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Coronary heart disease death and sudden cardiac death: a 20-year population-based study
Tauqir Y Goraya1, Steven J Jacobsen, Thomas E Kottke
1Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA.
Insights
Out-of-hospital coronary heart disease (CHD) deaths, including unexpected sudden cardiac death (SCD), declined slower than in-hospital deaths. Primary prevention is crucial for continued CHD mortality reduction.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Coronary heart disease (CHD) mortality decline is partly understood through out-of-hospital deaths, a surrogate for sudden cardiac death (SCD).
- Unexpected SCD, defined as out-of-hospital CHD death without a prior CHD diagnosis, remains understudied.
- Understanding trends in unexpected SCD is vital for assessing the overall reduction in CHD mortality.
Purpose of the Study:
- To analyze secular trends in CHD death and unexpected SCD over a 20-year period (1979-1998).
- To examine the association between prior CHD diagnosis and SCD.
- To test the hypothesis that in-hospital deaths declined more significantly than SCDs.
Main Methods:
- Analysis of secular trends in out-of-hospital and in-hospital CHD deaths.
- Examination of trends in sudden cardiac death (SCD), differentiating between those with and without prior CHD diagnosis.
- Statistical comparison of mortality rate declines between in-hospital deaths and various SCD categories.
Main Results:
- Yearly decline in CHD mortality rates: 5.3% for in-hospital deaths vs. 1.8% for out-of-hospital deaths (p = 0.001).
- Unexpected SCD constituted 49% of all SCDs.
- Rates of unexpected SCD declined slower than SCD with prior CHD (p = 0.001), indicating a persistent challenge.
Conclusions:
- The decline in CHD mortality was more pronounced for in-hospital deaths compared to out-of-hospital deaths (SCDs).
- Given that nearly half of SCDs are unexpected and declining at a slower rate, primary prevention strategies are increasingly critical.
- Sustaining the reduction in CHD mortality necessitates a greater focus on primary prevention to address unexpected SCD.
Abstract:
Trends in out-of-hospital coronary heart disease (CHD) death, a surrogate for sudden cardiac death (SCD), are important for understanding the decline in CHD mortality. Little is known about out-of-hospital CHD death without prior CHD diagnosis, the definition of unexpected SCD. The authors analyzed secular trends in CHD death and unexpected SCD over a 20-year period (1979-1998) to examine the association between prior CHD and SCD and to test the hypothesis that in-hospital deaths declined more than SCDs. The yearly decline in CHD mortality rates was 5.3% for in-hospital deaths and 1.8% for out-of-hospital deaths (p = 0.001). Among all SCDs, the proportion of unexpected SCD was 49%. Mortality rates for both unexpected SCD and SCD with prior CHD declined over time, but unexpected SCD declined at a slower rate than SCD with prior CHD (p = 0.001). The relative odds of prior CHD were higher among persons with SCD than among controls, but there was a modest decline in the magnitude of the association. Thus, during the past 20 years, the decline was greater for in-hospital CHD deaths than for SCDs. Since approximately half of the SCDs were unexpected and rates of these deaths declined less over time than rates of SCD with prior CHD, primary prevention is becoming increasingly more important in sustaining the decline in CHD mortality.