Advertisement

Causes of sudden cardiac death according to age and sex in persons aged 1–49 years

Published:September 05, 2022DOI:https://doi.org/10.1016/j.hrthm.2022.08.036

      Background

      Knowledge of causes of sudden cardiac death (SCD) according to age is important in clinical decision making and to lower the risk of SCD in family members of the deceased.

      Objective

      The purpose of this study was to report overall and sex-stratified causes of SCD according to age in persons aged 1–49 years.

      Methods

      The study population consisted of all persons in Denmark aged 1–35 years in 2000–2009 and 36–49 years in 2007–2009, which equals 27.1 million person-years. Danish death certificates, discharge summaries, autopsy reports, and data from nationwide registries were used to identify all SCD cases. The SCD cases were divided into 5-year age groups.

      Results

      In the 10-year study period, there were 14,294 deaths, of which 1362 (10%) were classified as SCD. Potentially inherited cardiac disease accounted for a high proportion (43%–78%) of autopsied SCD in all age groups. A significant proportion (19%–54%) of SCD was caused by sudden arrhythmic death syndrome in all age groups. Autopsy rates in both sudden unexpected death cases and SCD cases declined significantly with increasing age (74% in the youngest age group vs 35% in the oldest).

      Conclusion

      The proportion of SCD cases that were identified with a potentially inherited cardiac disease postmortem was high in all studied age groups, while autopsy rates in sudden and unexpected death cases declined markedly with increasing age. Our findings indicate that diagnoses of inherited heart disease are likely missed in some SCD cases, along with the opportunity for treatment and prevention in surviving relatives.

      Graphical abstract

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Heart Rhythm
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Lynge T.H.
        • Risgaard B.
        • Banner J.
        • et al.
        Nationwide burden of sudden cardiac death: a study of 54,028 deaths in Denmark.
        Heart Rhythm. 2021; 18: 1657-1665
        • Bagnall R.D.
        • Weintraub R.G.
        • Ingles J.
        • et al.
        A prospective study of sudden cardiac death among children and young adults.
        N Engl J Med. 2016; 374: 2441-2452
        • Winkel B.G.
        • Holst A.G.
        • Theilade J.
        • et al.
        Nationwide study of sudden cardiac death in persons aged 1–35 years.
        Eur Heart J. 2011; 32: 983-990
        • Risgaard B.
        • Winkel B.G.
        • Jabbari R.
        • et al.
        Burden of sudden cardiac death in persons aged 1 to 49 years: nationwide study in Denmark.
        Circ Arrhythm Electrophysiol. 2014; 7: 205-211
        • Bowker T.J.
        • Wood D.A.
        • Davies M.J.
        • et al.
        Sudden, unexpected cardiac or unexplained death in England: a national survey.
        QJM. 2003; 96: 269-279
        • Byrne R.
        Multiple source surveillance incidence and aetiology of out-of-hospital sudden cardiac death in a rural population in the West of Ireland.
        Eur Heart J. 2008; 29: 1418-1423
        • Chugh S.S.
        • Jui J.
        • Gunson K.
        • et al.
        Current burden of sudden cardiac death: multiple source surveillance versus retrospective death certificate-based review in a large U.S. community.
        J Am Coll Cardiol. 2004; 44: 1268-1275
        • Wang H.
        • Yao Q.
        • Zhu S.
        • et al.
        The autopsy study of 553 cases of sudden cardiac death in Chinese adults.
        Heart Vessels. 2014; 29: 486-495
        • Wilde A.A.M.
        • Behr E.R.
        Genetic testing for inherited cardiac disease.
        Nat Rev Cardiol. 2013; 10: 571-583
        • Semsarian C.
        • Ingles J.
        • Wilde A.A.M.
        Sudden cardiac death in the young: the molecular autopsy and a practical approach to surviving relatives.
        Eur Heart J. 2015; 36: 1290-1296
        • Priori S.G.
        • Blomström-Lundqvist C.
        • Mazzanti A.
        • et al.
        2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death.
        Eur Heart J. 2015; 36: 2793-2867
        • Lahrouchi N.
        • Raju H.
        • Lodder E.M.
        • et al.
        Utility of post-mortem genetic testing in cases of sudden arrhythmic death syndrome.
        J Am Coll Cardiol. 2017; 69: 2134-2145
        • Tester D.J.
        • Ackerman M.J.
        Postmortem long QT syndrome genetic testing for sudden unexplained death in the young.
        J Am Coll Cardiol. 2007; 49: 240-246
        • Chugh S.S.
        • Senashova O.
        • Watts A.
        • et al.
        Postmortem molecular screening in unexplained sudden death.
        J Am Coll Cardiol. 2004; 43: 1625-1629
        • Skinner J.R.
        • Crawford J.
        • Smith W.
        • et al.
        Prospective, population-based long QT molecular autopsy study of postmortem negative sudden death in 1 to 40 year olds.
        Heart Rhythm. 2011; 8: 412-419
        • Behr E.R.
        • Dalageorgou C.
        • Christiansen M.
        • et al.
        Sudden arrhythmic death syndrome: familial evaluation identifies inheritable heart disease in the majority of families.
        Eur Heart J. 2008; 29: 1670-1680
        • McGorrian C.
        • Constant O.
        • Harper N.
        • et al.
        Family-based cardiac screening in relatives of victims of sudden arrhythmic death syndrome.
        Europace. 2013; 15: 1050-1058
        • van der Werf C.
        • Hofman N.
        • Tan H.L.
        • et al.
        Diagnostic yield in sudden unexplained death and aborted cardiac arrest in the young.
        Heart Rhythm. 2010; 7: 1383-1389
        • Kumar S.
        • Peters S.
        • Thompson T.
        • et al.
        Familial cardiological and targeted genetic evaluation: low yield in sudden unexplained death and high yield in unexplained cardiac arrest syndromes.
        Heart Rhythm. 2013; 10: 1653-1660
        • Lynge E.
        • Sandegaard J.L.
        • Rebolj M.
        The Danish National Patient Register.
        Scand J Public Health. 2011; 39: 30-33
        • Winkel B.G.
        • Risgaard B.
        • Bjune T.
        • et al.
        Gender differences in sudden cardiac death in the young—a nationwide study.
        BMC Cardiovasc Disord. 2017; 17: 19
        • Milman A.
        • Gourraud J.-B.
        • Andorin A.
        • et al.
        Gender differences in patients with Brugada syndrome and arrhythmic events: data from a survey on arrhythmic events in 678 patients.
        Heart Rhythm. 2018; 15: 1457-1465
        • Calkins H.
        • Corrado D.
        • Marcus F.
        Risk stratification in arrhythmogenic right ventricular cardiomyopathy.
        Circulation. 2017; 136: 2068-2082
        • Zareba W.
        • Moss A.J.
        • Locati E.H.
        • et al.
        Modulating effects of age and gender on the clinical course of long QT syndrome by genotype.
        J Am Coll Cardiol. 2003; 42: 103-109
        • Locati E.H.
        • Zareba W.
        • Moss A.J.
        • et al.
        Age- and sex-related differences in clinical manifestations in patients with congenital long-QT syndrome.
        Circulation. 1998; 97: 2237-2244
        • Lynge T.H.
        • Nielsen T.S.
        • Gregers Winkel B.
        • Tfelt-Hansen J.
        • Banner J.
        Sudden cardiac death caused by myocarditis in persons aged 1-49 years: a nationwide study of 14 294 deaths in Denmark.
        Forensic Sci Res. 2019; 4: 247-256
        • Bleakley L.E.
        • Soh M.S.
        • Bagnall R.D.
        • et al.
        Are variants causing cardiac arrhythmia risk factors in sudden unexpected death in epilepsy?.
        Front Neurol. 2020; 11: 925
        • Skjelbred T.
        • Lynge T.H.
        • Nielsen J.
        • Winkel B.G.
        • Tfelt-Hansen J.
        Symptoms and healthcare contact preceding sudden cardiac death in persons aged 1-49 years.
        Trends Cardiovasc Med. 2021; 31: 119-124
        • Kløvgaard M.
        • Lynge T.H.
        • Tsiropoulos I.
        • et al.
        Sudden unexpected death in epilepsy in persons younger than 50 years: a retrospective nationwide cohort study in Denmark.
        Epilepsia. 2021; 62: 2405-2415
        • van der Werf C.
        • Hendrix A.
        • Birnie E.
        • et al.
        Improving usual care after sudden death in the young with focus on inherited cardiac diseases (the CAREFUL study): a community-based intervention study.
        Europace. 2016; 18: 592-601
        • Sington J.D.
        • Cottrell B.J.
        Analysis of the sensitivity of death certificates in 440 hospital deaths: a comparison with necropsy findings.
        J Clin Pathol. 2002; 55: 499-502
        • Kircher T.
        • Nelson J.
        • Burdo H.
        The autopsy as a measure of accuracy of the death certificate.
        N Engl J Med. 1985; 313: 1263-1269
        • Tseng Z.H.
        • Olgin J.E.
        • Vittinghoff E.
        • et al.
        Prospective countywide surveillance and autopsy characterization of sudden cardiac death: POST SCD study.
        Circulation. 2018; 137: 2689-2700
        • Lynge T.H.
        • Nielsen J.L.
        • Blanche P.
        • et al.
        Decline in incidence of sudden cardiac death in the young: a 10-year nationwide study of 8756 deaths in Denmark.
        Europace. 2019; 21: 909-917
        • Basso C.
        • Aguilera B.
        • Banner J.
        • et al.
        Guidelines for autopsy investigation of sudden cardiac death: 2017 update from the Association for European Cardiovascular Pathology.
        Virchows Arch. 2017; 471: 691-705