Get access

Low Rate of Secondary Prevention ICDs in the General Population: Multiple-Year Multiple-Source Surveillance of Sudden Cardiac Death in the Oregon Sudden Unexpected Death Study

Authors


  • Funded in part by National Heart Lung and Blood Institute R01HL088416 and R01HL105170 to SSC. R.H. is supported by a grant (#2011-1071) from the Swedish Research Council. S.S.C. is the Pauline and Harold Price Professor of Cardiac Electrophysiology at the Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA.

  • No disclosures.

Sumeet S. Chugh, M.D., The Heart Institute, Saperstein Plaza Suite 2S46, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA 90048, USA. E-mail: sumeet.chugh@cshs.org

Abstract

Sudden Cardiac Death. Introduction: Sudden cardiac death (SCD) is a large public health problem that warrants on-going evaluation in the general population. While single-year community-based studies have been performed there is a lack of studies that have extended evaluation to multiple years in the same community.

Methods and Results: From the on-going Oregon Sudden Unexpected Death Study, we analyzed prospectively identified SCD cases in Multnomah County, Ore, (population ≈700,000) from February 1, 2002 to January 31, 2005. Detailed information ascertained from multiple sources (first responders, clinical records, and medical examiner) was analyzed. A total of 1,175 SCD cases were identified (61% male) with a mean age of 65 ± 18 years for men versus 70 ± 20 for women (P < 0.001). The overall incidence rate for the period was 58/100,000 residents/year. One-quarter (24.6%) was ≤55 years of age. The most common initial rhythm was ventricular tachycardia or fibrillation (39% of cases, survival 27%) followed by asystole (36%, survival 0.7%) and pulseless electrical activity (23%, survival 6%). Among subjects that underwent resuscitation, the rate of survival to hospital discharge was 12% and overall survival to hospital discharge irrespective of resuscitation was 8%. Of the 68 survivors, 16 (24%) received a secondary prevention ICD.

Conclusion: We report annualized SCD incidence from a multiple-year, multiple-source community-based study, with higher than expected rates of women and subjects age ≤55 years. The low implantation rate of secondary prevention ICDs is likely to be multifactorial, but there are potential implications for recalibration of the projected need for ICD implantation; larger and more detailed studies are warranted. (J Cardiovasc Electrophysiol, Vol. 24, pp. 60-65, January 2013)

Ancillary