Sudden death is less common than might be expected in underprivileged ethnic minorities at high cardiovascular risk

Sudden cardiac death can be the presenting feature of coronary disease. Limited epidemiological studies from the US suggest an increased prevalence of sudden death in the African-American community. There are no reports in UK minority communities. We present sudden death data from an area with a high density of underprivileged ethnic minority groups.

Ambulance data forms and accident and emergency records of all sudden unexpected deaths bought to City Hospital Birmingham in 2002 were extracted by retrospective review. The clinical characteristics and timing of the events were defined and analysed on the basis of the ethnic origins of the victims.

The prevalence of sudden death amongst Caucasians was substantially greater than among minorities. Both Indo-Asians and Afro-Caribbean groups had a lower than expected sudden death rate. Caucasian patients more commonly demonstrated a ventricular fibrillation (VF) rhythm at presentation while Indo-Asians and Afro-Caribbean's demonstrated a non-VF rhythm (asystole and pulseless electrical activity (PEA). Collapse with syncope was more common in Afro-Caribbean subjects while Indo-Asian subjects more often arrested in transit. There were no differences in call or transfer times.

Despite a well-described pattern of more aggressive coronary disease, particularly noted in South Asian communities in the UK, the sudden death rate are not increased and may be decreased. This implies a potentially separate mechanism or a confounding cultural influence in these events.