Epidemiology of Sudden Cardiac Death: Global and Regional Perspectives
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
References (78)
- et al.
Aus-ROC Steering Committee Regional variation in the characteristics, incidence and outcomes of out-of-hospital cardiac arrest in Australia and New Zealand: results from the Aus-ROC Epistry
Resuscitation
(2018) - et al.
Trends in the incidence of presumed cardiac out-of-hospital cardiac arrest in Perth, Western Australia, 1997–2010
Resuscitation
(2014) - et al.
Survival after out-of-hospital cardiac arrest in Sydney, Australia
Crit Care Resusc
(2006) - et al.
Temporal trends in sudden cardiac death from 1997 to 2010: a data linkage study
Heart Lung Circ
(2017) - et al.
Outcomes of out-of-hospital cardiac arrest patients in Perth, Western Australia, 1996–1999
Resuscitation
(2001) - et al.
Survival from out-of-hospital cardiac arrest in New Zealand following the 2005 resuscitation guideline changes
Resuscitation
(2010) - et al.
Incidence of sudden cardiac death in China: analysis of 4 regional populations
J Am Coll Cardiol
(2009) - et al.
Regionalisation of out-of-hospital cardiac arrest care for patients without prehospital return of spontaneous circulation
Resuscitation
(2012) - et al.
Sudden cardiac death in South India: Incidence, risk factors and pathology
Indian Pacing Electrophysiol J
(2016) - et al.
Contribution of sudden cardiac death to total mortality in India – a population based study
Int J Cardiol
(2012)
Comparison of chest compression only and standard cardiopulmonary resuscitation for out-of-hospital cardiac arrest in Singapore
Resuscitation
Sudden unexplained death during sleep occurred commonly in the general population in the Philippines: a sub study of the National Nutrition and Health Survey
J Clin Epidemiol
Current burden of sudden cardiac death: multiple source surveillance versus retrospective death certificate-based review in a large U.S. community
J Am Coll Cardiol
EuReCa ONE Collaborators. EuReCa ONE-27 Nations, ONE, Europe, ONE Registry: a prospective one month analysis of out-of-hospital cardiac arrest outcomes in 27 countries in Europe
Resuscitation
Sudden cardiac death in low- and middle-income countries
Glob Heart
Global incidences of out-of-hospital cardiac arrest and survival rates: Systematic review of 67 prospective studies
Resuscitation
PAROS Clinical Research Network: Outcomes for out-of-hospital cardiac arrests across 7 countries in Asia: The Pan Asian Resuscitation Outcomes Study (PAROS)
Resuscitation
Trends in traumatic out-of-hospital cardiac arrest in Perth, Western Australia from 1997 to 2014
Resuscitation
Declining incidence of sudden cardiac death from 1990–2010 in a general middle-aged and elderly population: the Rotterdam study
Heart Rhythm
The incidence of out-of-hospital ventricular fibrillation in Helsinki, Finland, from 1994 to 1999
Lancet
A trend in epidemiology and outcomes of out-of-hospital cardiac arrest by urbanization level: a nationwide observational study from 2006 to 2010 in South Korea
Resuscitation
Obstructive sleep apnea and the risk of sudden cardiac death: a longitudinal study of 10,701 adults
J Am Coll Cardiol
Light-to-moderate alcohol consumption and risk of sudden cardiac death in women
Heart Rhythm
Sudden death in the young
Heart Rhythm
Natural history of the early repolarization pattern in a biracial cohort: CARDIA (Coronary Artery Risk Development in Young Adults) Study
J Am Coll Cardiol
Out-of-hospital cardiac arrest: Evaluation of one year of activity in Saint-Etienne's emergency medical system using the Utstein style
Resuscitation
CardiacArrest and sudden cardiac death (in Braunwald's heart disease: a textbook of cardiovascular medicine)
Prospective study of sudden cardiac death among women in the United States
Circulation
Early defibrillation in out-of-hospital sudden cardiac death: an Australian experience
Arch Emerg Med
Sudden cardiac death rates in an Australian population: a data linkage study
Aust Health Rev
Evaluation of autopsy and police reports in the investigation of sudden unexplained death in the young
Forensic Sci Med Pathol
Incidence, characteristics and survival outcomes of out-of-hospital cardiac arrest in children and adolescents between 1997 and 2014 in Perth, Western Australia
Emerg Med Australas
Causes of sudden cardiac death in young Australians
Med J Aust
Impact of advanced cardiac life support-skilled paramedics on survival from out-of-hospital cardiac arrest in a statewide emergency medical service
Emerg Med J
Out-of-hospital cardiac arrest in Victoria: rural and urban outcomes
Med J Aust
Auckland ambulance Service cardiac arrest data 1991–1993
N Z Med J
Outcomes from out-of-hospital cardiac arrest in the Wellington region of New Zealand. Does use of the fire service make a difference?
N Z Med J
Nationwide improvements in survival from out-of-hospital cardiac arrest in Japan
Circulation
Effectiveness of bystander-initiated cardiac-only resuscitation for patients with out-of-hospital cardiac arrest
Circulation
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