Elsevier

Journal of Electrocardiology

Volume 40, Issue 6, Supplement 1, November–December 2007, Pages S118-S122
Journal of Electrocardiology

ISCE 2007 Session V: Developments in Device Management of Cardiac Arrhthmias
Global public health problem of sudden cardiac death

https://doi.org/10.1016/j.jelectrocard.2007.06.023Get rights and content

Abstract

Cardiovascular disease is a leading cause of global mortality, accounting for almost 17 million deaths annually or 30% of all global mortality. In developing countries, it causes twice as many deaths as HIV, malaria and TB combined. It is estimated that about 40-50% of all cardiovascular deaths are sudden cardiac deaths (SCDs) and about 80% of these are caused by ventricular tachyarrhythmias. Therefore, about 6 million sudden cardiac deaths occur annually due to ventricular tachyarrhythmias. The survival rate from sudden cardiac arrest is less than 1% worldwide and close to 5% in the US. Prevention of cardiovascular disease by increasing awareness of risk factors such as lack of exercise, inappropriate diet and smoking has reduced cardiovascular mortality in the US over the past few decades. However, there is still a huge cardiovascular disease burden globally as well as in the US. Therefore, there is a need to develop complementary strategies for management of sudden cardiac death. The data from several trials conclusively indicate that implantable defibrillators improve mortality in patients who have experienced an episode or are at high risk of developing ventricular tachyarrhythmias. These devices are reimbursed and are being used frequently in the developed economies for management of SCD. However, due to that low level of public and private health spending in developing economies and the relatively high cost of ICDs, their implant rates are very low there. The Automatic External Defibrillators and Emergency Medical Response Services equipped with AEDs provide complementary as well as alternative opportunities for management of SCD. There are several challenges associated with the adoption of these strategies. The efficacy and cost-effectiveness of these strategies need to be compared with ICDs to determine the appropriate strategy for various geographies. The global problem of SCD as well as the various options for its management will be discussed in the presentation.

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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