Journal of Electrocardiology
ISCE 2007 Session V: Developments in Device Management of Cardiac ArrhthmiasGlobal public health problem of sudden cardiac death
Section snippets
Sudden cardiac death
It is with this global perspective that the problem of SCD will be discussed. Firstly, the accepted epidemiological definition of SCD requires that the death be “unexpected” due to cardiac cause and heralded by abrupt loss of consciousness 1 hour or less after the onset of acute symptoms.4 Based on this definition, recent prospective studies indicate that the estimated incidence of out-of-hospital sudden cardiac arrest (SCA) in the United States is approximately 0.55 per 1000 population. In one
Who is at risk for SCA?
Although presence of cardiovascular risk factors is predictive of SCA, no single risk factor predicts with high accuracy who will die suddenly. The total incidence of SCA represents an estimate for the total population that is composed of subgroups at varying levels of risk. The subgroups with the highest risk such as patients with low ejection fraction, history of heart failure, and survivors of out-of-hospital cardiac arrests do not generate most SCA events. The largest patient groups are
Management of SCA
Sudden cardiac arrest can be managed by primary or secondary prevention strategies. Primary prevention refers to the prevention of the first life-threatening arrhythmic events such as VF. Secondary prevention refers to the prevention of the recurrence of a potentially fatal arrhythmia or cardiac arrest among patients who have had a clinical SCA. The first strategy of primary prevention is to modify the traditional risk factors for cardiovascular disease. Modifiable risk factors of coronary
Sudden cardiac arrest in developing economies
How should the problem of SCA be addressed in low- and middle-class countries, where ICDs are not affordable or reimbursed for most of the population? Clearly, primary prevention with population-based interventions such as cessation of smoking, healthier diets, and improved lifestyles should be of the highest priority. Another strategy is to improve the medical response system infrastructure in developing countries. Presently, many congested urban cities have high traffic congestion, which does
Future
In the near future, a significant research focus will be on risk stratification, that is, defining patient groups with or without cardiovascular disease who are at the highest risk of SCAs so that the appropriate treatment technologies can be delivered to these individuals in a more cost-effective manner. This will lower the health care costs in the developed and developing economies. At the same time, the efficacy and cost-effectiveness of AEDs for SCA management need to be evaluated
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