Current burden of sudden cardiac death: multiple source surveillance versus retrospective death certificate-based review in a large U.S. community.
OBJECTIVE
We sought to determine the annual incidence of sudden cardiac death (SCD) in the general population using a prospective approach. To assess the validity of retrospective surveillance, a simultaneous comparison was made with a death certificate-based method of determining SCD incidence.


BACKGROUND
Accurate surveillance and characterization of SCD in the general population is likely to significantly facilitate current and future community-based preventive and therapeutic interventions.


METHODS
We performed a prospective evaluation of SCD among all residents of Multnomah County, Oregon (population 660,486) using multiple sources of surveillance. A comprehensive analysis of circumstances of death, medical records, and available autopsy data was performed. Comparisons were made with a retrospective, death certificate-based determination of SCD incidence using International Classification of Diseases-Version 10 codes and location of death.


RESULTS
Between February 1, 2002, and January 31, 2003, 353 residents suffered SCD (incidence 53 of 100,000; median age 69 years, 57% male) accounting for 5.6% of overall mortality. Of these, 75 cases (21%) were identified using sources other than first responders. Resuscitation was attempted in 237 cases (67%) and successful (survival to hospital discharge) in 28 (8%). The retrospective death certificate-based review yielded 1,007 cases (incidence 153 of 100,000; median age 81 years, 51% male), and the positive predictive value of this methodology was 19%.


CONCLUSIONS
Sudden cardiac death accounts for 5.6% of annual mortality, and prospective evaluation in the general population appears to be feasible. The use of multiple sources of ascertainment and information significantly enhances phenotyping of SCD cases. Retrospective death certificate-based surveillance results in significant overestimation of SCD incidence.
Chugh
Sumeet S
SS
Heart Rhythm Research Laboratory, Division of Cardiology, Oregon Health and Science University, Portland, Oregon 97239, USA. chughs@ohsu.edu
Jui
Jonathan
J
Gunson
Karen
K
Stecker
Eric C
EC
John
Benjamin T
BT
Thompson
Barbara
B
Ilias
Nasreen
N
Vickers
Catherine
C
Dogra
Vivek
V
Daya
Mohamud
M
Kron
Jack
J
Zheng
Zhi-Jie
ZJ
Mensah
George
G
McAnulty
John
J
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D002940:Circadian Rhythm; D003644:Death Certificates; D016757:Death, Sudden, Cardiac / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009922:Oregon / Q000453:epidemiology; D011159:Population Surveillance; D011446:Prospective Studies; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012737:Sex Factors; D015996:Survival Rate