Sudden cardiac death: The clinical and public health challenges

Sudden cardiac death (SCD) and the broader category of unexpected out-of-hospital cardiac deaths (OHCD) remain major clinical and public health problems. In the US, an estimated 400,000-450,000 OHCDs occur each year, of which approximately 250,000 deaths result directly from cardiac arrest. Although recent advances in clinical and population science research coupled with technological innovations in device therapy have provided a wealth of evidence from which to manage SCD survivors, daunting clinical and public health challenges persist. In this paper, we summarize recent trends in SCD and OHCD in the United States, and explore public health strategies in the prevention of SCD and OHCD. Sudden cardiac death (SCD) and the broader category of unexpected out-of-hospital cardiac deaths (OHCD) remain major clinical and public health problems, despite recent advances in clinical and population science research, as well as technological innovations in device therapy [1). Important ambiguities in case definition and ascertainment remain unresolved. Lack of a national registry hampers reliable national-level estimation of incidence and trends. Public awareness of the symptoms and signs of heart attack and cardiac arrest is relatively low and knowledge of action by bystanders is limited when encountering a sudden cardiac arrest. Low public awareness and inadequate response may contribute in part to the low success rate (less than 10%) of resuscitation of cardiac arrest. Clinically SCD is defined as an unexpected natural death from a cardiac etiology within a short time period (usually one hour or less) lifestyle modification, smoking cessation, blood pressure and cholesterol control, diabetes and weight control, beta-blocker, ACE inhibitor, and aspirin use; (5) Support public health infrastructure to address definitions, surveillance, health education, policy development and assurance; (6) Promote policies on universal 9-1-1 coverage and accessibility of AED in home, public places and in rural communities; (7) Support health-related quality of life and outcomes research in SCD survivors, and economic analyses from a societal perspective for the use of innovative device therapy, especially in primary prevention of SCD.