Sudden cardiac death: epidemiology and risk factors

Sudden cardiac death (SCD) is an important public-health problem with multiple etiologies, risk factors, and changing temporal trends. Substantial progress has been made over the past few decades in identifying markers that confer increased SCD risk at the population level. However, the quest for predicting the high-risk individual who could be a candidate for an implantable cardioverter-defibrillator, or other therapy, continues. In this article, we review the incidence, temporal trends, and triggers of SCD, and its demographic, clinical, and genetic risk factors. We also discuss the available evidence supporting the use of public-access defibrillators.

[1]  T. Cottle The Life Study , 1973 .

[2]  K. Thygesen,et al.  Prognosis after first myocardial infarction. , 2009, Acta medica Scandinavica.

[3]  E. Braunwald Heart Disease: A Textbook of Cardiovascular Medicine , 1992, Annals of Internal Medicine.

[4]  J. Goldberg,et al.  Psychosocial influences on mortality after myocardial infarction. , 1984, The New England journal of medicine.

[5]  A. Jaffe,et al.  Risk factors for sudden death after acute myocardial infarction: two-year follow-up. , 1984, The American journal of cardiology.

[6]  W. Kannel,et al.  Cardiac failure and sudden death in the Framingham Study. , 1988, American heart journal.

[7]  J. Fleiss,et al.  Mechanism of death and prevalence of myocardial ischemic symptoms in the terminal event after acute myocardial infarction. , 1988, The American journal of cardiology.

[8]  Left ventricular hypertrophy as a factor in arrhythmias and sudden death. , 1989, American journal of hypertension.

[9]  Jan Pool,et al.  QTc Prolongation Measured by Standard 12‐Lead Electrocardiography Is an Independent Risk Factor for Sudden Death Due to Cardiac Arrest , 1991, Circulation.

[10]  J. Murabito,et al.  Prognosis after first myocardial infarction. Comparison of Q-wave and non-Q-wave myocardial infarction in the Framingham Heart Study. , 1992, JAMA.

[11]  W. Kannel,et al.  Long- and short-term risk of sudden coronary death. , 1992, Circulation.

[12]  S. Willich,et al.  Increased onset of sudden cardiac death in the first three hours after awakening. , 1992, The American journal of cardiology.

[13]  M. Davies,et al.  Anatomic features in victims of sudden coronary death. Coronary artery pathology. , 1992, Circulation.

[14]  D. Eitel,et al.  One-year survival after prehospital cardiac arrest: the Utstein style applied to a rural-suburban system. , 1994, The American journal of emergency medicine.

[15]  G. Lombardi,et al.  Outcome of Out-of-Hospital Cardiac Arrest in New York City: The Pre-Hospital Arrest Survival Evaluation (PHASE) Study , 1994 .

[16]  J. Ornato,et al.  Public access defibrillation. A statement for healthcare professionals from the American Heart Association Task Force on Automatic External Defibrillation. , 1995, Circulation.

[17]  K. Bailey,et al.  Sudden unexpected nontraumatic death in 54 young adults: a 30-year population-based study. , 1991, The American journal of cardiology.

[18]  J. Hung,et al.  Cigarette smoking acutely increases platelet thrombus formation in patients with coronary artery disease taking aspirin. , 1995, Circulation.

[19]  W. Kannel,et al.  Clinical misconceptions dispelled by epidemiological research. , 1995, Circulation.

[20]  R. Virmani,et al.  Sudden coronary death. Frequency of active coronary lesions, inactive coronary lesions, and myocardial infarction. , 1995, Circulation.

[21]  M. Schoenfeld,et al.  Exploration of the precision of classifying sudden cardiac death. Implications for the interpretation of clinical trials. , 1996, Circulation.

[22]  R. Virmani,et al.  Coronary risk factors and plaque morphology in men with coronary disease who died suddenly. , 1997, The New England journal of medicine.

[23]  H. Wellens,et al.  Out-of-hospital cardiac arrest in the 1990's: a population-based study in the Maastricht area on incidence, characteristics and survival. , 1997, Journal of the American College of Cardiology.

[24]  R. Gillum Sudden cardiac death in Hispanic Americans and African Americans. , 1997, American journal of public health.

[25]  C. Fahrenbruch,et al.  Public locations of cardiac arrest. Implications for public access defibrillation. , 1998, Circulation.

[26]  Roger D. White,et al.  Seven years' experience with early defibrillation by police and paramedics in an emergency medical services system. , 1998, Resuscitation.

[27]  D. Jacobs,et al.  Validation of death certificate diagnosis of out-of-hospital sudden cardiac death. , 1998, The American journal of cardiology.

[28]  G. Bardy,et al.  Comparison of naive sixth-grade children with trained professionals in the use of an automated external defibrillator. , 1999, Circulation.

[29]  P Ducimetière,et al.  Predicting sudden death in the population: the Paris Prospective Study I. , 1999, Circulation.

[30]  Classification of Death in Clinical Trials: , 1999, Journal of cardiovascular electrophysiology.

[31]  S. Chugh,et al.  Sudden cardiac death with apparently normal heart. , 2000, Circulation.

[32]  D J Roe,et al.  Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos. , 2000, The New England journal of medicine.

[33]  V. Roger,et al.  Validation of death certificate diagnosis of out-of-hospital coronary heart disease deaths in Olmsted County, Minnesota. , 2000, Mayo Clinic proceedings.

[34]  J Engdahl,et al.  Experiences from treatment of out-of-hospital cardiac arrest during 17 years in Göteborg. , 2000, European heart journal.

[35]  H P Schultheiss,et al.  Diurnal, weekly and seasonal variation of sudden death. Population-based analysis of 24,061 consecutive cases. , 2000, European heart journal.

[36]  J. Moses,et al.  Transcatheter therapeutic embolization of multiple coronary artery fistulas. , 2001, Circulation.

[37]  R. Elston,et al.  Sudden cardiac death, genes, and arrhythmogenesis : consideration of new population and mechanistic approaches from a national heart, lung, and blood institute workshop, part I. , 2001, Circulation.

[38]  R. Elston,et al.  Sudden cardiac death, genes, and arrhythmogenesis: consideration of new population and mechanistic approaches from a National Heart, Lung, and Blood Institute workshop, Part II. , 2001, Circulation.

[39]  George A. Mensah,et al.  Sudden Cardiac Death in the United States, 1989 to 1998 , 2001, Circulation.

[40]  D R Jacobs,et al.  Trends in Acute Coronary Heart Disease Mortality, Morbidity, and Medical Care From 1985 Through 1997: The Minnesota Heart Survey , 2001, Circulation.

[41]  J R Hampton,et al.  Geographical distribution of cardiac arrest in Nottinghamshire. , 2001, Resuscitation.

[42]  M. Kuisma,et al.  The incidence of out-of-hospital ventricular fibrillation in Helsinki, Finland, from 1994 to 1999 , 2001, The Lancet.

[43]  R. Virmani,et al.  Sudden cardiac death. , 1987, Human pathology.

[44]  J. Oss,et al.  PROPHYLACTIC IMPLANTATION OF A DEFIBRILLATOR IN PATIENTS WITH MYOCARDIAL INFARCTION AND REDUCED EJECTION FRACTION , 2002 .

[45]  T. Raghunathan,et al.  Sudden death and myocardial infarction in first degree relatives as predictors of primary cardiac arrest. , 2002, Atherosclerosis.

[46]  J. Engdahl,et al.  The epidemiology of out-of-hospital 'sudden' cardiac arrest. , 2002, Resuscitation.

[47]  M. Peberdy,et al.  Defibrillators in public places--one step closer to home. , 2002, The New England journal of medicine.

[48]  R. Berger,et al.  B-Type Natriuretic Peptide Predicts Sudden Death in Patients With Chronic Heart Failure , 2002, Circulation.

[49]  M. Copass,et al.  Changing incidence of out-of-hospital ventricular fibrillation, 1980-2000. , 2002, JAMA.

[50]  R. Myerburg,et al.  Scientific Gaps in the Prediction and Prevention of Sudden Cardiac Death , 2002, Journal of cardiovascular electrophysiology.

[51]  F. Cappuccio,et al.  Variant of SCN5A Sodium Channel Implicated in Risk of Cardiac Arrhythmia , 2002, Science.

[52]  T. Rea,et al.  Temporal Patterns in Long-Term Survival After Resuscitation From Out-of-Hospital Cardiac Arrest , 2003, Circulation.

[53]  H. Wellens,et al.  Out-of-hospital cardiac arrest--the relevance of heart failure. The Maastricht Circulatory Arrest Registry. , 2003, European heart journal.

[54]  Douglas L Packer,et al.  Long-term outcomes of out-of-hospital cardiac arrest after successful early defibrillation. , 2003, The New England journal of medicine.

[55]  K. Wegscheider,et al.  Annual distribution of ventricular tachycardias and ventricular fibrillation. , 2004, American heart journal.

[56]  Sandeep Vijan,et al.  Public use of automated external defibrillators. , 2003, The New England journal of medicine.

[57]  Pekka Raatikainen,et al.  Prediction of sudden cardiac death after myocardial infarction in the beta-blocking era. , 2003, Journal of the American College of Cardiology.

[58]  A. Tenenbaum,et al.  Current smoking, smoking cessation, and the risk of sudden cardiac death in patients with coronary artery disease. , 2003, Archives of internal medicine.

[59]  S. Chugh,et al.  Postmortem molecular screening in unexplained sudden death. , 2004, Journal of the American College of Cardiology.

[60]  J P Ornato,et al.  Public-access Defibrillation and Survival after Out-of-hospital Cardiac Arrest Recommended Citation Public-access Defibrillation and Survival after Out-of-hospital Cardiac Arrest , 2022 .

[61]  Mohamud Daya,et al.  Current burden of sudden cardiac death: multiple source surveillance versus retrospective death certificate-based review in a large U.S. community. , 2004, Journal of the American College of Cardiology.

[62]  D. Levy,et al.  Temporal Trends in Coronary Heart Disease Mortality and Sudden Cardiac Death From 1950 to 1999: The Framingham Heart Study , 2004, Circulation.

[63]  D. Tester,et al.  Targeted mutational analysis of the RyR2-encoded cardiac ryanodine receptor in sudden unexplained death: a molecular autopsy of 49 medical examiner/coroner's cases. , 2004, Mayo Clinic proceedings.

[64]  M. Josephson,et al.  Electrocardiographic Predictors of Arrhythmic Death and Total Mortality in the Multicenter Unsustained Tachycardia Trial , 2004, Circulation.

[65]  D. Levy,et al.  QT interval is a heritable quantitative trait with evidence of linkage to chromosome 3 in a genome-wide linkage analysis: The Framingham Heart Study. , 2005, Heart rhythm.

[66]  Jagmeet P. Singh,et al.  Factors influencing appropriate firing of the implanted defibrillator for ventricular tachycardia/fibrillation: findings from the Multicenter Automatic Defibrillator Implantation Trial II (MADIT-II). , 2005, Journal of the American College of Cardiology.

[67]  Ali H. Mokdad,et al.  State of Disparities in Cardiovascular Health in the United States , 2005, Circulation.

[68]  Wanchun Tang,et al.  Lay Rescuer Automated External Defibrillator (“Public Access Defibrillation”) Programs: Lessons Learned From an International Multicenter Trial Advisory Statement From the American Heart Association Emergency Cardiovascular Committee; the Council on Cardiopulmonary, Perioperative, and Critical Care; , 2005, Circulation.

[69]  R. Holle,et al.  Common Variants in Myocardial Ion Channel Genes Modify the QT Interval in the General Population: Results From the KORA Study , 2005, Circulation research.

[70]  Renu Virmani,et al.  Role of SCN5A Y1102 Polymorphism in Sudden Cardiac Death in Blacks , 2005, Circulation.

[71]  S. Solomon,et al.  Sudden death in patients with myocardial infarction and left ventricular dysfunction, heart failure, or both. , 2005, The New England journal of medicine.

[72]  L. Saxon Sudden cardiac death: epidemiology and temporal trends. , 2005, Reviews in cardiovascular medicine.

[73]  Douglas L Packer,et al.  Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. , 2005, The New England journal of medicine.

[74]  T. Rea,et al.  Diabetes, glucose level, and risk of sudden cardiac death. , 2005, European heart journal.

[75]  Karina W Davidson,et al.  The epidemiology, pathophysiology, and management of psychosocial risk factors in cardiac practice: the emerging field of behavioral cardiology. , 2005, Journal of the American College of Cardiology.

[76]  D. Levy,et al.  A comparison of death certificate out-of-hospital coronary heart disease death with physician-adjudicated sudden cardiac death. , 2005, The American journal of cardiology.

[77]  K. Reinier,et al.  Incidence of sudden cardiac arrest is higher in areas of low socioeconomic status: a prospective two year study in a large United States community. , 2006, Resuscitation.

[78]  A. Wilde,et al.  Familial Sudden Death Is an Important Risk Factor for Primary Ventricular Fibrillation: A Case-Control Study in Acute Myocardial Infarction Patients , 2006, Circulation.

[79]  H. Huikuri,et al.  Frequency of sudden cardiac death among acute myocardial infarction survivors with optimized medical and revascularization therapy. , 2006, The American journal of cardiology.

[80]  P. Ott,et al.  Electrocardiographic markers of sudden death. , 2006, Cardiology clinics.

[81]  Christian Gieger,et al.  A common genetic variant in the NOS1 regulator NOS1AP modulates cardiac repolarization , 2006, Nature Genetics.

[82]  J. Killian,et al.  Seasonality and daily weather conditions in relation to myocardial infarction and sudden cardiac death in Olmsted County, Minnesota, 1979 to 2002. , 2006, Journal of the American College of Cardiology.

[83]  Roger B. Davis,et al.  Impact of Unrecognized Myocardial Scar Detected by Cardiac Magnetic Resonance Imaging on Event-Free Survival in Patients Presenting With Signs or Symptoms of Coronary Artery Disease , 2006, Circulation.

[84]  H. Arntz,et al.  How Sudden Is Sudden Cardiac Death? , 2006, Circulation.

[85]  D. Zipes,et al.  Sudden cardiac death: better understanding of risks, mechanisms, and treatment. , 2006, Circulation.

[86]  J. Killian,et al.  Secular Trends in Deaths From Cardiovascular Diseases: A 25-Year Community Study , 2006, Circulation.

[87]  Karen L. Gunson,et al.  Population-based analysis of sudden cardiac death with and without left ventricular systolic dysfunction: two-year findings from the Oregon Sudden Unexpected Death Study. , 2006, Journal of the American College of Cardiology.

[88]  H. Huikuri,et al.  Family History and the Risk of Sudden Cardiac Death as a Manifestation of an Acute Coronary Event , 2006, Circulation.

[89]  A. Hofman,et al.  Common NOS1AP variants are associated with a prolonged QTc interval in the Rotterdam Study. , 2007, Circulation.

[90]  K. Anderson Risk assessment for defibrillator therapy: Il Trittico. , 2007, Journal of the American College of Cardiology.

[91]  Michael J Ackerman,et al.  Postmortem long QT syndrome genetic testing for sudden unexplained death in the young. , 2007, Journal of the American College of Cardiology.

[92]  A. Wal Coronary artery pathology , 2007, Heart.

[93]  D. Levy,et al.  Common Genetic Variation in KCNH2 Is Associated With QT Interval Duration: The Framingham Heart Study , 2007, Circulation.

[94]  Michael R Gold,et al.  Limitations of ejection fraction for prediction of sudden death risk in patients with coronary artery disease: lessons from the MUSTT study. , 2007, Journal of the American College of Cardiology.

[95]  D. Levy,et al.  Common Genetic Variation in KCNH 2 Is Associated With QT Interval Duration The Framingham Heart Study , 2007 .

[96]  A. Adabağ,et al.  Brugada Pattern Electrocardiogram Associated with Supratherapeutic Phenytoin Levels and the Risk of Sudden Death , 2007, Pacing and clinical electrophysiology : PACE.

[97]  Douglas L. Mann,et al.  Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 8th edition , 2018 .

[98]  E. Rimm,et al.  Cardiac Sodium Channel Gene Variants and Sudden Cardiac Death in Women , 2008, Circulation.

[99]  P. Noseworthy,et al.  Genetic Determinants of Sudden Cardiac Death , 2008, Circulation.

[100]  K. Reinier,et al.  Epidemiology of sudden cardiac death: clinical and research implications. , 2008, Progress in cardiovascular diseases.

[101]  D. Kent,et al.  Association of prolonged QRS duration with ventricular tachyarrhythmias and sudden cardiac death in the Multicenter Automatic Defibrillator Implantation Trial II (MADIT-II). , 2008, Heart rhythm.

[102]  A. Moss,et al.  Risk stratification for primary implantation of a cardioverter-defibrillator in patients with ischemic left ventricular dysfunction. , 2008, Journal of the American College of Cardiology.

[103]  Barry J Maron,et al.  American Heart Association/American College of Cardiology Foundation/Heart Rhythm Society Scientific Statement on Noninvasive Risk Stratification Techniques for Identifying Patients at Risk for Sudden Cardiac Death. A scientific statement from the American Heart Association Council on Clinical Cardi , 2008, Journal of the American College of Cardiology.

[104]  R. Passman,et al.  American Heart Association/American College of Cardiology Foundation/Heart Rhythm Society scientific statement on noninvasive risk stratification techniques for identifying patients at risk for sudden cardiac death: a scientific statement from the American Heart Association Council on Clinical Cardi , 2008, Circulation.

[105]  R. Byrne,et al.  Multiple source surveillance incidence and aetiology of out-of-hospital sudden cardiac death in a rural population in the West of Ireland. , 2008, European heart journal.

[106]  W. Manning,et al.  Occurrence and frequency of arrhythmias in hypertrophic cardiomyopathy in relation to delayed enhancement on cardiovascular magnetic resonance. , 2008, Journal of the American College of Cardiology.

[107]  K. Stein Noninvasive risk stratification for sudden death: signal-averaged electrocardiography, nonsustained ventricular tachycardia, heart rate variability, baroreflex sensitivity, and QRS duration. , 2008, Progress in cardiovascular diseases.

[108]  Warren Smith,et al.  Home use of automated external defibrillators for sudden cardiac arrest. , 2008, The New England journal of medicine.

[109]  N. Sotoodehnia,et al.  Genetics of sudden cardiac arrest. , 2008, Progress in cardiovascular diseases.

[110]  R. Luepker Decline in incident coronary heart disease: why are the rates falling? , 2008, Circulation.

[111]  Hanna E Bloomfield,et al.  Relation of heart rate parameters during exercise test to sudden death and all-cause mortality in asymptomatic men. , 2008, The American journal of cardiology.

[112]  Dawn Peters,et al.  Determinants of Prolonged QT Interval and Their Contribution to Sudden Death Risk in Coronary Artery Disease: The Oregon Sudden Unexpected Death Study , 2009, Circulation.

[113]  K. Reinier,et al.  Predicting sudden death in the general population: another step, N terminal B-type natriuretic factor levels. , 2009, Circulation.

[114]  Shu Zhang,et al.  Incidence of sudden cardiac death in China: analysis of 4 regional populations. , 2009, Journal of the American College of Cardiology.

[115]  P. Armstrong,et al.  Incidence of and outcomes associated with ventricular tachycardia or fibrillation in patients undergoing primary percutaneous coronary intervention. , 2009, JAMA.

[116]  N. Cook,et al.  Amino-Terminal Pro-B-Type Natriuretic Peptide and High-Sensitivity C-Reactive Protein as Predictors of Sudden Cardiac Death Among Women , 2009, Circulation.

[117]  D. Mozaffarian,et al.  Heart disease and stroke statistics--2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. , 2009, Circulation.

[118]  A. Capucci,et al.  Faculty Opinions recommendation of Determinants of prolonged QT interval and their contribution to sudden death risk in coronary artery disease: the Oregon Sudden Unexpected Death Study. , 2009 .

[119]  Hanyu Ni,et al.  Trends from 1987 to 2004 in sudden death due to coronary heart disease: the Atherosclerosis Risk in Communities (ARIC) study. , 2009, American heart journal.

[120]  D. Zipes,et al.  Fragmented QRS: a predictor of mortality and sudden cardiac death. , 2009, Heart rhythm.

[121]  A. Castellanos,et al.  Indications for implantable cardioverter-defibrillators based on evidence and judgment. , 2009, Journal of the American College of Cardiology.

[122]  D. Ross,et al.  Outcomes of Early Risk Stratification and Targeted Implantable Cardioverter-Defibrillator Implantation After ST-Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention , 2009, Circulation.

[123]  Daniel P. Morin,et al.  QRS duration predicts sudden cardiac death in hypertensive patients undergoing intensive medical therapy: the LIFE study. , 2009, European heart journal.

[124]  D. Mozaffarian,et al.  Heart disease and stroke statistics--2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. , 2009, Circulation.

[125]  A. Buxton Risk stratification for sudden death in patients with coronary artery disease. , 2009, Heart rhythm.

[126]  J. F. van der Heijden [Sudden death after a myocardial infarction]. , 2009, Nederlands tijdschrift voor geneeskunde.

[127]  D. Mozaffarian,et al.  Maximizing Survival Benefit With Primary Prevention Implantable Cardioverter-Defibrillator Therapy in a Heart Failure Population , 2009, Circulation.

[128]  H. Krumholz,et al.  Racial differences in survival after in-hospital cardiac arrest. , 2009, JAMA.

[129]  C. Lepage,et al.  A 30-year, population-based study shows improved management and prognosis of hepatocellular carcinoma. , 2010, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[130]  Fred S Apple,et al.  Etiology of sudden death in the community: results of anatomical, metabolic, and genetic evaluation. , 2010, American heart journal.

[131]  W. Brown Framingham Heart Study. , 2011, Journal of Clinical Lipidology.

[132]  B. Gersh,et al.  Etiology of sudden death in the community: Results of anatomical, metabolic, and genetic evaluation , 2011 .

[133]  Douglas P. Zipes,et al.  Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 2-Volume Set, 10th Edition , 2011 .