Issue on Ventricular Arrhythmias and SCD.

Section snippets

Regional and Global Incidence of SCD

The following sections summarise the available data on the global and regional incidence of SCD (Figure 1). However, estimates of SCD need to be interpreted in the context of several limitations. First, utilised definitions vary from study to study, despite attempts at standardisation. Second, it can be challenging to exclude non-cardiac causes of death, particularly when complete documentation of event and background history is unavailable, and autopsies are not routinely performed. Third,

Outcomes Following SCD

Outcomes following OOHCA remain poor despite efforts to progress cardiopulmonary resuscitation (CPR) and post-resuscitation care. In the AusROC Epistry in Australia and New Zealand, immediate post-event survival was 28% (range 21–36%) in cases of attempted resuscitation, but only 12% (range 9–17%) survived to hospital discharge or to 30 days [3]. Survival rates appear to be significantly lower in other Asia Pacific countries, with the PAROS (Pan-Asian Resuscitation Outcomes Study) reporting

Trends in Incidence, Rhythm and Survival

Most of the available data seem to support a declining incidence of SCD in recent years. For example, several studies from Western Australia have reported that age-standardised rates of SCD decreased in the late 1990s and early 2000s. However, more contemporary data now raised the possibility of a potential increase in recent years [4], [6], [36]. Similarly, the incidence of OOHCA <18 years of age has been reported to have decreased from 14.1 (1997–2000) to 8.7 (2011–2014) per 100,000 in Perth,

Age, Sex and Ethnicity

The majority of SCD occurs in the adult population in whom the incidence of SCD rises with increasing age (Figure 2 and Table 2) [2], [29]. Amongst individuals under 35 years of age, the highest incidence is observed in the 0–5 year age group [29]. Data suggest that men have a three- to four-fold higher risk for SCD compared to women, although recent studies suggest this disparity may be declining [29]. It is well-established that individuals of African-American descent appear to have a higher

Conclusions

Although data from many regions of the world is limited, SCD remains a major public health burden worldwide. Improving our understanding of risk factors and underlying conditions, and how these vary across regional populations and ethnicities, may offer new opportunities for prevention and treatment. Further study on the global and regional epidemiology of SCD is thus urgently required to reduce the societal burden of premature demise from SCD.

Sources of Funding

Dr Wong is supported by a Neil Hamilton Farley Early Career Fellowship from the National Health and Medical Research Council of Australia (NHMRC). Dr Lau is supported by the Robert J. Craig Lectureship from the University of Adelaide. Dr Brown is supported by a NHMRC Senior Research Fellowship. Drs Kalman and Sanders are supported by Practitioner Fellowships from the NHMRC. Dr Sanders is supported by the National Heart Foundation of Australia.

Disclosures

Dr Wong reports having received lecture and/or travel funding from Novartis, Servier, Boehringer-Ingelheim and Medtronic. Dr. Albert reports research grants from the NIH, Abbott, Roche, and St. Jude Medical. Dr Sanders reports having served on the advisory board of Medtronic, Abbott and CathRx. Dr Sanders reports that the University of Adelaide has received on his behalf lecture and/or consulting fees from Medtronic, St Jude Medical, Boston Scientific. Dr Sanders reports that the University of

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